Comparative Analysis Of Chronic Low Back Pain After Standard Discectomy For Lumbar Disc Herniation By Modified PLIF+TLIF And Traditional PLIF

Objective: To investigate the occurrence of chronic low back pain afterstandard discectomy for lumbar disc by herniation modified PLIF+TLIF andtraditional PLIF, and to go through comparative analysis.Methods: From October2009to April2011,30patients,18males and12females, aged35~60years old (47.5on average), underwent modified PLIF+TLIF(group A). Among them,there were13cases of Central lumber discherniation,6cases of lumbar spinal stenosis, and11cases of lumbar discherniation and lumbar spinal stenosis,with25of single segment interbodyfusion,4of two segment interbody fusion and1of three segment interbodyfusion.The courses of disease were3months-15years(3years and5monthson average).Meanwhile,30patients,17males and13females,aged33~54years old(43.3on average) underwent traditional PLIF(group B). Amongthem,there were10cases of Central lumber disc herniation,8cases of lumbarspinal stenosis, and12cases of lumbar disc herniation and lumbar spinalstenosis,with23of single segment interbody fusion,6of two segmentinterbody fusion and1of three segment interbody fusion.The courses ofdisease were3months-12years(2years and7months onaverage).X-ray,CT,MRI examination were undertook for all the cases. In bothgroups,operation time, bleed amount during operation, length ofclinotherapy,rate of interbody fusion and the neurologic recovery rate at thepostoperative follow-up were recorded and compared. Japanese OrthopaedicAssociation Scores system was used to evaluate the clinical outcome,the Sukmethod were used to evaluate the interbody fusion rate. Chronic low back painis a clinical syndrome with lumboscaral area pain or uncomfortable feel, without lower limps pain. The incidence of chronic low back pain wererecorded and compared.Result: The incision all healed by first intention. The operation time ofmodified PLIF+TLIF was146±23min,bleed amount during operation was660±50.5ml,length of clinotherapy was6.0±1.8day,rate of interbody fusionwas100%. The operation time of traditional PLIF was108±18min,bleedamount during operation was430±32.4ml, length of clinotherapy was5.0±1.5day,rate of interbody fusion was100%.The operation time and bleedamount during operation of group modified PLIF+TLIF were obviouslyhigher than that of group traditional PLIF(P﹤0.05),and the difference wasstatistically significant (P﹤0.05).There were no significant differencesbetween two groups in terms of the length of clinotherapy and rate ofinterbody fusion(P﹤0.05).All of60patients were followed up for24~42months(average30.6months).All patients exhibited bony fusion on X-rayafter operation,wiithout plate and bolt loose or broken.In modified PLIF+TLIF group,the average preoperative JOA score was (6.96±1.59)points,the average JOA score at the end of follow-up was (13.26±1.63)points,theimprovement rate was87.39%±8.11%. In traditional PLIF group,the averagepreoperative JOA score was (6.35±1.23)points,the average JOA score at theend of follow-up was (13.13±1.29)points,the improvement rate was82.54%±7.40%. In both groups of patients,the JOA scores at postoperativefollow-up increased obviously than preoperative(P﹤0.01).There was nosignificant difference between the two groups before the operation and at theend of the follow-up(P﹤0.05).Among patients of modified PLIF+TLIFgroup,there were excellent in18cases,good in8cases,fair in3cases,badin1case. Among patients of traditional PLIF group,there were excellent in12cases,good in6cases,fair in7cases,bad in5case. The rate of postoperativechronic low back pain was13.33%in modified PLIF+TLIF group and40%intraditional PLIF group,and the difference was statistically significant(P﹤0.05).Conclusion: Compared with traditional PLIF,the use of modified PLIF+ TLIF is associated with good outcomes.At the same time,it can avoid and theincidence of the postoperative chronic low back pain.