Objective:To analyze the correlation between the amplitude changes of motor evoked potential(MEP),the 3D volume changes of spinal canal measuring by postoperative CT and the improvement rate of clinical symptoms after...Objective:To analyze the correlation between the amplitude changes of motor evoked potential(MEP),the 3D volume changes of spinal canal measuring by postoperative CT and the improvement rate of clinical symptoms after the spinal canal decompression in minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF),and to explore the predictive value of the changes of both MEP amplitude and spinal canal volume in the assessment of long-term clinical prognosis in MIS-TLIF.Methods:A retrospective study of 68 patients with L4/5 spinal stenosis treated with MIS-TLIF was performed.The changes of both intraoperative MEP amplitude and 3D spinal canal volume during the spinal canal decompression,as well as the visual analogue scale(VAS)and Oswestry dysfunction index(ODI)scores in the long-term follow-up were all recorded.Results:The values of intraoperative MEP amplitude was 159.04%higher in 68 patients with MIS-TLIF after spinal canal decompression(P<0.01).The 3 postoperative 3D spinal canal volume(4.89±1.27)cm increased by 31.22%in comparison 3 with preoperative date(3.78±1.08)cm(P<0.01).The VAS and ODI scores were improved to 78.55%and 80.60%,respectively at the last follow-up(P<0.01).The improvement rate of MEP amplitude on the decompression side was positively correlated with the improvement rate of postoperative spinal canal volume(r=0.272,P=0.025).The improvement rate of postoperative spinal canal volume was positively correlated with the improvement rate of VAS and ODI at the last follow-up(r=0.656,r=0.490,P<0.01).Moreover,the improvement rate of MEP amplitude on the decompression side was also positively correlated with the improvement rate of VAS and ODI at the last follow-up(r=0.322 and 0.235,respectively,P<0.05).Conclusion:The increase of MEP amplitude after spinal canal decompression in patients with lumbar spinal stenosis treated by MIS-TLIF was closely correlated with both of the increase of spinal canal volume and the improvement of clinical symptoms.Therefore,MEP amplitude monitoring was not only the one of the important monitoring methods for predicting the prognosis of MIS-TLIF but also the reliably predictive value in the long-term clinical prognosis in MIS-TLIF.展开更多
Background: For decades, traditional open surgical techniques were used to treat lumbar disc herniation and lumbar canal stenosis (LCS). However, seeking for better outcomes for patients and avoiding extensive bony lo...Background: For decades, traditional open surgical techniques were used to treat lumbar disc herniation and lumbar canal stenosis (LCS). However, seeking for better outcomes for patients and avoiding extensive bony loss with its sequences had raised minimally invasive technique for treating these disorders as an alternative surgery. Methods: This is a retrospective study in which 54 patients of LCS were operated upon via unilateral minimally invasive technique to decompress the canal in a 360 degrees fashion through laminotomy, deroofing of opposite laminar side, sublaminar ligamintectomy, bilateral foraminotomies and discectomy. We used VAS scores and ODI to assess clinical outcomes with a period of one year follow-up. Results: Our results demonstrated that minimally invasive techniques for treating these disorders are effective procedures. Minimally invasive 360 degrees decompression for treating LCS had better outcomes regarding postoperative back pain, smaller incisions, less bony loss and early ambulation. Conclusion: Minimally invasive techniques for treating lumbar canal stenosis of different causes could be considered a better option instead of traditional full laminectomy with better outcomes as regards respecting the anatomical layers such as posterior spinal integrity and musculature, postoperative pain, accompanied with less blood loss, shorter hospital stays, and shorter recovery periods.展开更多
