[Effectiveness of minimally invasive transforaminal lumbar interbody fusion assisted with microscope in treatment of lumbar degenerative disease]

Wenzhi Zhang, Liqun Duan, Xifu Shang, Xiang Xu, Yefeng Hu, Rui He
Chinese Journal of Reparative and Reconstructive Surgery 2013, 27 (3): 268-73

OBJECTIVE: To investigate the effectiveness of minimally invasive transforaminal lumbar interbody fusion (TLIF) assisted with microscope for lumbar degenerative disease.

METHODS: Retrospective analysis was made on the clinical data of 82 patients with lumbar degenerative disease (minimally invasive group) undergoing minimally invasive TLIF assisted with microscope between January 2010 and June 2011, which was compared with those of 76 patients (traditional group) undergoing traditional open TLIF. There was no significant difference in age, gender, disease duration, disease type, lesion level, preoperative visual analogue scale (VAS), and preoperative Oswestry disability index (ODI) between 2 groups (P > 0.05). The perioperative related parameters, radiography index, and effectiveness were documented and compared.

RESULTS: There was no significant difference in operation time and intraoperative radiological exposure time between 2 groups (P > 0.05), but intraoperative blood loss and postoperative drainage volume in the minimally invasive group were significantly less than those in the traditional group (P < 0.05). Dural tear occurred in 2 patients of the traditional group. Superficial infection of incision occurred in 1 case in each group, respectively; and primary healing of incision was obtained in the other patients. All patients were followed up 12-28 months (mean, 18 months). No failure of internal fixation occurred. Radiological analysis showed that the bone graft fusion rate was 96.1% (73/76) in the traditional group and 95.1% (78/82) in the minimally invasive group at last follow-up, showing no significant difference (chi2 = 0.012 2, P = 0.912 0). The postoperative ODI and VAS score were significantly improved when compared with preoperative ones in 2 groups (P < 0.05); the ODI of the minimally invasive group were significantly better than those of the traditional group at 3 months (t = -11.941 1, P = 0.000 0), and the VAS score of the minimally invasive group was significantly lower than that of the traditional group at 1 day and 3 months (P < 0.05); but no significant difference was found in ODI and VAS score between 2 groups at 1 year and last follow-up (P > 0.05).

CONCLUSION: Minimally invasive TLIF is an effective method to treat lumbar degenerative disease. This procedure is safe and reliable because it has less injury, less blood loss, and milder pain than the traditional open TLIF, and the short-term effectiveness is comparable in 2 procedures.

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