Clinical effect of posterior lumbar interbody fusion under Delta large channel endoscope on degenerative lumbar diseases

English Keywords:Degenerative lumbar disease  Posterior endoscopic fusion  Delta large channel endoscope  Pain  Lumbar function

English Abstract:

  【Abstract】 Objectives: To explore the curative effect of posterior lumbar interbody fusion under Delta large channel endoscope(Endo-PLIF) on degenerative lumbar diseases. Methods: A retrospective analysis was performed on the case data of 80 patients with degenerative lumbar diseases treated in the hospital between September 2021 and September 2022. The patients were divided into observation group(38 cases, 17 males and 21 females, aged 61.0±4.9 years) and control group(42 cases, 20 males and 22 females, aged 60.5±5.4 years). The patients in the observation group were treated with Endo-PLIF, while those in the control group were treated with open posterior lumbar interbody fusion. The intraoperative blood loss, postoperative drainage volume, operative time, length of surgical incisions, length of hospital stays, and complications of both groups of patients were recorded and compared. The visual analogue scale(VAS) was used to evaluate patients′ low back pain and Oswestry disability index(ODI) was used to assess the lumbar function before surgery, at 1 week, 1 month, 3 months and 6 months after surgery. The patients were also evaluated using the modified Macnab criteria for treatment efficacy, and using the Bridwell criteria for assessing the segmental fusion within 1 year after surgery. Results: The intraoperative blood loss and postoperative drainage volume in the observation group were 88.46±10.98mL and 159.73±18.42mL, lower than those in the control group 112.99±12.01mL and 201.36±23.06mL(P<0.05); The lengths of surgical incision and hospital stays were 1.54±0.36cm and 6.79±1.22d, which were shorter in the observation group than those in the control group of 5.43±1.01cm and 8.03±1.43d(P<0.05); And the operative time was longer in the observation group than that in the control group(162.33±19.57min vs 126.87±23.15min, P<0.05). All the patients were followed up for 15-40 months(19.0±6.3 months). At 1 week and 1 month after surgery, VAS scores in observation group were 2.46±0.51 and 1.21±0.38, and ODI were (17.84±4.15)% and (10.69±1.88)%, which were lower than those in the control group[VAS score: 3.68±0.62, 2.01±0.41; ODI: (21.33±3.48)%, (12.33±2.17)%, P<0.05]. At 3 months and 6 months after surgery, there was no significant difference in VAS scores between the two groups(P>0.05). There was neither significant difference in the excellent and good rate of treatment (92.11% vs 85.71%, P=0.487) nor significant difference in fusion grading between the observation group and control group(Z=0.487, P=0.624). No significant difference was noticed in the incidence of postoperative complications between observation group and control group(5.26% vs 9.52%, P=0.678). Conclusions: The curative effect of Endo-PLIF is satisfactory on degenerative lumbar diseases, which can reduce intraoperative blood loss, shorten surgical incision and hospitalization time, improve short-term pain and lumbar function faster, with good safety.