Comparison of clinical outcomes and postoperative multifidus injury between two kinds of transforaminal lumbar interbody fusion in the treatment of lumbar degenerative disease

English Keywords:Transforaminal lumbar interbody fusion  Biportal endoscopy  Wiltse approach  Multifidus atrophy rate

English Abstract:

  【Abstract】 Objectives: To compare and analyze the clinical outcomes and postoperative multifidus injury conditions between unilateral biportal endoscopic transforaminal lumbar interbody fusion(UBE-TLIF) and transforaminal lumbar interbody fusion via the Wiltse approach(W-TLIF) in the treatment of lumbar degenerative disease(LDD). Methods: A retrospective analysis was performed on 48 patients with LDD treated with transforaminal lumbar interbody fusion between January 2020 and February 2021 in our hospital. The patients were divided into the UBE-TLIF group(n=25) and the W-TLIF group(n=23) according to different surgical methods. The UBE-TLIF group consisted of 9 males and 16 females, with an average age of 62.1±12.7 years, while the W-TLIF group consisted of 11 males and 12 females, with an average age of 58.7±14.3 years. The operative time, intraoperative bleeding, postoperative drainage volume, and postoperative hospital stay were compared between the two groups, as well as the visual analogue scale(VAS) for low back and leg pain before surgery, at 1 day, 3 and 6 months, and 1 year after surgery, and Oswestry disability index(ODI) before surgery, at 3 and 6 months, and 1 year after surgery. Modified Macnab criteria were employed to evaluate the clinical efficacy and the Bridwell criteria were used to evaluate the bone graft fusion at one year after surgery. Serum creatine kinase(CK) levels were compared between pre-operation and 1 day after operation, and the atrophy rate and fat infiltration of multifidus muscle were measured and calculated at 3 months, 6 months, and 1 year after operation to evaluate the injury of multifidus muscle. Surgical complications and revision rates were counted and anlyzed between the two groups. Results: The surgery went uneventfully in all the patients. Comparing with the W-TLIF group, the UBE-TLIF group had shorter operative time(159.9±27.5min vs 183.8±27.8min, P＜0.05), less intraoperative bleeding(69.6±44.7ml vs 144.8±77.7ml, P＜0.05), and less postoperative drainage volume(91.4±73.6ml vs 168.9±126.2ml, P＜0.05). The VAS scores and ODI of the two groups at each postoperative time point were all significantly improved than those before operation, respectively(P＜0.05), and no significant difference was found between the two groups at the same time point. One year after the operation, the excellent and good rate of modified Macnab criteria was 88% in the UBE-TLIF group and 87% in the W-TLIF group, with no significant difference(P＞0.05). The fusion rate 1 year after operation was 96% in the UBE-TLIF group and 91.3% in the W-TLIF group, with no significant difference between the two groups(P>0.05). The serum CK levels of the two groups of patients at 1 day after surgery increased significantly than those before operation(P<0.05), and there was no statistical difference between the two groups at the same time points(P>0.05), nor was there significant difference in the rate of multifidus muscle atrophy or fat infiltration at same follow-up time points after surgery(P>0.05). The incidence of surgical complications was 8%(2/25) in the UBE-TLIF group and 13%(3/23) in the W-TLIF group, and there was no significant difference between the two groups(P>0.05). There were no revision cases in either group. Conclusions: Both UBE-TLIF and W-TLIF can achieve satisfactory and similar clinical outcomes in the treatment of LDD with similar intervertebral fusion rate and multifidus atrophy rate, while UBE-TLIF had shorter operative time, less intraoperative blood loss and postoperative drainage volume.