The minimal invasive posterior transforminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion in the treatment of single level lumbar spine degenerative diseases

English Keywords:【Key words】 Lumbar degenerative diseases  Minimal invasive surgery  Transforminal lumbar interbody fusion  Interbody fusion

English Abstract:

  【Abstract】 Objectives: To compare the fusion rate between minimal invasive posterior transforminal lumbar interbody fusion(minimal invasive posterior transforaminal lumbar interbody fusion, MIS-TLIF) and open transforaminal lumbar interbody fusion(open transforaminal lumbar interbody fusion, open TLIF), and to evaluate the safety and reliability of MIS-TLIF for single level lumbar spine degenerative diseases. Methods: 48 patients with single level lumbar degenerative diseases were followed up. Among them, 22 cases received MIS-TLIF, there were 7 males and 15 females, with a mean age of 49.4±12.1 years(range from 26 to 65 years). 26 cases received open TLIF: 11 males, 15 females, with a mean age of 50.7±11.8 years(range from 27 to 70 years). The operation time, intraoperative blood loss and postoperative drainage were compared between two groups. Clinical outcomes in terms of back pain VAS score, leg pain VAS score, ODI score and JOA score were performed before surgery and during follow-up. Futhermore, X-ray and three-dimansional computed tomography were used to evaluate the fusion status. Results: There were no significant differences between two groups in age, sex, smoking history, BMI and surgery levels(P＞0.05). The preoperative back pain VAS score, leg pain VAS score, ODI score and JOA score in MIS-TLIF group were 4.9±2.5, 6.6±2.4, 23.3±10.2, 14.7±5.8 respectively; and 5.4±2.2, 6.0±2.8, 23.8±9.0, 13.6±4.8 respectively in open TLIF group. Operation time, intraoperative blood loss, postoperative drainage in MIS-TLIF group were 235.8±46.3min, 198.6±81.6ml, 115.7±74.5ml respectively; and 127.8±45.8min, 350.0±143.6ml, 494.7±243.9ml respectively in open TLIF group. Although the operation time of MIS-TLIF group was longer than that of open TLIF group(P＜0.05), the blood loss and the postoperative drainage of MIS-TLIF group were less than those of open TLIF group(P＜0.05). After a mean follow-up of 12 months, the VAS score of back pain in MIS-TLIF group was lower than that of open TLIF group within 3 months after operation(P＜0.05), and there was no difference between two groups regarding to VAS score after 3 months of postoperation. X-ray and three-dimansional computed tomography were performed at the final follow-up. Lumbar fusion rate assessed by three-dimansional computed tomography in MIS-TLIF group was 81.8%(18/22), and 92.3%(24/26) in open TLIF group. The lumbar spine fusion rate in MIS-TLIF group was lower than that in open TLIF group, but no significant difference(P＞0.05) was noted. There were no complications in two groups. Conclusions: For single level lumbar spine degenerative diseases, MIS-TLIF can achieve similar result and similar fusion rate with the open TLIF. MIS-TLIF is of high reliability because of lower bleeding and drainage.