Clinical Comparative Study Of CLIF Combined With Posterior Percutaneous Nail Placement And PLIF In The Treatment Of Degenerative Lumbar Spinal Stenosis Based On The Theory Of "Equal Emphasis On Muscles And Bones"

Objective: Based on the theory of "equal emphasis on muscles and bones" in Traditional Chinese medicine,the clinical efficacy of minimally invasive lateral Cage bone graft fusion(CLIF)combined with posterior percutaneous nail placement and traditional posterior total laminectomy(PLIF)in the treatment of degenerative lumbar spinal stenosis(DLSS)was observed and compared,and data were collected and analyzed to provide ideas for clinical diagnosis and treatment.Methods:Forty patients with degenerative lumbar spinal stenosis treated in the Affiliated Hospital of Shandong University of Traditional Chinese Medicine and hospitalized in the minimally invasive orthopaedic ward from September 2018 to December 2020 were selected.Patients were divided into group ⅰ(treatment group,CLIF)and group ⅱ(control group,PLIF)according to different surgical protocols.Twenty cases in each group were followed up.The basic information such as gender,age and number of lumbar spinal stenosis in 2 groups were recorded and compared.Operative time,intraoperative blood loss,operative skin incision length,and length of hospital stay were recorded and compared.SVA,C7PL-CSVL,Cobb Angle and bone graft fusion rates were measured and compared before and 6 months after surgery.ODI and VAS scales were used to score the pain function before surgery,1 month after surgery and 6 months after surgery,respectively,to evaluate the surgical efficacy.The above data were collected and SPSS22.0 was used for statistical analysis to draw the research conclusion.Results:All patients were followed up and no adverse events occurred.1.There were no statistically significant differences between the two groups in gender,age and number of lumbar spinal stenosis segments(P > 0.05).2.CLIF group had shorter operation time and hospital stay,shorter skin incision length,and less intraoperative blood loss than PLIF group,with statistically significant differences among all groups(P < 0.05).3.SVA,C7PL-CSVL and Cobb Angle before and 6 months after surgery: the two groups were better than those before surgery.There was no significant difference between the two groups before surgery(P > 0.05),and the CLIF group was significantly better than the PLIF group after surgery(P < 0.01).4.Pain function scores before,1 month after and 6 months after surgery :CLIF group and PLIF group had good improvement effect on pain,and the postoperative scores were better than those before surgery.The two scores of CLIF group were better than PLIF group 1 month after surgery,the difference was statistically significant(P < 0.05),and there was no significant difference between the two groups before surgery and 6 months after surgery(P > 0.05).5.Both CLIF group and PLIF group had good bone graft fusion rate,and there was no significant difference between the two groups(P > 0.05).Conclusion:For the treatment of degenerative lumbar spinal stenosis,CLIF and PLIF can both achieve good results and satisfactory results.However,CLIF group had less surgical trauma and less injury to patients,which was more consistent with the theory of "equal emphasis on muscles and bones" in Traditional Chinese medicine.Meanwhile,CLIF group was better than PLIF group in correcting the balance of coronal and sagittal spine.The two surgical methods have their own characteristics,and the appropriate surgical method should be selected according to the patient’s own condition and relevant imaging data before surgery.