[Minimally invasive transforaminal lumbar interbody fusion for treatment of degenerative lumbar scoliosis stenosis]

Yue Ding, Shisheng He, Hailong Zhang
Chinese Journal of Reparative and Reconstructive Surgery 2013, 27 (4): 404-8

OBJECTIVE: To explore the effectiveness of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for degenerative lumbar scoliosis stenosis by expandable tubular retractor.

METHODS: Between April 2009 and October 2010, 39 patients with degenerative lumbar scoliosis stenosis were treated. Of 39 patients, 20 underwent MI-TLIF (group A) and 19 underwent open surgery (group B). There was no significant differences in gender, age, disease duration, range of lumbar degenerative scoliosis, Cobb angle, Oswestry disability index (ODI), and visual analogue scale (VAS) between 2 groups (P > 0.05). The operation time, intraoperative blood loss, postoperative independently turning over time, postoperative complication rate, Cobb angle, fusion rates, ODI score, and VAS score were compared between 2 groups.

RESULTS: The operation time of group A was significantly longer than that of group B (P < 0.05), and the intraoperative blood loss of group A was significantly less than that of group B (P < 0.05); no significant difference was found in postoperative independently turning over time between 2 groups (t=1.869, P=0.069). The complication rate was 20.0% (4/20) in group A and 26.3% (5/19) in group B, showing no significant difference (Chi2=0.219, P=0.640). All patients were followed up 2 years to 3 years and 6 months (mean, 2.9 years). At last follow-up, the fusion rate of bone graft was 92.9% (78/84) in group A and 95.2% (80/84) in group B, showing no significant difference (Chi2=0.425, P=0.514). According to the Macnab standard for effectiveness evaluation, the results were excellent in 12 cases, good in 6 cases, fair in 1 case, and poor in 1 case, with an excellent and good rate of 90.0% in group A; the results were excellent in 12 cases, good in 5 cases, and fair in 2 cases, with an excellent and good rate of 89.5% in group B; there was no significant difference between 2 groups (Z= -0.258, P=0.835). The postoperative VAS score, ODI score, and Cobb angle were significantly improved when compared with preoperative ones in 2 groups (P < 0.05); and there was no significant differences between 2 groups at 2 weeks after operation and last follow-up (P > 0.05).

CONCLUSION: MI-TLIF by expandable tubular retractor is an available clinical choice in treating degenerative lumbar scoliosis stenosis. It can obtain the same effectiveness as the open surgery.

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