| BackgroundLumbar spinal stenosis(lumbar spinal stenosis)is one of the most common diseases that cause low back pain in the lower back and leg.It is a chronic,progressive dural sac and cauda equina injury.It is caused by spinal stenosis and root canal stenosis.Or the stenosis of the intervertebral foramen causes the dural sac and nerve root to be compressed and the corresponding neurological symptoms appear.The pressure of the dural sac appears as cauda equina syndrome,intermittent claudication and other symptoms.When the nerve root is compressed,it shows the root symptoms of the lower limbs(one side or both sides),which is more common in middle-aged and elderly people.With the advent of China’s aging society,its incidence has also increased year by year,which is one of the main causes of low back pain in middle-aged and old people.The mild and early cases of this disease are mainly non-surgical treatment.Non-surgical treatment includes lumbar traction,physiotherapy,nutritional nerves,and non-steroidal drugs.Patients who have been treated with strict conservative treatment often need surgery to expand the dura mater and nerve compression.The classic clinical procedure is total laminectomy and semi-laminectomy.It seems that the decompression is sufficient,but the adverse effects of excessive removal of lumbar posterior structural resection are iatrogenic lumbar instability.Epidural scar adhesion,lumbar failure syndrome,the excellent rate of long-term follow-up showed a downward trend.At the same time,middle-aged and elderly patients have more medical complications,more bleeding during open surgery,more intraoperative complications,increased risk associated with surgery,longer bed rest after surgery,increased waist atrophy,lower extremity venous thrombosis Risk,affecting the efficacy of surgery.At the same time,patients with lumbar spinal stenosis often have lumbar instability,lumbar disc herniation,etc.The operation itself destroys the stability of the spine.In operation,it is necessary to remove the protruding nucleus pulposus and remove the vertebral body.Therefore,the lumbar spine reduction is performed.The pressure + internal fixation fusion technology has been widely used in clinical practice.At present,the conventional surgical procedure for treating lumbar spinal stenosis is posterior lumbar interbody fusion.PLIF surgery is fully and thoroughly decompressed,and the treatment effect is exact.However,it is necessary to extensively exfoliate the paraspinal muscles on both sides.Continuous traction is required during the operation.There are large trauma,intraoperative blood loss and postoperative drainage,and postoperative bed rest time.Long,is not conducive to the rapid recovery of patients.From the long-term follow-up results,the rate of excellent treatment showed a downward trend.Nowadays,more and more spine surgeons realize that the treatment of lumbar spinal stenosis is not the greater the decompression range,the more emphasis on limited decompression and precise decompression.With the popularization of the minimally invasive concept of the spine and the improvement of the instrument,minimally invasive tranforaminal lumbar interbody fusion(MIS-TLIF)has been widely used clinically,and its surgical indications are also Constantly expanding.Decompression,fixation,and anterior and posterior column fusion were performed after the channel was placed through the muscle gap approach(Wiltse).With the expandable channel and intraoperative adjustment of the channel direction,all operations of open surgery can be performed under the microscope,such as laminectomy and bilateral crypt decompression,which not only reduces muscle soft tissue injury and intraoperative bleeding,but also recovers quickly after surgery.The shortening of the average hospitalization day has promoted the rapid recovery of patients,so it has been widely used in clinical practice.We applied MIS-MILF technology to the treatment of lumbar spinal stenosis,using Mast-Quandrant expandable bilateral unilateral decompression,statistical analysis of relevant indicators before and after surgery,follow-up tracking treatment effect,and compared with traditional PLIF surgery Compare the effects of the two procedures in degenerative lumbar spinal stenosis and better guide clinical work.ObjectiveTo analyze the difference of Mast-Quandrant MIS-MILF unilateral approach bilateral decompression for the treatment of degenerative lumbar spinal stenosis and traditional PLIF.MethodsRetrospective analysis of the data of degenerative lumbar spinal stenosis patients admitted to the Department of Spine,the First Affiliated Hospital of Zhengzhou University from June 2016 to June 2017,and 87 suitable cases were screened.The