The effect of microscope assisted fixed channel minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) in the treatment of double segment lumbar spondylolisthesis

English Keywords:Microscope  Fixed channel  Minimally invasive transforaminal lumbar interbody fusion surgery  Double segment lumbar spondylolisthesis  Lumbar stability  Complication

English Abstract:

  【Abstract】 Objectives: To observe the efficacy of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) under microscope via fixed channel in the treatment of patients with double segment lumbar spondylolisthesis, and analyze its impact on lumbar stability and complications. Methods: 108 patients with bilateral lumbar spondylolisthesis admitted and treated in our hospital from January 2022 to January 2024 were selected as the study subjects in this prospective study. Using a random number table, the patients were divided into two groups: conventional group(n=53, 29 males and 24 females, 53.23±4.30 years old) and microscope group(n=55, 28 males and 27 females, 53.45±4.28 years old). The patients in the conventional group underwent MIS-TLIF via fixed channel through conventional approach, and patients in the microscope group received MIS-TLIF via fixed channel under microscope. There was no significant difference between the two groups in baseline data(P>0.05). The drainage volume and bleeding volume, fluoroscopy frequency, operative time and the occurrence of complications of the two groups of patients were recorded and compared. The clinical efficacy was evaluated using the modified MacNab scoring standard 6 months after operation. X-ray examinations were performed before operation, 3 months and 6 months after operation, and the height of intervertebral space and spondylolisthesis angle were measured and compared to evaluate the stability of the lumbar spine; During the same period, Japanese Orthopaedic Association(JOA) score and Oswestry disability index(ODI) were used to evaluate and compare the lumbar dysfunction of the two groups of patients. The levels of C-reactive protein(CRP), tumor necrosis factor-α(TNF-α), and creatine kinase(CK) in the two groups of patients were detected and compared by enzyme-linked immunosorbent assay(ELISA) before operation, 3d, and 6d after operation to evaluate inflammatory factors. Results: Compared with the conventional group, the total excellent and good rate of the microscope group was higher(78.18% vs 60.38%, P<0.05), and the drainage and bleeding volume were less(98.03±9.77mL vs 120.73±13.52mL and 113.42±11.03mL vs 142.69±15.72mL, P<0.05), fluoroscopy frequency was fewer(6.71±0.58 vs 8.36±0.72, P<0.05), operative time was shorter(123.59±13.58min vs 157.42±16.89min, P<0.05), and complication rate were lower （3.64% vs 16.98%, P<0.05). Before operation, the intervertebral space height, slip angle, JOA score, and ODI were comparable between the two groups(P>0.05). At 3 and 6 months after operation, the intervertebral space height and JOA score increased, and the microscope group was higher(Postoperative 3 months: 8.03±0.80mm vs 6.12±0.72mm, 15.28±1.24 points vs 11.14±1.02 points; Postoperative 6 months, 11.02±1.27mm vs 9.23±0.95mm, 21.72±2.14 points vs 18.03±1.60 points, P<0.05), while the slip angle and ODI score decreased, and the microscope group was lower(Postoperative 3 months: 2.41°±0.28° vs 3.01°±0.32°, 32.14±2.96 points vs 36.01±3.14 points;Postoperative 6 months: 1.60°±0.16° vs 2.03°±0.25°, 24.77±2.15 points vs 28.01±2.60 points, P<0.05). Before operation and on 6d after operation, the levels of CRP, TNF-α, and CK were comparable between the two groups(P>0.05); 3d after operation, the levels of CRP, TNF-α and CK in the microscope group were lower(6.01±0.75mg/L vs 8.23±0.93mg/L, 23.01±2.01pg/mL vs 29.36±2.57pg/mL, 170.43±19.01U/L vs 205.72±30.89U/L, P<0.05). Conclusions: Microscopically-assisted MIS-TLIF demonstrates excellent short-term efficacy in treating two-segment lumbar spondylolisthesis, which can significantly reduce complication risks. It effectively enhances postoperative lumbar stability, promotes functional recovery, and suppresses early inflammatory responses, making it a clinically valuable treatment option.