Clinical Observation Of Facet Joint Fusion Combined With Interbody Fusion In The Treatment Of Lumbar Degenerative Diseases

Lumbar degenerative disease(LDD)is one of the common causes of low back and leg pain.Patients with symptoms for the first time can be treated conservatively for 3-6 months,and the patients with invalid conservative treatment can be treated surgically.At present,the common surgical methods in the clinic are transforaminal lumbar interbody fusion(TLIF)and posterior lumbar interbody fusion(PLIF).And a long-term follow-up study,the results show that no matter which fusion method can effectively improve the clinical symptoms of patients with LDD,but the complication after fusion is common.Bilateral facet joints,which maintain the stability of the spine to some extent,are important structures in the back of the spine.Intraoperatively,if the bilateral facet joints are removed,it increases the stress of the pedicle screws which in turn leads to the occurrence of their failure.If the degenerated contralateral facet joints are not treated,the postoperative patients experience poor relief of low back pain.So the management of the contralateral facet joint should be paid enough attention to during the TLIF procedure.Objective:To explore the clinical efficacy of facet joint fusion(FJF)combined with lumbar interbody fusion in the treatment of lumbar degenerative diseases.Methods:A total of 104 patients who underwent modified TLIF operation in our hospital from January 2018 to January 2020 were collected.The average follow-up time was 18 months,including 40 males and 64 females.In this study,the preservation of the contralateral facet joint during the operation was defined as facet joint fusion group,and the contralateral articular process untreated during operation was defined as traditional group.Evaluation indicators:(1)collecting patients’ age,sex,BMI and the symptom duration through the Donghua Electronic Medical record system of our hospital;(2)Operation: incision length,operation time,blood loss and postoperative drainage.(3)Clinical efficacy evaluation: Visual analogue scale(VAS)was used to evaluate low back pain(LBP-VAS)and leg pain(LP-VAS)before and 3,6 and 12 months after operation,and Oswestry Disability Index(ODI)and modified Mac Nab score were used to evaluate patients’ functional recovery and satisfaction.(4)Radiological evaluation: the postoperative imaging data were obtained to evaluate the fusion of facet joint and intervertebral body.Results:1.Compared with the two groups,there was no significant difference in the general condition and operation condition of the patients in the facet fusion group(P>0.05).2.Compared between the two groups,it was found that the LBP-VAS score at 6 and 12 months after operation and the ODI at 12 months after operation in the facet joint fusion group were lower than those in the traditional group,and there was statistical significance between the two groups(P<0.05).3.The excellent and good rate of postoperative patients was 98.04% in the facet joint fusion group and 96.23% in the traditional non-fusion group.4.The 12-month postoperative radiographic results showed that in the facet joint group,the facet joint rate was 94.12%,and the interbody fusion rate was 100%;and the interbody fusion rate was 96.23% in the conventional group.Conclusion:The technique of lumbar fusion combined with facet joint fusion not only can increase the stability of the spine,but also can reduce postoperative low back pain and improve patient satisfaction after surgery.