Clinical outcomes and changes in paraspinal muscles after posterior lumbar interbody fusion(PLIF) and percutaneous endoscopic transforaminal lumbar interbody fusion(PE-TLIF) in patients with single-segment lumbar spinal stenosis

English Keywords:Lumbar spinal stenosis  Percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF)  Paraspinal muscles

English Abstract:

  【Abstract】 Objectives: To compare the clinical outcomes of posterior lumbar interbody fusion(PLIF) and percutaneous endoscopic transforaminal lumbar interbody fusion(PE-TLIF) in treating single-segment lumbar spinal stenosis and their effects on the paraspinal muscles. Methods: This prospective study included 52 patients with L4/5 lumbar spinal stenosis treated in our hospital between January 2019 and January 2022. Among the patients, 22 were in the PLIF group(10 females, 12 males, aged 60.2±10.3 years old) and 30 were in the PE-TLIF group(14 females, 16 males, aged 60.4±12.3 years old). The two groups were compared of the perioperative indicators including operative time, intraoperative blood loss, postoperative drainage volume, and postoperative bed rest time; And paraspinal muscles related indicators such as creatine kinase(CK) before operation and at postoperative 1d and 1 week, and multifidus muscle(MF) cross-sectional area(CSA), fatty infiltration(FI) score, and muscle CT density before operation and at postoperative 6 and 12 months; Preoperative, postoperative 1d, 1 week, 6 months and 12 months′ visual analogue scale on low back pain(VAS-LBP), visual analogue scale on leg pain(VAS-LP), and Oswestry disability index(ODI). The complications of the two groups were analyzed and compared, and at 12 months after operation, the fusion rate was evaluated and compared according to the Bridwell criteria. Results: PE-TLIF group was different from PLIF group significantly in operative time(211.2±38.5min vs 98.9±31.6min, P=0.000), postoperative bed rest time(25.9±8.3h vs 52.4±14.8h, P=0.001), intraoperative blood loss(112.8±79.6mL vs 232.5±122.5mL, P=0.002), and postoperative drainage volume(46.5±28.2mL vs 283.6±142.1mL, P=0.000). The MF CSA before operation, at 6 and 12 months after operation was not significantly different between PE-TLIF group and PLIF group(P＞0.05), and there was no statistical difference between pre-operation MF CSA and MF CSA 6 months and 12 months after surgery within either group(P>0.05). The PE-TLIF group was not significantly different from the PLIF group in MF FI score before operation and at 6 months after operation(P＞0.05), while at 12 months after operation, the PE-TLIF group was lower than the PLIF group[3.0(2.8, 3.0) vs 3.0(3.0, 4.0), P=0.031]. There was no statistical difference in MF FI score between pre-operation, 6 months after surgery and 12 months after surgery within the PE-TLIF group(P>0.05). And, there was no statistical difference in MF FI score between pre-operation and 6 months after surgery in the PLIF group(P>0.05), while statistically significant difference was found between pre-operation and 12 months after surgery in the PLIF group[3.0(2.0, 3.3) vs 3.0(3.0, 4.0), P=0.016]. The difference in preoperative MF CT density and MF CT density 6 months after operation between the two groups was not statistically significant(P＞0.05). At the 12-month follow-up, MF CT density in the PLIF group was significantly lower than that in the PE-TLIF group[30.5(28.5, 32.1)HU vs 34.2(31.8, 36.9)HU, P=0.000]. There was no significant difference in MF density between pre-operation, and 6 months after surgery or 12 months after surgery within the PE-TLIF group(P>0.05). And there was no statistically significant difference in MF density between pre-operation and 6 months after surgery in the PLIF group(P=0.516), but there was a statistical difference between pre-operation and 12 months after surgery within the PLIF group[34.6(30.5, 36.4)HU vs 30.5(28.5, 32.5)HU, P=0.017). The PE-TLIF group and PLIF group was not significantly different in preoperative CK(P=0.712), while the PE-TLIF group was lower on 1d and 7d after operation(P<0.05). VAS-LBP, VAS-LP, and ODI at all follow-up time points after surgery of both groups were better compared to those before surgery(P<0.05). The VAS-LBP of the PE-TLIF group was better than that of the PLIF group at 1d and 1 week after surgery(P<0.05). There was no statistical difference in VAS-LBP between the PLIF and PE-TLIF at 6 months or 12 months after surgery. There was no statistical difference in VAS-LP or ODI between the PLIF and PE-TLIF at any follow-up time point(P>0.05). There was no significant difference in the incidence of postoperative complications between the two groups(P=0.379). And there was no significant difference in the fusion rate between the two groups(P=0.877). Conclusions: PE-TLIF can achieve similar clinical outcomes as traditional PLIF in the treatment of single-segment lumbar spinal stenosis, which reduces effects on paraspinal muscles and alleviate operative trauma.