Comparison Of Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion In The Treatment Of Lower Lumbar Disc Herniation

Objective:To analyze the short-term clinical efficacy of mini-invasive and open transforminal lumbar interbody fusion in the treatment of lower lumbar disc herniation,comparing the advantages and disadvantages of the two methods in order to provide a safe and efficient surgery method for patients.Methods:From February 2013 to February 2015,we conduct a retrospective analysis of 58 patients with single level lumbar disc herniation who were treated in the Department of Spinal Surgery at the First Affiliated Hospital of Dalian Medical University;they were divided into MIS-TLIF group and OPEN-TLIF group.Two groups of patients were treated with bilateral pedicle screw fixation.30 patients among them were treated with minimally invasive transforaminal lumbar interbody fusion assisted by Quadrant system in MIS-TLIF group,consisting of 17 cases of male,13 cases of female,aged from 40 to 85 years old,with an average of 55.7±9.2 years old.The mean course of their disease was 20.6 months,range from 3 months to 10 years,and the lesion affected levels:L4/5:16 cases,L5/S1:14 cases.The rest of the 28 patients in OPEN-TLIF group,underwent traditional open TLIF surgery.There are 16 cases of male and 12 cases of female,aged from 38 to 72 years old,with an average of 55.4±8.7 years old.The mean course of their disease was 22.1 months,range from 3 months to 20 years old,and the lesion affected levels:L4/5:17 cases,L5/S1:11 cases.No statistical differences were found between the two groups in gender,age,spinal level affected,preoperative clinical status,visual analogue scale(VAS)and Oswestry disability index(ODI)before operation(P>0.05).The operation time,incision length,blood loss,volume of incision drainage,time of ambulation after operation,hospital stay,VAS score,ODI score were compared and follow-up X-ray reexamination of lumbar spine after surgery,to observe intervertebral fusion in the two groups of patients.Results:All patients were followed up after operation between 12 and 18 months,with an average of 14.5 months.The operation time of MIS-TLIF group was longer than that in the OPEN-TLIF group(P<0.05).Significant differences were found in incision length,blood loss,volume of incision drainage,time of ambulation after operation,hospital stay between OPEN-TLIF group and MIS-TLIF group,all of which were less in latter.There was no significant difference between the two groups' VAS and ODI scores before the operation(P>0.05),but the MIS-TLIF group's VAS and ODI scores were significantly less than those in OPEN-TLIF group after the operation(P<0.05).There was no significant difference between the two groups after 12 months(P>0.05).Two groups of postoperative patients with lower back pain symptoms improved significantly compared with pre-operation.The postoperative VAS score and ODI score of each group were significantly lower than those before operation(P<0.05).None of perioperative complications were found in the MIS-TLIF group.There were perioperative complications in 3 cases of OPEN-TLIF group,including one temporary root pain and numbness after surgery.It completely recovered after 3 months.One patient had infection from a deep incision which healed after debridement.The other patient with more blood loss,was given blood transfusion.Postoperative X-ray showed that the location of internal fixation was good,no need for secondary surgery.Conclusion:Compared with OPEN-TLIF operation,MIS-TLIF has the advantages of minimal surgical trauma,less perioperative complications,quick recovery of postoperative function and better short-term effects.The treatment is a safer and more efficient minimally invasive surgical method for lower lumbar disc herniation.It is worth practicing in clinical treatment.