COMPARISON OF SHORT-TERM EFFECTIVENESS BETWEEN MINIMALLY INVASIVE SURGERY- AND OPEN- TRANSFORAMINAL LUMBAR INTERBODY FUSION FOR SINGLE-LEVEL LUMBAR DEGENERATIVE DISEASE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Jin , KONG Qingquan , SONG Yueming , LIU Hao , ZENG Jiancheng.

Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China. Corresponding author: KONG Qingquan, E-mail: kongspine@126.com;

Corresponding author：

Keywords：

Single-level lumbar degenerative disease; Transforaminal lumbar interbody fusion; Minimally invasive surgery; Open surgery

DOI：

10.7507/1002-1892.20130061

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Objective To compare the short-term effectiveness of minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF) versus open-TLIF in treatment of single-level lumbar degenerative disease. Methods Between February 2010 and February 2011, 147 patients with single-level lumbar degenerative diseases underwent open-TLIF in 104 cases (open-TLIF group) and MIS-TLIF in 43 cases (MIS-TLIF group), and the clinical data were analyzed retrospectively. There was no significant difference in gender, age, disease type, lesion level, disease duration, preoperative visual analogue scale (VAS), and preoperative Oswestry disability index (ODI) between 2 groups (P gt; 0.05). The operation time, intraoperative radiological exposure time, intra- and post-operative blood loss, postoperative hospitalization time, and postoperative complications were compared between 2 groups. The VAS score and ODI were observed during follow-up. The imaging examination was done to observe the bone graft fusion and the locations of internal fixator and Cage. Results There was no significant difference in operation time between 2 groups (t=0.402, P=0.688); MIS-TLIF group had a decreased intra- and post-operative blood loss, shortened postoperative hospitalization time, and increased intraoperative radiological exposure time, showing significant differences when compared with open-TLIF group (P lt; 0.05). Cerebrospinal fluid leakage (2 cases) and superficial infection of incision (2 cases) occurred after operation in open-TLIF group, with a complication incidence of 3.8% (4/104); dorsal root ganglion stimulation symptom (3 cases) occurred in MIS-TLIF group, with a complication incidence of 7.0% (3/43); there was no significant difference in the complication incidence between 2 groups (χ2=0.657, P=0.417). The patients were followed up 18-26 months (mean, 21 months) in MIS-TLIF group, and 18-28 months (mean, 23 months) in open-TLIF group. The VAS scores and ODI of 2 groups at each time point after operation were significantly improved when compared with those before operation (P lt; 0.05). There was no significant difference in VAS score between 2 groups at discharge and 3 months after operation (P gt; 0.05); VAS score of MIS-TLIF group was significantly lower than that of open-TLIF group at last follow-up (t= — 2.022, P=0.047). At 3 months and last follow-up, no significant difference was found in the ODI between 2 groups (P gt; 0.05). The imaging examination showed good positions of Cage and internal fixator, and bone graft fusion in 2 groups. Conclusion The short-term effectiveness of MIS-TLIF and open-TLIF for single-level degenerative lumbar diseases was similar. MIS-TLIF has the advantages of less invasion and quick recovery, but the long-term effectiveness needs more observation.

Citation： YANG Jin,KONG Qingquan,SONG Yueming,LIU Hao,ZENG Jiancheng.. COMPARISON OF SHORT-TERM EFFECTIVENESS BETWEEN MINIMALLY INVASIVE SURGERY- AND OPEN- TRANSFORAMINAL LUMBAR INTERBODY FUSION FOR SINGLE-LEVEL LUMBAR DEGENERATIVE DISEASE. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(3): 262-267. doi: 10.7507/1002-1892.20130061 Copy

