Surgical treatment of lumbar spondylolisthesis by minimally invasive transmultifidus approach

English Keywords:Lumbar vertebrae  Spondylolisthesis  Minimally invasive  Surgical procedures

English Abstract:

  【Abstract】 Objective：To evaluate the method and clinical effect of minimally invasive transmultifidus approach for lumbar spondylolisthesis.Method：From March 2006 to September 2009，95 patients with spondylolisthesis underwent minimally invasive transmultifidus PLIF.After surgery，the skin incision length，operative time，blood loss and complications were analyzed retrospectively.Radiography assessment included the slipping angle，intervertebral disc height，Taillard index and fusion rate.Visual Analogue Scores（VAS）　and JOA scores were used for clinical assessment.Result：The average length of skin incision was 3.2cm（range，2.8 to 3.5cm），the average operative time was 115min（range，80 to 210min），and the average blood loss was 170ml（range，120 to 700ml）.All cases were followed up for 1２~42 months（mean，25 months）.Complications were noted in 5 cases，with 1 case presented with skin atrophy near the incision，which were healed after debridement；dura matter tearing was noted in 1 case，which was resolved after repairing；1 case presented with L5 nerve root deficit which recovered three months later by neuronutrition；2 cases presented with leg pain after operation，which was resolved after administration.The total incidence rate of complications was 5.2%.At final followed-up，the slipping angle decreased from preoperative 6.02±1.91° to postoperative 1.22±0.70°，the intervertebral disc height increased from preoperative（5.06±1.61）mm to postoperative（10.78±0.90）mm，Taillard index decreased from preoperative 26.17±8.50 to postoperative 8.34±2.35.Complete bony fusion was observed in 89 cases，with the fusion rate of 93.7%，and the VAS for leg pain decreased from preoperative 7.69±1.61 to postoperative 2.34±1.60，and VAS for low back pain decreased from preoperative 7.15±1.76 to postoperative 2.15±1.77.The average JOA score increased form preoperative 10.09±3.18 to postoperative 23.14±2.81.Conclusion：Minimally invasive transmultifidus approach for lumbar spondylolisthesis is reliable and less complicationsive.