Preliminary clinical efficacy of posterolateral endoscopic lumbar interbody fusion for lumbar spondylolisthesis

English Keywords:Spinal endoscope  Lumbar interbody fusion  Minimally invasive  Lumbar spondylolisthesis

English Abstract:

  【Abstract】 Objective: To analyze the safety and early efficacy of posterolateral endoscopic lumbar interbody fusion(PELIF) in the treatment of lumbar spondylolisthesis. Methods: Data of 22 patients with lumbar spondylolisthesis underwent PELIF admitted to our department from March 2018 to September 2019 were retrospective reviewed. There were 9 males and 13 females, averaged 55.1±11.3 years old (36 to 77). Among them, there were 21 cases of single-level spondylolisthesis and 1 case of double-level spondylolisthesis. The operation time was 170.7±23.4min, and the postoperative follow-up period was 20.3±3.0 months(12-29 months). The clinical outcomes were assessed by visual analogue scale (VAS) and Oswestry disability index (ODI) before surgery, 2 weeks after surgery, 6 months after surgery, and at final follow-up. X-rays were taken preoperatively, 2 weeks postoperatively, and at final follow-up to measure the height of intervertebral space, physiological angle, and the rate of lumbar spondylolisthesis at surgical segments. The fusion rate was evaluated by CT one year postoperatively. Perioperative complications were also recorded. Results: The VAS of back pain was 7.14±0.83 points before operation, 3.23±0.69 points at 2 weeks postoperatively, 2.91±0.53 points at 6 months after operation, and 2.32±0.57 points at final follow-up. The leg VAS was 6.82±0.80 before operation, 2.91±0.61 at 2 weeks postoperatively, 2.60±0.50 at 6 months postoperatively, and 2.28±0.63 at final follow-up. The ODI was (65.60±10.28)% preoperatively, (19.59±6.54)% at 2 weeks postoperatively, (15.95±5.27)% at 6 months postoperatively, and (13.45±3.63)% at final follow-up. The back pain and leg pain VAS scores, and ODI at 2-week, 6-month, and final follow-up were significantly lower than those before surgery, and the differences were statistically significant(P<0.05). The height of the intervertebral space was 9.23±2.11mm at pre-op, 11.77±2.07mm at 2 weeks postoperatively, and 11.04±1.67mmat final follow-up(P<0.05). The lordotic angle was 12.39°±8.42° before operation, 15.17°±8.90° at 2 weeks postoperatively, and 15.09°±6.44° at final follow-up(P<0.05). The lumbar spondylolisthesis rate was improved from (39.70±6.01)% preoperatively to(14.50±2.88)% at final follow-up(P<0.05). The reduction rate of spondylolisthesis at final follow-up was 59.9%. At 12-month postoperatively, all cases achieved bony fusion. In this group of cases, there was one case of nerve root sleeve injury and one case of transient psoas major muscle weakness cured after conservative treatment. No infection, hematoma, internal fixation failure and other complications occurred. Conclusions: PELIF is highly safety in the treatment of lumbar spondylolisthesis, and the short-term clinical effect is satisfactory. Yet, its long-term effect still needs further follow-up observation.