A Comparative Study Of The Efficacy Of Modified TLIF Via Wiltse Approach And MIS-TLIF Assisted By Channel

Objective:Comparing the efficacy and influence on paravertebral muscles of lumbar interbody fusion using self-made improved muscle retracter via muscular space(Wiltse approach)and mis-TLIF minimally invasive transforaminal lumbar interbody fusion assisted by Quadrant channel.Methods : A retrospective study was conducted on 63 patients who received unilateral single-level TLIF in our hospital from January 2019 to January 2020.According to the two different surgical methods,they were divided into modified TLIF group via Wiltse approach(group A,33 cases)and MIS-TLIF group assisted by channel(group B,30 cases).And all of the patients were followed up for more than 12 months after surgery.Observational study indicators have a baseline data,surgical segment,incision length,intraoperative C arm X-ray transmission times and operation time,intraoperative blood loss,postoperative flow,different periods after the serum creatine kinase(CK creatine kinase)content,fusion rate after operation,torn muscle atrophy and Oswestry disability index(ODI Oswestry idsability index),visual analog pain score(VAS visual analogue score).Results:There were no statistical differences in baseline data and surgical segments between the two groups.The length of surgical incision in group A was greater than that in group B(P < 0.05),and the operative time in group A was not significantly different from that in group B.Intraoperative blood loss and postoperative drainage volume in group B were less than that in group A(P< 0.05).The serum CK of group A was lower than that of group B at 1 and 3days after surgery(P < 0.05),and there was no statistical difference in serum CK between the two groups at 5 days after surgery.VAS scores in group A at 3days and 3 months after surgery were lower than those in group B(P <0.05).ODI of group A was higher than that of group B 3 months after surgery(P< 0.05),and there was no statistical difference in ODI between the two groups 6months and 12 months after surgery,and there was no difference in fusion rate between the two groups.Postoperative lumbar MRI reexamination was completed in 13 cases of group A and 15 cases of group B with little artifact interference.The atrophy ratio before and after multifidus surgery in group A(0.14±0.06)and group B(0.13±0.04)showed no statistical significance.Conclusion: The modified TLIF by Wiltse approach and the MIS-TLIF assisted by Quadrant channel could achieve satisfactory clinical efficacy,the latter had a shorter incision,and the former had less effect on the parapartebral muscle during operation.