criteria included in the study were:(1)diagnosis of single-segment or double-segment lumbar spinal stenosis;(2)patient symptoms,signs and imaging data were consistent;(3)lumbar CT,MRI examination prompted central spinal canal and(or Side crypt stenosis;(4)strict conservative treatment for more than 3 months;(5)no previous history of mental illness,no symptoms of mental disorders such as depression and anxiety.Exclusion criteria:(1)patients with severe osteoporosis;(2)multi-segment lumbar spinal stenosis(more than 2 segments)with lumbar instability or spondylolisthesis;(3)bilateral epidural severe fibrosis;(4)Although the imaging data showed spinal stenosis,the clinical symptoms,signs and imaging were not consistent;(5)Traumatic and iatrogenic spinal stenosis.Among them,47 patients underwent MIS-TLIF surgery(hereinafter referred to as the minimally invasive group),and 40 patients underwent PLIF surgery(hereinafter referred to as the open group).There were 31 males and 16 females in the minimally invasive group;the age ranged from 59 to 72 years,with an average of(65.2±7.3)years.The course of disease was 6-36 months,and the average disease duration was 26.7±4.8 months.There were 31 patients with single-segment stenosis and 16 patients with double segment.There were 28 cases of 4,5 segments of the stenosis section,and 35 cases of 5 腰 1 section of the waist.There were 40 patients in the open group,including 27 males and 13 females;aged 55-74 years,mean age 67.3±5.8 years,duration 7-40 months,mean duration 28.5±5.7 months.Among them,27 patients had single-segment stenosis and 13 patients had double segment.There were 24 cases of stenosis in the 4th and 5th segments of the waist,and 29 cases of stenosis in the 5th and 5th segments of the waist.All patients had lumbosacral pain and lower limb cramps.There were 52 patients with unilateral lower extremity radiation pain and 35 patients with bilateral and lower extremity neurogenic claudication symptoms.There were no significant differences in the age,duration of disease,and stenosis between the two groups.The operation time,intraoperative blood loss,serious neurological complications,and bed rest time were observed and recorded in the two groups.The differences of surgical indexes between the two groups were analyzed.The efficacy of the modified Macnab criteria was evaluated by preoperative and postoperative visual analogue scale VAS and Oswesrty functional index(ODI).X-ray examination of the lumbar spine was performed before the operation,and the X-ray examination of the over-extension was performed.All patients had lumbar instability or assessed potential lumbar instability.Lumbar X-ray films and CT examinations were performed at the postoperative follow-up.The postoperative vertebral fusion rate was compared between the two groups.There was no lumbar instability,and the dural sac and nerve roots were again compressed.ResultsAll patients enrolled in the study completed the operation successfully,and no neurological and cauda equine injury,cerebrospinal fluid leakage,postoperative blood transfusion,infection and death occurred.The minimally invasive group did not transfer to an opener.The amount of intraoperative blood loss and postoperative drainage were significantly higher in the open group than in the minimally invasive group.There was no significant difference in operation time between the two groups(P>0.05),and the postoperative bed rest time in the minimally invasive group was significantly shorter than that in the open group,the difference was statistically significant(P<0.05).One case of dural sac tear occurred in the minimally invasive group,and no complications occurred in the open group.The VAS score and ODI score of the two groups were significantly improved after operation(P<0.05).The VAS score and ODI score of the minimally invasive group were significantly lower than those of the open group(P<0.05),but after 3 months.There was no significant difference in VAS score and ODI score between the two groups at the last follow-up(P>0.05).There was no significant difference in the excellent rate of surgery between the two groups.All patients with lumbar spine X-ray films were successfully combined in the outpatient clinic in March.As of the last follow-up,lumbar spine instability and nerve compression were not found in all patients with lumbar X-ray and lumbar CT.ConclusionsCompared with the traditional posterior approach,mis-tlif technique has the advantages of less bleeding,shorter bed time and smaller incision in the treatment of central lumbar spinal stenosis under the premise of consistent effect,which promotes the rapid recovery of patients. |
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