| Objective: By comparing the variations of trauma-related serum index followingminimally invasive transforaminal lumbar interbody fusion (TLIF) versus open TLIF in thetreatment of lumbar degenerative disease through a prospectively non-randomizedcontrolled study to quantitatively evaluate the degree of traumatic reaction induced by thetwo surgical procedures. The results may provide evidence for minimally invasive TLIF asa superior selection in the treatment of lumbar degenerative disease.Method: Sixty patients were enrolled by the entry criteria between May andNovember2012, and were assigned to minimally invasive TLIF group (minimally invasivegroup, n=30) and open TLIF group (open group, n=30). The length of skin incision,duration of operation, intra-operative blood loss, post-operative drainage volume, andpost-operative hospital stay were recorded, as well as the pain severity of incision wasevaluated by visual analog scale (VAS). The serum levels of C-reactive protein (CRP) andcreatine kinase (CK) were measured before and24hours after operation. The serum levelsof Interleukin-6(IL-6), interleukin-10(IL-10) and tumor necrosis factor-alpha (TNF-α)levels were also measured before and2h,4h,8h,24h after operation to monitor theinflammatory response to the either operations. All data were analysized by the SPSS15.0statistical software.Results:1. There were no statistically significant differences between the two comparablegroups in age, gender distribution, weight, lesion type, incidence of segment, clinicalmanifestations, signs and course (P>0.05).2. Comparing the data of incision length, duration of operation, intra-operative bloodloss, drainage volume after operation and postoperative hospital stay, the minimallyinvasive group was superior to the open group in all aspects. The minimally invasive grouphad shorter incision length than the open group (3.1±0.5cm vs.7.8±2.4cm)(P<0.01). The operation time of minimally invasive group was shorter than that of open group(149.5±40.9min vs.175.2±37.3min)(P<0.05). The intraoperative blood loss of minimallyinvasive group was significantly less than that of open group (131.3±74.1mL vs.318.3±177.4mL)(P<0.01). The drainage volume of minimally invasive group was significantlyless than that of open group (54.1±17.6mL vs.142.8±35.7mL)(P<0.01). The postoperativehospital stay of minimally invasive group was shorter than that of open group (7.5±2.7d vs.9.3±4.2d)(P<0.05). The patients-pain severity of the skin incision was less in minimallyinvasive group at1-3d after surgery than open group (P<0.05).3. There were no significant differences between the two groups about the preoperativeserum concentrations of CK and CRP (P>0.05). In both groups, the levels of CK and CRPsignificantly increased at24hours after operation (P<0.01), but the two indices inminimally invasive group were significantly lower than that in open group (both P<0.01).4. Compared with preoperative baselines, the serum levels of IL-6and IL-10increasedin both groups at2h,4h,8h, and24h after surgery (P<0.05). The levels of TNF-α onlyincreased in4h (minimally invasive group) and24h (open group) after surgery (P<0.05).There was no significant differences in the preoperative serum concentrations of IL-6,IL-10and TNF-α between the two groups (P>0.05). The levels of IL-6and IL-10at everytime point after surgery in minimally invasive group were lower than those in opengroup(P<0.05), and the differences of TNF-α level at every time point after surgery in thetwo groups had no statistical significance (P>0.05).Conclusion:1. Minimally invasive TLIF has obvious advantages compared to traditional open TLIF,such as reducing the blood loss, postoperative local pain, and rapid postoperative recovery.2. Minimally invasive TLIF causes less influence on serum indices related to traumaticreaction comparing with open TLIF, with a lower tissue injury and systemic surgical stressresponse which related to reducing the impact of internal environment, embodying theadvantages of minimally invasive surgery. |
PDF Full Text Request