Early clinical efficacy of IntraSPINE non-fusion technique hybrid operation with transforaminal lumbar interbody fusion in the treatment of double-segment lumbar degenerative disease

English Keywords:Lumbar degenerative disease  IntraSPINE  Transforaminal lumbar interbody fusion  Adjacent segment degeneration

English Abstract:

  【Abstract】 Objectives: To investigate the early clinical efficacy of the non-fusion technique of IntraSPINE hybrid operation with transforaminal lumbar interbody fusion(TLIF) in the treatment of double-segment lumbar degenerative disease(LDD). Methods: A retrospective analysis was conducted on the clinical data of 74 patients with double-segment LDD who were treated with IntraSPINE technique combined with TLIF and simple TLIF in our hospital from September 2019 to May 2021. The patients were divided according to surgical modalities into observation group(IntraSPINE technique hybrid operation with TLIF, n=36) and control group(TLIF, n=38). There were no statistically significant differences in gender, age, follow-up period between the two groups(P＞0.05). The visual analogue scale(VAS) of back and leg pain, Japanese Orthopaedic Association(JOA) score, Oswestry disability index(ODI) were recorded before surgery, at 3 months and 6 months postoperatively, and final follow-up. At the same time, lumbar lordosis(LL), range of motion(ROM), and height of intervertebral space of the upper adjacent segment of fusion segment were measured on lateral lumbar X-ray films. And Pfirrmann grade of intervertebral disc of the upper adjacent segment of fusion segment on lumbar MRI were recorded before surgery and at final follow-up. The complications were recorded of the two groups. Results: There were no statistically significant differences in operative time, intraoperative blood loss, or length of hospitalization between the two groups(P＞0.05). The VAS scores of leg pain, JOA scores and ODI at 3 months, 6 months after operation and final follow-up were significantly improved in both groups after surgery(P<0.05), and there was no significant difference between groups at the same time point, respectively(P>0.05). The VAS scores of back pain were significantly improved in both groups after surgery(P<0.05), which in the observation group was more significantly improved than that in the control group at 3 and 6 months postoperatively, and final follow-up(P＜0.05). The LL were significantly improved in both groups after surgery(P<0.05), and there was no significant difference between groups at the same time point(P>0.05). At final follow-up, the intervertebral height of the upper adjacent segment of fusion segment was increased after operation in the observation group(P＜0.05), and decreased after operation in the control group(P＜0.05); the ROM of the upper adjacent segment was not statistically different from that before operation in the fusion segment of observation group(P＞0.05), while it was increased after operation in the control group(P＜0.05). There were statistically significant differences in the Pfirrmann grade of intervertebral disc of the upper adjacent segment of the fusion segment between the two groups at final follow-up(P＜0.05). No patients in either group had severe complications, such as nerve root injury, dural tears, internal fixation system fracture, or displacement of the interbody device. Conclusions: IntraSPINE non-fusion technique combined with TLIF can achieve satisfactory early outcomes in the treatment of double-segment LDD, significantly improve low back pain than TLIF, and delay ASD in early stage.