Clinical Effect Of Traditional Posterior Open Surgey And Minimally Invasive Surgey In The Treatment Of Lumbar Spondylolisthesis

Objective:To analyze the clinical outcomes of traditional posterior open surgey (PLIF or TLIF) and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) with pedicle screw fixation for lumbar spondylolisthesis.Methods:From May 2013 to May 2015,50 patients with lumbar spondylolisthesis were treated through PLIF(31 cases) or TLIF (19 cases) with pedicle screw fixation, including 18 males and 32 females, aged from 31 to 72 years(average,56 years). All the 50 cases were single-level desease, including 26 cases of L4 and 24 cases of L5. According to Meyerding classification, I degrees of spondylolisthesis in 20 cases, II degrees of slippage in 23 cases,7 cases of more than II degrees.48 patients with lumbar spondylolisthesis were treated through MIS-TLIF with unilateral pedicle screw fixation (11 cases) or bilateral pedicle screw fixation (37 cases), including 17 males and 31 females, aged from 35 to 66 years(average,51 years). All the 48 cases were single-level desease, including 29 cases of L4 and 19 cases of L5. According to Meyerding classification, Ⅰ degrees of spondylolisthesis in 39 cases, Ⅱ degrees of slippage in 9 cases. The length of incision, operation time, blood loss, postoperative bed time and complications were recorded. The pre- and post-operative clinical outcomes were assessed by visual analogue scal (VAS) and low back outcome score (LBOS).Thin-layer helical CT scanning reconstruction was used to evaluate the fusion rate and cage cutting.Results:Traditional open surgey group:The length of incision was 9～13 cm(mean,9.8cm); the operation time was 75～130 minutes(mean,100 minutes); blood loss was 250-750 ml(mean,450 ml); and postoperative bed time was 5～7d(mean,6d). The wounds of 47 patients healed by first intention, while 2 cases were incision infection cured after debridement and drainage and sensitive antibiotic therapy, and 1 case was fat liquefaction around the incision which healing condition was satisfactory after wound dressing. Dural laceration occurred in 7 cases during operation while the leakage of cerebrospinal fluid (CSF) was observed in 2 cases. The ending was good through trendelenburg lying in bed for 1 months, strengthen wound dressing, prolong the time of antibiotic use. Cerebral vascular accident was occurred in 1 case, after ICU treatment to improve. Cauda equine and nerve root injury did not occur arfter the operation. All the patients were followed up from 12 to 18 months(average 16 months). VAS score of low back pain and leg pain from preoperative (5.5±1.0), (7.5±1.5) to (3.2±1.2), (3.0±1.2) at 7th day after operation and (1.8±1.0), (1.9±1.2) at 1 year after operation. There were significant difference before after operation and 1 year after operation (both P<0.05). LBOS was evaluated at 1 month after operation, excellent in 42 cases, good in 4 cases, fair in 3 cases, and poor in 1 case, the excellent and good rate was 92%. Also LBOS was evaluated at 1 year after operation, excellent in 46 cases, good in 3 cases, fair in 1 case, the excellent and good rate was 98%.Minimally invasive surgey group:The length of incision was 4-6 cm(mean, 4.8cm); the operation time was 55～85 minutes(mean,70 minutes); blood loss was 150-350 ml(mean,250 ml); and postoperative bed time was 2-4d(mean,2.7d). The wounds of 48 patients healed by first intention, while 2 cases were occurred nerve root injury, cured after the treatment of neurotrophic drugs and hyperbaric oxygen. All the patients were followed up from 12 to 16 months(average 15 months). VAS score of low back pain and leg pain from preoperative (5.6±1.4), (7.8±1.2) to (3.0±1.4), (3.0±1.2) at 7th day after operation and (2.0±1.2), (1.9±1.2) at 1 year after operation. There were significant difference before after operation and 1 year after operation (both P<0.05). LBOS was evaluated at 1 month after operation, excellent in 43 cases, good in 3 cases, fair in 2 cases, the excellent and good rate was 95.8%. Also LBOS was evaluated at 1 year after operation, excellent in 46 cases, good in 2 cases, the excellent and good rate was 100%.After 1 year of follow-up, two groups of patients were obtained bony fusion, the fusion rate of bone graft was 100%, no internal fixation loosening, fracture, interbody fusion cage displacement, false joint formation and other complications were obtained.Conclusion:There were many treatments for lumbar spondylolisthesis, PLIF and TLIF were the most used menthods, MIS-TLIF was a minimally invasive approach through the muscle gap developed in recent years. Two groups of patients were later road section of the lesion segment decompression, interbody graft bone fusion combined with pedicle screw fixation in the treatment of lumbar spondylolisthesis, lumbocrural pain were significantly improved after operation, obtained satisfactory bone graft fusion and the same treatment effect. However, MIS-TLIF has the advantage of less trauma, less bleeding, less operation time, less bed time, quicker recoverer, and less postoperative complications. So traditional posterior open surgey and minimally invasive surgey with pedicle fixation was effective and feasible. The clinical outcomes was satisfied. In addition, the long-term curative effect remains to be examined in further clinical studies.