| Objective: To compare the clinical effects of endoscopic transforaminal lumbar interbody fusion(Endo-TLIF),conventional Endo-TLIF and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in the treatment of single-level lumbar spondylolisthesis,and explore the clinical application of electromagnetic navigation technology in Endo-TLIF.Methods: A total of 95 patients were enrolled in this study,all of whom were diagnosed with single-level lumbar spondylolisthesis and underwent surgery in the Department of Spinal Surgery of the Affiliated Hospital of Qingdao University from May2019 to January 2020.95 patients were divided into three groups according to the surgical methods: navigational Endo TLIF group,routine Endo TLIF group and MIS-TLIF group.Various surgical indicators of the patients were recorded,including screw placement time,total operation time,intraoperative fluoroscopy number,intraoperative blood loss,postoperative bedridden time and surgical complications.Using Visual Analog Score(VAS),Oswestry Disability Index(ODI)and the Japanese Orthopedic Association(JOA)score,evaluation of three group’s patients was made respectively in the preoperative and postoperative 1,3,6 and 12 months.Postoperative lumbar interbody fusion was assessed in 12 months postoperatively using three-dimensional CT scans.Results: A total of 30 patients were enrolled in the navigation Endo-TLIF group,including 9 males and 21 females with average age of 58.57±5.63 years.A total of 38 patients were included in the conventional Endo-TLIF group,including 18 males and 20 females,with average age of 59.58±6.76 years.A total of 27 patients were enrolled in MIS-TLIF group,including 12 males and 15 females,with average age of 60.11±9.92 years.There were no significant differences in age,sex,body mass index(BMI),type of lumbar spondylolisthesis,grade of spondylolisthesis and surgical level among the three groups(P>0.05).The mean screw placement time in navigation Endo-TLIF group was14.43±2.94 min,which was significantly shorter than that in conventional Endo-TLIF group(30.23±4.88 min)and MIS-TLIF group(28.61±3.05 min)(P<0.01).The mean operation time of navigation Endo-TLIF group was 190.33±22.96 min,which was similar to that of MIS-TLIF group(182.22±18.36 min),but significantly shorter than that of conventional Endo-TLIF group(219.26±22.51min).In terms of intraoperative fluoroscopy,the navigation Endo-TLIF group has the least intraoperative fluoroscopy times with an average of 14.23±1.89 times.The conventional Endo-TLIF group has the most intraoperative fluoroscopy times with an average of 62.18±1.80 times,and the MIS-TLIF group has 28.67±2.06 times.The mean intraoperative blood loss in navigation Endo-TLIF group was 70.23±12.92 ml,which was significantly lower than that in conventional Endo-TLIF group(84.39±32.09 ml,P>0.05)and MIS-TLIF group(136.04±24.27 ml,P<0.01).In addition,the incision of navigation Endo-TLIF group and conventional Endo-TLIF group is shorter comparing with MIS-TLIF group,and the postoperative bedridden time is shorter,but there is no statistical difference between navigation Endo-TLIF group and conventional Endo-TLIF group.In terms of postoperative efficacy evaluation indexes,the variation trend of conventional Endo-TLIF group and navigational Endo-TLIF group was the same,and there was no statistical significance in the comparison of indexes between the two groups during the follow-up period(P>0.05).There was no significant difference in preoperative indicators among the three groups(P>0.05).The postoperative quality of life and function of patients in the three groups were significantly improved,respectively.Patients in the early navigation group and the conventional End-TLIF group recovered faster,and the VAS,ODI and JOA score were significantly improved compared with those in the MIS-TLIF group in the three months after surgery(P <0.01).However,there was no difference in the final symptom relief among the three groups.Besides,the interbody fusion rate of navigation Endo-TLIF group,conventional End-TLIF group and MIS-TLIF group was 96.67%,94.74% and 100% respectively,and there were no significant differences in terms of the interbody fusion rate between groups(P>0.05).There were 3cases of operation-related complications,including 1 case in the navigational Endo-TLIF group and 2 cases in the conventional Endo-TLIF group.Conclusion: Endo-TLIF assisted by electromagnetic navigation has a definite and significant clinical effect in the treatment of single-level lumbar spondylolisthesis.Conventional Endo-TLIF is difficult,with many fluoroscopic times and long operation time.Endo-TLIF technology assisted by electromagnetic navigation optimized the technical defects of conventional Endo-TLIF,which not only ensured the surgical outcome,but also reduced the number of intraoperative fluoroscopies,shortened the operative time and improved the surgical accuracy.While the Endo-TLIF is significantly easier to operate with the help of electromagnetic navigation,the learning curve is still steep. |
