The Early Clinical Outcome Of Minimal Invasive Modified TLIF On Lumbar Degenerative Diseases With Mast Quadrant

ObjectiveTo study the early clinical outcome of minimal invasive modified TLIF (Transforaminal lumbar interbody fusion ) on lumbar degenerative disease with Mast Quadrant.MethodsFrom September 2006 to February 2008, 79 patients (80 levels) undergo minimal invasive modified TLIF surgery with Mast Quadrant (the minimal invasive group) were studied. The preoperative diagnosis of patients included lumbar degenerative spondylolisthesis (18 cases, GradeⅠtoⅡ),lumbar intervertebral disc protrusion combined with segmental instability (35 cases ) and lumbar spinal stenosis ( 26 cases), and compared with 79 patients (79 levels) undergo open modified TLIF surgery with Mast Quadrant (the open group). The preoperative diagnosis of the open group included lumbar degenerative spondylolisthesis (14 cases, GradeⅠtoⅡ),lumbar intervertebral disc protrusion combined with segmental instability (37 cases ) and lumbar spinal stenosis (28 cases). The clinical outcome of intraoperative blood loss, total operative time were studied. The quality of life postoperation were studid with Oswestry disability index, SF-36 Health investigation, VAS. 32 cases were examined the CPK and the CK-MB preoperatively and postoperatively. The patients were undergo postoperative X-Ray, CT, MRI, EMG examination 3-12 months to indentify the difference of the two groups.Results:1. There's significant difference of the change of the Oswestry disability index, SF-36 Health investigation, VAS score preoperatively and postoperatively between the minimal invasive group and the open group. The intraoperative blood loss of the minimal invasive group is 253.3ml, and the open group is 224.2ml. The total operative time of the minimal invasive group is 178.7 minutes, and the open group is 147.7 minutes.2. In the minimal invasive group, the length of time for the patients return to their preoperative life is 49.2±15.6 days. And in the open group, the length of time for the patients return to their preoperative life is 75.3±21.5 days.3. In the minimal invasive group, the length of time for the patients return to their work is 75.2±26.4 days. And in the open group, the length of time for the patients return to their preoperative life is 136.7±30.9 days.4. There's no significant difference between the change of the CPK and the CK-MB results between the two groups and the other two groups took different length of total operative time.5. The MRI examination and the EMG examination showed that the trunk muscle of the open group is relatively degenerated and loss of function in the open group.Conclusions:1. The minimal invasive group took more than the open group in total operative time. But the blood loss of the minimal invasive group is less than the open group. And the drain postoperative of the minimal invasive group is less than the open group. Patients in the minimal invasive group take less time to return to life and work postoperatively.2. There's no significant difference between the change of the CPK and the CK-MB results between the two groups and the other two groups took different length of total operative time.3. The MRI examination and the EMG examination showed that the minimal invasive surgery lessen the demage of the trunk muscle than the open group. The early results of the Minimal Invasive Modified TLIF On Lumbar Degenerative Diseases With Mast Quadrant suggested that the trunk muscle in the minimal invasive group is protected by the equipment. The patients in the minimal invasive group has a better outcome in the quality of life and earlier recovery.