Clinical efficacy of full surgical area closure technique in percutaneous co-axial large-channel endoscopic lumbar interbody fusion in the treatment of degenerative lumbar spondylolisthesis

English Keywords:Percutaneous co-axial large channel endoscopic fusion  Single segment  Lumbar spondylolisthesis  Full surgical area closure technique

English Abstract:

  【Abstract】 Objectives: To explore the application value of percutaneous co-axial large-channel endoscopic lumbar interbody fusion(PLE-LIF) combined with full surgical area closure technique(FSAC) in the treatment of degenerative lumbar spondylolisthesis. Methods: A retrospective analysis was conducted on 83 patients with single-segment degenerative lumbar spondylolisthesis who underwent PLE-LIF in our hospital from January 2020 to January 2023. Among the patients, 46 received FSAC treatment during operation(FSAC group), and 37 patients did not receive FSAC treatment(N-FSAC group). Both groups of patients were comparable in general information such as gender, age, course of illness, and length of hospital stay(P>0.05). The two groups of patients were followed up for 1 year. The operative time and complications of the two groups of patients were recorded. Both groups of patients were followed up regularly for 1 year. The visual analogue scale(VAS) for low back pain and lower limb pain was recorded on 1d before surgery, 3d after surgery, at 3 months and 1 year after surgery, in addition, the Oswestry disability index(ODI) on 1d before surgery, at 3 months and 1 year after surgery was recorded. X-ray examination was performed at 3 months after operation, and Meyerding grading was used to evaluate the reduction of spondylolisthesis. CT examination was performed at 1 year after operation, and Brantigan criteria were used to evaluate the intervertebral fusion. Results: The operative time in the FSAC group was shorter than that in the N-FSAC group(118.9±10.6min vs 130.6±16.3min, P<0.05). The VAS for low back pain and lower limb pain and ODI at each postoperative time point in the two groups were significantly lower than those before surgery(P<0.05), and there was no statistically significant difference between the two groups at each time point(P>0.05). Two cases of lower limb numbness occurred in the N-FSAC group, while none occurred in the FSAC group; There were 4 cases and 1 case of neuroedema pain in the N-FSAC group and FSAC group, respectively; 1 case in each group respectively had cage displacement, and there was no internal fixation loosening, infection, or dural sac tear in both groups. The incidence rate of intraoperative complications in the N-FSAC group was higher than that in the FSAC group(18.9% vs 4.3%) (P<0.05). One year after surgery, the degree of slippage in both groups of patients improved significantly compared to the conditions before operation(P<0.05), and there was no significant difference between the two groups(P>0.05); Intervertebral fusion occurred in 42 cases in the FSAC group, and 34 cases in the N-FSAC group, and no statistically significant difference was there in the fusion rate(91.3% vs 91.9%) and intervertebral fusion grading between the two groups(P<0.05). Conclusions: PEL-LIF combined with FSAC can shorten the operative time and improve safety in treating single-segment degenerative lumbar spondylolisthesis.