Objective We aimed to compare the clinical and radiological outcomes of midline lumbar fusion(MIDLF)versus minimally invasive transforaminal lumbar interbody fusion(MI-TLIF)in patients with degenerative spondylolisthe...Objective We aimed to compare the clinical and radiological outcomes of midline lumbar fusion(MIDLF)versus minimally invasive transforaminal lumbar interbody fusion(MI-TLIF)in patients with degenerative spondylolisthesis and/or stenosis in L4-L5 two years after surgery.Methods Consecutively treated patients with lumbar pathology who underwent MIDLF(n=16)and a historical control group who underwent MI-TLIF(n=34)were included.Clinical symptoms were evaluated using Oswestry Disability Index(ODI),the 36-Item Short-Form Health Survey,and visual analog scale(VAS)scores before surgery and 3,6,12,and 24 months after surgery.Results The mean operative time and hematocrit(HCT,Day 1)were significantly shorter and lower in MIDLF cases(174 min vs.229 min,P<0.001;0.34 vs.0.36,P=0.037).The MI-TLIF group showed better improvement than the MIDLF group in ODI and VAS back and leg pain at 3 months postoperatively.VAS leg pain was higher in MIDLF than in MI-TLIF cases at 6 months.At 24 months follow-up,VAS back pain was higher in MI-TLIF than in MIDLF cases(P=0.018).Conclusion MIDLF is comparable to MI-TLIF at L4-5 in clinical outcomes and fusion rates,and the results verified the meaningful advantage of using MIDLF for the elderly with osteoporosis.展开更多
Degenerative disease of the lumbar spine is a common and increasingly prevalent condition that is often implicated as the primary reason for chronic low back pain and the leading cause of disability in the western wor...Degenerative disease of the lumbar spine is a common and increasingly prevalent condition that is often implicated as the primary reason for chronic low back pain and the leading cause of disability in the western world. Surgical management of lumbar degenerative disease has historically been approached by way of open surgical procedures aimed at decompressing and/or stabilizing the lumbar spine. Advances in technology andsurgical instrumentation have led to minimally invasive surgical techniques being developed and increasingly used in the treatment of lumbar degenerative disease. Compared to the traditional open spine surgery, minimally invasive techniques require smaller incisions and decrease approach-related morbidity by avoiding muscle crush injury by self-retaining retractors, preventing the disruption of tendon attachment sites of important muscles at the spinous processes, using known anatomic neurovascular and muscle planes, and minimizing collateral soft-tissue injury by limiting the width of the surgical corridor. The theoretical benefits of minimally invasive surgery over traditional open surgery include reduced blood loss, decreased postoperative pain and narcotics use, shorter hospital length of stay, faster recover and quicker return to work and normal activity. This paper describes the different minimally invasive techniques that are currently available for the treatment of degenerative disease of the lumbar spine.展开更多
We report a series of patients operated for one or multilevel lumbar spinal stenosis (with and without spondylolisthesis) using the minimal invasive bilateral interlaminar decompression. We discuss our results, compar...We report a series of patients operated for one or multilevel lumbar spinal stenosis (with and without spondylolisthesis) using the minimal invasive bilateral interlaminar decompression. We discuss our results, comparing this procedure (from a technical point of view) with the muscle-preserving interlaminar decompression (MILD) and the unilateral approach for bilateral decompression (ULBD). Clinical and outcome data of 62 consecutive patients were reviewed, using the Visual Analogue Scale for both low back pain (LBP) and legs pain and the Oswestry Disability Index (ODI) for the degree of disability. Mean age was 68.88 ± 9.54 years and mean follow-up (FU) was 16.38 ± 11.12 months. A statistically significant improvement of LBP, legs pain and ODI was globally observed. At latest FU, patients