Comparison of therapeutic effects of percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) and posterior lumbar interbody fusion(PLIF) in the treatment of lumbar spine stenosis

English Keywords:Lumbar spinal stenosis  Minimally invasive surgery  Transforaminal lumbar interbody fusion  Posterior lumbar interbody fusion

English Abstract:

  【Abstract】 Objectives: To compare the clinical efficacy of percutaneous endoscopic transforaminal lumbar interbody fusion(PE-TLIF) and posterior lumbar interbody fusion(PLIF) in the treatment of lumbar spinal stenosis. Methods: Retrospective analysis was performed on 36 patients who received lumbar decompression and fusion surgery in our hospital from December 2017 to December 2018 due to single-segment lumbar spinal stenosis(LSS). The patients were divided into PE-TLIF group(15 cases) and PLIF group(21 cases) according to the surgical methods. The operation time, intraoperative bleeding volume, incision length, postoperative drainage volume, postoperative bedridden time, and postoperative complications of patients in both groups were recorded. Serum creatine kinase(CK) was used to assess paravertebral muscle injury at 1 day preoperatively, 1 day postoperatively, and 7 days postoperatively. VAS(visual analogue scale for lumbar and leg pain at 1 day preoperatively, 7 days postoperatively, 3 months postoperatively, 6 months postoperatively, and final follow-up) and ODI (Oswestry disability index at 1 day preoperatively, 3 months postoperatively, 6 months postoperatively and final follow-up) scores were used to compare the clinical efficacy of the two groups. The Bridwell criteria was used to evaluate the intervertebral fusion via CT at 6 months after operation. Results: All the patients were followed up, with average follow-up periods of 16.4±4.7 months in PE-TLIF groupand 17.4±4.9 months in PLIF group. In addition to the operation time, the intraoperative bleeding volume, incision length, postoperative drainage volume and postoperative bedridden time in PE-TLIF group were less than those in PLIF group, and the difference was statistically significant(P<0.05). The operation time in PE-TLIF group was longer than that in the PLIF group, and the difference was statistically significant(P<0.05). The injury degrees of paravertebral muscle evaluated by CK at 1 day and 7 days after operation were significantly lower in PE-TLIF group than those in PLIF group(P<0.05). The VAS score and ODI of patients with lumbar and leg pain after surgery were significantly higher than those before operation(P<0.05). The VAS scores of PE-TLIF group at 1 week and 3 months after operation were significantly lower than those of PLIF group(P<0.05). One patient in PE-TLIF group had transient tendon hyperreflexia immediately after operation, and two patients in PLIF group had superficial incision infections. There was no significant difference inthe complication rate between the two groups(P>0.05). At the 6-month follow-up, the intervertebral fusion of all patients was evaluated. In PE-TLIF group, there were 7 cases of grade Ⅱ fusion and 8 cases of grade Ⅲ fusion. In PLIF group, there were 12 cases of grade Ⅱ fusion and 9 cases of grade Ⅲ fusion. There was no significant difference in the intervertebral fusion rate between the two groups(P>0.05). Conclusions: PE-TLIF technique could obtain comparable effective outcomes as conventional PLIF for the treatment of LSS. The patients with PE-TLIF have less muscle injury, less pain and quicker postoperative rehabilitation, but te operation time in PE-TLIF group was longer.