Clinical Study Of MIS-TLIF Combined With Contralateral Bridge-Shaped Percutaneous Pedicle Screw Fixation In The Treatment Of Double-Segement Lumbar Degenerative Diseases

Objective:This study aims to compare the clinical efficacy of minimally invasive transforaminal interbody fusion(MIS-TLIF)combined with contralateral Bridge-Shaped percutaneous pedicle screw fixation(MIS-TLIF)and traditional minimally invasive transforaminal interbody fusion(MIS-TLIF)in the treatment of double-segement lumbar degenerative diseases.To explore the advantages of Bridge-Shaped MIS-TLIF and its feasibility as a modified operation of MIS-TLIF,and to propose a novel,improved and effective minimally invasive surgical method for the treatment of double-segement lumbar degenerative diseases.Methods:A retrospective analysis was made of the clinical data of 48 patients who were admitted to the spinal surgery department of Dalian Central Hospital from June 2017 to August 2018.There were 24 patients in each group.There was no significant difference in sex,age and lesion segment between the two groups.All patients were operated by the same surgeon and were followed up for 2 months.Relevant perioperative indicators(intraoperative bleeding volume,operation time),incision length,hospitalization time and hospitalization expenses,visual analogue scale(VAS)and Oswestry dysfunction index questionnaire(ODI)were compared between the two groups.The data were analyzed by SPSS22.0.Results:1.Comparisons of perioperative related indexes between the two groups: the intraoperative bleeding volume in Bridge-Shaped MIS-TLIF group was 195±42.06 ml and the operation time was 143.67±18.64 min;the intraoperative bleeding volume in traditional MIS-TLIF group was 246.25±60.26 ml and the operation time was 165.71±22.08 min.The bleeding volume and operation time of Bridge-Shaped MIS-TLIF group were lower than those of traditional MIS-TLIF group,and the difference was statistically significant(P < 0.05).2.Comparison of incision length between the two groups: The total length of bilateral incision in Bridge-Shaped MIS-TLIF group was 8.21±0.47 cm,and that in traditional MIS-TLIF group was 8.57±0.56 cm.The difference was statistically significant(P<0.05).3.Comparison of hospitalization time and hospitalization expenses between the two groups: the hospitalization time of Bridge-Shaped MIS-TLIF group was 14.13±2.09 days,and the hospitalization cost was14591.67±1447.31 yuan;the hospitalization time of traditional MIS-TLIF group was 14.20±0.93 days,and the hospitalization cost was 17852.08±2051.18 yuan.There was no significant difference in hospitalization time between the two groups(P > 0.05),but the hospitalization cost of Bridge-Shaped MIS-TLIF group was lower than that of traditional MIS-TLIF group(P < 0.05).4.Comparison of VAS score and ODI score before and after operation in two groups: VAS score of low back pain before operation in Bridge-Shaped MIS-TLIF group was 6.27±1.32 and ODI score before operation was 42.74±5.25;VAS score of low back pain before operation in traditional MIS-TLIF group was 6.15±1.27 and ODI score before operation was 41.27±5.64.There was no significant difference in preoperative score between the two groups.In Bridge-Shaped MIS-TLIF group,VAS was 2.12±0.48 at 3 days post-operation,1.24±0.42 at 2 months post-operation,30.21+4.17 at 3 days post-operation and 25.86±3.52 at 2 months post-operation.In traditional MIS-TLIF group,VAS was 2.43±1.03 three days after operation,1.37(+0.78)two months after operation,32.77±4.35 three days after ODI,and 26.18±3.26 two months after operation.The VAS and ODI scores of the two groups were improved compared with those before operation,and the difference was statistically significant(P< 0.05).Conclusion:Both Bridge-Shaped MIS-TLIF and traditional MIS-TLIF can effectively treat double-segement lumbar degenerative diseases.However,compared with traditional minimally invasive surgery,Bridge-Shaped MIS-TLIF has the advantages of less bleeding,less operation time,smaller incision and lower operation cost.It can be used as a novel,improved and effective minimally invasive surgical method for the treatment of double-segement lumbar degenerative diseases.In clinical diagnosis and treatment,surgeons can choose appropriate surgical methods for different situations.