Comparison Of The Efficacy Of Spinal Endoscopic Fusion And Traditional Open TLIF In The Treatment Of Single Segmental Lumbar Degenerative Diseases

Objective:Retrospective analysis of the clinical efficacy of percutaneous endoscopic transforaminal lumbar interbody fusion(PE-TLIF)and open transforaminal lumbar interbody fusion(TLIF)in the treatment of single segment,unilateral symptomatic lumbar degenerative diseases.Summarize the advantages and disadvantages of the two surgical methods,in order to find a more reasonable treatment in line with the concept of minimally invasive spinal surgery and can effectively treat lumbar degenerative diseases.Methods:The clinical data of patients with single segment and unilateral symptom degenerative lumbar degenerative diseases(LDD)treated by percutaneous endoscopic transforaminal lumbar interbody fusion(PE-TLIF)and open transforaminal lumbar interbody fusion(TLIF)in the first affiliated Hospital of Jilin University from January2021 to December 2022 were collected and analyzed retrospectively.A total of 66 patients were enrolled according to the exclusion criteria,including lumbar spinal stenosis with lumbar instability(19 cases),lumbar disc herniation with lumbar instability(36 cases),lumbar spondylolisthesis(11 cases)(Meyerding grade I,II).All patients were randomly divided into two groups.One group of patients underwent percutaneous endoscopic transforaminal lumbar interbody fusion(PE-TLIF group),and the other group underwent open transforaminal lumbar interbody fusion(TLIF group).All patients were under general anesthesia.Patients in both groups were aged between 45 and 60 years old.Twenty-five patients(14 males and 11 females)in the PE-TLIF group,with a mean of(52.36±4.57)years;Forty-one patients(23 males and18 females)in the TLIF group,with an average age of(52.83±4.58)years.The operation time,blood loss,knife size,fluoroscopy times,bed rest time,hospital stay and inflammatory factors before operation,1 day after operation and 1 week after operation were recorded and evaluated by clinical hospitalization system and anesthesia system;The clinical effects of the patients were compared and analyzed by comparing the visual analog score(Visual Analogue Score,VAS)and Oswestry dysfunction index(Oswestry Disability Index,ODI)before and after follow-up;The relative functional cross-sectional area(r FCSA)of multifidus in responsible segment was calculated by MRI imaging data before and 3 months after operation,and the degree of paraspinal muscle injury caused by two surgical methods was compared and analyzed;The Mac Nab scale was used to analyze the excellent and good rate of operation at the last follow-up.The data were analyzed by SPSS27.0 software.Result:1.There were no statistical differences in gender and age between the two groups(P >0.05);2.The amount of bleeding in PE-TLIF group was less than that in TLIF group,and the incision size,bed rest and hospital stay in TLIF group were shorter than those in TLIF group,but the times of C-arm fluoroscopy and operation time in TLIF group were significantly higher than those in TLIF group(P <0.001);3.The VAS score and ODI index of low back pain at each time point after operation in the two groups were lower than those before operation,and the differences were statistically significant(P<0.001);The VAS score of low back pain in PE-TLIF group was lower than that in TLIF group 1 week after operation(P <0.001);There was no significant difference in the VAS scores of low back pain between the two groups at 6months and 1 year after surgery(P>0.05);The ODI index of PE-TLIF group was lower than that of TLIF group one week after surgery(P<0.001);There was no significant difference in ODI index between the two groups at 6 months and 1 year after surgery(P>0.05);There was no significant difference in preoperative inflammatory factors between the two groups.C-reactive protein(CRP)and ESR in PE-TLIF group were lower than those in TLIF group at 1 day and 1 week after operation;4.There was no significant difference in r FCSA between the two groups before operation(P>0.05),but r FCSA PE-TLIF group was significantly better than TLIF group after operation(P<0.001);In the intra-group comparison of the two procedures,the r FCSA of the multifidus muscle after operation was significantly worse than that before operation,and the difference was statistically significant P<0.001).5.According to the modified Mac Nab scoring standard,the excellent and good rates of the two groups were 88.0% and 82.90%,respectively,with no significant difference(χ~2=1.406,P =0.819);The incidence of complications in the two groups was 8% and 10% respectively,and the difference was not statistically significant(χ~2=4.924,P =0.295).Conclusion:1.Both of the two surgical methods can effectively treat single segment and unilateral symptom lumbar degenerative diseases.The incidence of postoperative complications and long-term effect were similar between the two groups;2.PE-TLIF operation has the advantages of small incision,less bleeding,rapid postoperative recovery and less paraspinal muscle injury,so it is worth popularizing in clinic;3.PE-TLIF operation also has some shortcomings,such as many times of intraoperative X-ray fluoroscopy,prolonged operation time,difficulty in hemostasis under microscope,long learning curve and so on,which need to be further improved and developed.