Comparison of the efficacies of two operational sequences of endoscopic posterolateral lumbar interbody fusion in the treatment of lumbar degenerative diseases

English Keywords:Lumbar degenerative diseases  Spinal endoscopy  Lumbar fusion  Operation sequence

English Abstract:

  【Abstract】 Objectives: To compare the clinical effects of two operational sequences of endoscopic posterolateral lumbar interbody fusion(Endo-PLIF) in the treatment of lumbar degenerative diseases(LDD). Methods: The data of 64 LDD patients treated with full-endoscopic lumbar fusion in our hospital from October 2019 to October 2021 were analyzed retrospectively. There were 29 males and 35 females, aged 40-79 years(59.7±13.5 years). The course of disease was 1-10 years(3.1±1.6 years) and body mass index(BMI) was 10-31kg/m2(25.3±3.1kg/m2). Among the patients, 20 were of degenerative lumbar spondylolisthesis with spinal canal stenosis, 21 were of lumbar disc herniation with degenerative spinal canal stenosis, 18 were of degenerative spinal canal stenosis with lumbar instability, and 5 were of degenerative scoliosis with spinal canal stenosis; And 59 cases were of single segment lesion and 5 cases were of double segment lesion. Of the patients, 38 cases were treated with the operational sequence of "Locating and marking of diseased segments under C-arm X-ray machine-Inserting nail guide wire-Endoscopic decompression and bone graft fusion-Percutaneous nail placement"(group A), and the other 26 cases were treated with sequence of "Locating and marking of diseased segments under C-arm X-ray machine-Endoscopic decompression and bone graft fusion-Inserting nail guide wire-Percutaneous nail placement"(group B). There was no significant difference in age, gender, BMI, course of disease, and lesion segment between the two groups(P>0.05). The perioperative indexes(operative time, intraoperative fluoroscopy times, intraoperative blood loss, postoperative drainage volume, postoperative bed rest time, hospital stay, and complications), preoperative and postoperative 1 year′s visual analogue scale(VAS), Oswestry disability index(ODI), lumbar lordosis angle, height of intervertebral space, surgical segmental lordosis angle, as well as the accuracy of pedicle screw placement according to the Gertzbein-Robbins criteria were compared between the two groups. Intervertebral fusion status at 1 year after operation was observed. Results: There were significant differences in operative time and intraoperative fluoroscopy times between the two groups (group A 189.6±35.4min, 13.1±3.5 times vs group B 210.4 ±33.5min, 15.9±5.4 times, P<0.05), while there was no significant difference in intraoperative blood loss, postoperative drainage volume, postoperative bed rest time, hospital stay and the incidence of complications in group A(57.5±16.3ml, 110.8±55.0ml, 2.0±1.2d, 7.3±1.2d, and 7.89%) and group B(60.4±18.8ml, 119.8±49.0ml, 2.2±0.9d, 7.4±2.2d, and 19.23%)(P>0.05). The excellent and good rate of nail placement in group A(91.8%) was better than that in group B(77.8%) (P<0.05). The postoperative 1 year′s VAS scores(group A 1.9±1.0, group B 1.8±1.0) and ODI[group A (27.6±7.2)%, group B (26.8±6.7)%] were significantly improved compared with the VAS(group A 6.7±1.5, group B 6.4±1.6) and ODI[group A (72.4±11.2.2)%, group B (73.5±13.6)%] preoperatively(P<0.05), and there was no significant difference between the two groups at the same time points(P>0.05). The lumbar lordosis angle, intervertebral space height, and surgical segmental lordosis angle in group A(36.2°±6.5°, 15.8±2.4mm, and 11.2° ±1.1°) and group B(32.9°±6.5°, 15.3±2.0mm, 11.2°±1.1°) at 1 year after operation were significantly different from those before operation(group A, 21.6°±6.5°, 12.6±2.0mm, 8.5°±1.9°; group B, 22.2°±7.7°, 12.3±2.0mm, 8.0°±1.9°)(P<0.05), and there was no significant difference between the two groups at the same time points(P>0.05). The fusion rate of both groups at 1 year after operation was all 100% in both groups. Conclusions: The two operational sequences of Endo-PLIF are both effective in the treatment of LDD. However, the operational sequence of "Locating and marking of diseased segments under C-arm X-ray machine-Inserting nail guide wire-Endoscopic decompression and bone graft fusion-Percutaneous nail placement" is superior in shorter operative time, less fluoroscopy times, and higher excellent and good rate of screw placement.