Efficacy of bilateral mini-open Wiltse approach transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases in the elderly

English Keywords:Lumbar degenerative disease  Minimally invasive transforaminal lumbar interbody fusion  Percutaneous pedicle screw placement  Wiltse approach

English Abstract:

  【Abstract】 Objectives: To investigate the clinical efficacy of bilateral mini-open Wiltse approach transforaminal lumbar interbody fusion(MO-TLIF) in the treatment of degenerative lumbar diseases in the elderly. Methods: A retrospective analysis was conducted on 62 elderly patients with single-segment degenerative lumbar diseases who underwent MO-TLIF or minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) inthe First Affiliated Hospital of Naval Medical University between September 2017 and August 2020. Among them, 37 were male and 25 were female, aged 68.0±5.5 years. The patients were divided into the MO-TLIF group(32 cases) and the MIS-TLIF group(30 cases). There were no statistically significant differences between the two groups in terms of gender ratio, age, body mass index(BMI), surgical segment, disease duration, or follow-up time(P>0.05). The differences between the two groups were compared in terms of operative time, intraoperative blood loss, intraoperative fluoroscopy, postoperative wound drainage, time to ambulation, hospital stay, complications, and fusion rate. The visual analogue scale(VAS), lumbar Japanese Orthopedic Association(JOA) scores, and Oswestry disability index(ODI) before surgery, at 3 months postoperatively, and at the final follow-up were recorded and compared. Results: The two groups of patients all successfully completed the surgery without significant surgery-related complications. There were no statistically significant differences between the MO-TLIF and MIS-TLIF groups in terms of intraoperative blood loss(80.3±25.1mL vs. 72.3±21.8mL), postoperative wound drainage volume(30.7±10.2mL vs. 29.3±9.0mL), or hospital stay(5.4±0.9d vs. 5.4±0.8d)(P>0.05). Compared with the MIS-TLIF group, the MO-TLIF group had shorter operative time(90.8±8.8min vs. 98.3±8.0min, P=0.001) and fewer number of intraoperative fluoroscopy(4.7±0.7 times vs. 7.2±1.4 times, P<0.001). Both groups showed significant improvement in low back pain VAS score, lumbar JOA score, and ODI at postoperative 3 months and final follow-up compared with preoperative values(P<0.001), but there were no statistically significant differences between the two groups at the same time points(P>0.05). At the final follow-up, no internal fixation-related complications such as screw or rod breakage were observed in both groups, and all the cases achieved bone fusion. Conclusions: Bilateral MO-TLIF can achieve good therapeutic outcomes in treating single-segment degenerative lumbar diseases, which can reduce intraoperative fluoroscopy frequency and shorten operative time comparing with MIS-TLIF.