1.	11 Mummaneni PV, Haid RW, Rodts GE. Lumbar interbody fusion: state-of-the-art technical advances. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine, 2004, 1(1): 24-30. 12 Holly LT, Schwender JD, Rouben DP, et al. Minimally invasive transforaminal lumbar interbody fusion: indications, technique, and complications. Neurosurg Focus, 2006, 20(3): E6. 13 Mummaneni PV, Rodts GE Jr. The mini-open transforaminal lumbar interbody fusion. Neurosurgery, 2005, 57(4 Suppl): 256-261. 14 蒋淳, 姜小幸, 冯振洲, 等. 单侧置钉经椎间孔椎体融合术结合经椎板的关节突螺钉治疗退行性腰椎疾病. 中华临床医学, 2010, 17(6): 856-858.
2.	15 Lee P, Fessler RG. Perioperative and postoperative complications of single-level minimally invasive transforaminal lumbar interbody fusion in elderly adults. J Clin Neurosci, 2012, 19(1): 111-114. 16 O’Toole JE, Eichholz KM, Fessler RG. Surgical site infection rates after minimally invasive spinal surgery. J Neurosurg Spine, 2009, 11(4): 471-476.
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5.
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7.	Kawaguchi Y, Matsui H, Tsuji H. Back muscle injury after posterior lumbar spine surgery. A histologic and enzymatic analysis. Spine (Phila Pa 1976), 1996, 21(8): 941-944.
8.	Styf JR, Willén J. The effects of external compression by three different retractors on pressure in the erector spine muscles during and after posterior lumbar spine surgery in humans. Spine (Phila Pa 1976), 1998, 23(3): 354-358.
9.	Lee SH, Choi WG, Lim SR, et al. Minimally invasive anterior lumbar interody fusion followed by percutaneous pedicle screw fixation for isthmic spondylolisthesis. Spine J, 2004, 4(6): 644-649.
10.	Arts MP, Nieborg A, Brand R, et al. Serum creatine phosphokinase as an indicator of muscle injury after various spinal and nonspinal surgical procedures. J Neurosurg Spine, 2007, 7(3): 282-286.
11.	Humphreys SC, Hodges SD, Patwardhan AG, et al. Comparison of posterior and transforaminal approaches to lumbar interbody fusion. Spine (Phila Pa 1976), 2001, 26(5): 567-571.
12.	Foley KT, Lefkowitz MA. Advances in minimally invasive spine surgery. Clin Neurosurg, 2002, 49: 499-517.
13.	Wiltse LL, Bateman JG, Hutchinson RH, et al. The paraspinal sacrospinalis-splitting approach to the lumbar spine. J Bone Joint Surg (Am), 1968, 50(5): 919-926.
14.	Brantigan JW, Steffee AD. A carbon fiber implant to aid interbody lumbar fusion. Two-years clinical results in the first 26 patients. Spine (Phila Pa 1976), 1993, 18(14): 2106-2117.
15.	Fessler RG. Minimally invasive percutaneous posterior lumbar interbody fusion. Neurosurgery, 2003, 52(6): 1512.
16.	Foley KT, Gupta SK. Percutaneous pedicle screw fixation of the lumbar spine: preliminary clinical results. J Neurosurg, 2002, 97(1 Suppl): 7-12.

1. 11 Mummaneni PV, Haid RW, Rodts GE. Lumbar interbody fusion: state-of-the-art technical advances. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine, 2004, 1(1): 24-30. 12 Holly LT, Schwender JD, Rouben DP, et al. Minimally invasive transforaminal lumbar interbody fusion: indications, technique, and complications. Neurosurg Focus, 2006, 20(3): E6. 13 Mummaneni PV, Rodts GE Jr. The mini-open transforaminal lumbar interbody fusion. Neurosurgery, 2005, 57(4 Suppl): 256-261. 14 蒋淳, 姜小幸, 冯振洲, 等. 单侧置钉经椎间孔椎体融合术结合经椎板的关节突螺钉治疗退行性腰椎疾病. 中华临床医学, 2010, 17(6): 856-858.
2. 15 Lee P, Fessler RG. Perioperative and postoperative complications of single-level minimally invasive transforaminal lumbar interbody fusion in elderly adults. J Clin Neurosci, 2012, 19(1): 111-114. 16 O’Toole JE, Eichholz KM, Fessler RG. Surgical site infection rates after minimally invasive spinal surgery. J Neurosurg Spine, 2009, 11(4): 471-476.
3.
4.
5.
6.
7. Kawaguchi Y, Matsui H, Tsuji H. Back muscle injury after posterior lumbar spine surgery. A histologic and enzymatic analysis. Spine (Phila Pa 1976), 1996, 21(8): 941-944.
8. Styf JR, Willén J. The effects of external compression by three different retractors on pressure in the erector spine muscles during and after posterior lumbar spine surgery in humans. Spine (Phila Pa 1976), 1998, 23(3): 354-358.
9. Lee SH, Choi WG, Lim SR, et al. Minimally invasive anterior lumbar interody fusion followed by percutaneous pedicle screw fixation for isthmic spondylolisthesis. Spine J, 2004, 4(6): 644-649.
10. Arts MP, Nieborg A, Brand R, et al. Serum creatine phosphokinase as an indicator of muscle injury after various spinal and nonspinal surgical procedures. J Neurosurg Spine, 2007, 7(3): 282-286.
11. Humphreys SC, Hodges SD, Patwardhan AG, et al. Comparison of posterior and transforaminal approaches to lumbar interbody fusion. Spine (Phila Pa 1976), 2001, 26(5): 567-571.
12. Foley KT, Lefkowitz MA. Advances in minimally invasive spine surgery. Clin Neurosurg, 2002, 49: 499-517.
13. Wiltse LL, Bateman JG, Hutchinson RH, et al. The paraspinal sacrospinalis-splitting approach to the lumbar spine. J Bone Joint Surg (Am), 1968, 50(5): 919-926.
14. Brantigan JW, Steffee AD. A carbon fiber implant to aid interbody lumbar fusion. Two-years clinical results in the first 26 patients. Spine (Phila Pa 1976), 1993, 18(14): 2106-2117.
15. Fessler RG. Minimally invasive percutaneous posterior lumbar interbody fusion. Neurosurgery, 2003, 52(6): 1512.
16. Foley KT, Gupta SK. Percutaneous pedicle screw fixation of the lumbar spine: preliminary clinical results. J Neurosurg, 2002, 97(1 Suppl): 7-12.

Chinese Journal of Reparative and Reconstructive Surgery

COMPARISON OF SHORT-TERM EFFECTIVENESS BETWEEN MINIMALLY INVASIVE SURGERY- AND OPEN- TRANSFORAMINAL LUMBAR INTERBODY FUSION FOR SINGLE-LEVEL LUMBAR DEGENERATIVE DISEASE

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