with multilevel lumbar spinal stenosis significantly improved all scores and patients with spondylolisthesis significantly decreased their disability. No major complications occurred. Two cerebrospinal fluid (CSF) collections were treated conservatively. No wound infection occurred. No progression of spondylolisthesis was observed. No reoperation was needed. Although efficacious in patients with lumbar spinal stenosis, MILD and ULBD can have both some limitations. MILD has been found to decrease lumbar function in multilevel decompression (increasing sagittal translation and lumbar lordosis probably due to the removal of half of the spinous processes) and ULBD shows some disadvantages due to the difficulty of manipulating instruments through a small portal and the inadequate decompression due to a minimal exposure. The minimal invasive bilateral interlaminar decompression (in this technique, the access is bilateral but the supraspinous and interspinous ligaments and the spinous processes are preserved) allows wide access (bilateral exposure) with minimal invasiveness and very low morbidity in patients with lumbar spinal stenosis at one or more levels.展开更多
目的探讨皮肤至椎板距离(skr-to-laminal distme,SLD)和皮下脂肪厚度对微创腰椎减压术后的影响。方法选择2021年1月至2023年6月在该院接受微创腰椎减压术的173例患者作为研究对象,收集患者SLD距离和皮下脂肪厚度数据,分别根据中位值分...目的探讨皮肤至椎板距离(skr-to-laminal distme,SLD)和皮下脂肪厚度对微创腰椎减压术后的影响。方法选择2021年1月至2023年6月在该院接受微创腰椎减压术的173例患者作为研究对象,收集患者SLD距离和皮下脂肪厚度数据,分别根据中位值分为低值组和高值组,观察两组患者术前、住院及出院资料差异。结果高SLD距离患者与低SLD距离患者的体质量指数(body mass index,BMI)、肥胖、年龄、ASA分级、高血压、糖尿病、饮酒等比较,差异存在统计学意义(P<0.05);两组患者性别、心脏病、脑血管疾病、慢性肾脏病、吸烟、手术类型、相邻节段病变、住院时间、即时并发症、住院并发症、出院并发症、总并发症、术前ODI、术后1年ODI、术前腰痛VAS、术后1年腰痛VAS、术前腿痛VAS、术后1年腿痛VAS比较,差异均无统计学意义(P>0.05)。高皮下脂肪厚度患者和低皮下脂肪厚度患者的BMI、肥胖、年龄、ASA分级、高血压、糖尿病、饮酒比较,差异存在统计学意义(P<0.05);两组患者性别、心脏病、脑血管疾病、慢性肾脏病、吸烟、手术类型、相邻节段病变、住院时间、即时并发症、住院并发症、出院并发症、总并发症、术前ODI、术后1年ODI、术前腰痛VAS、术后1年腰痛VAS、术前腿痛VAS和术后1年腿痛VAS比较,差异均无统计学意义(P>0.05)。Pearson相关性分析显示,SLD距离和皮下脂肪厚度与BMI均存在显著相关性(r=0.703、0.712,P<0.05)。结论手术部位局部软组织厚度对腰椎微创减压术的临床结果无显著影响。展开更多
In recent years, a variety of minimally invasive lumbar surgery techniques have achieved desirable efficacy, but some dispute remains regarding the advantages over open surgery. This study aimed to compare minimally i...In recent years, a variety of minimally invasive lumbar surgery techniques have achieved desirable efficacy, but some dispute remains regarding the advantages over open surgery. This study aimed to compare minimally invasive lumbar interbody fusion via MAST Quadrant retractor with open surgery in terms of perioperative factors, postoperative back muscle function, and 24-month postoperative follow-up results. Methods From September 2006 to June 2008, patients with single-level degenerative lumbar spine disease who were not responsive to conservative treatment were enrolled in this study. Patients were randomized to undergo either minimally invasive surgery （MIS, transforaminal lumbar interbody fusion via MAST Quadrant retractor, 41 cases） or open surgery （improved transforaminal lumbar interbody fusion, 38 cases）. Results The MIS group had longer intraoperative fluoroscopy time than the open surgery group, and the open surgery group had significantly increased postoperative drainage volume and significantly prolonged postoperative recovery time compared with the MIS group （P 〈0.05 for all）. MRI scanning showed that the T2 relaxation time in the multifidus muscle was significantly shorter in the MIS group than in the open surgery group at 3 months after surgery （P 〈0.01）. Surface electromyography of the sacrospinalis muscle showed that the average discharge amplitude and frequency were significantly higher in the MIS group than in the open surgery group （P 〈0.01）. The Oswestry disability index and visual analog scale scores were better at 3, 6, 12 and 24 months postoperatively than preoperatively in both groups. Both groups of patients met the imaging convergence criteria at the last follow-up. Conclusions MIS can effectively reduce sacrospinalis muscle injury compared with open surgery, which is conducive to early functional recovery. In the short term, MIS is superior to open surgery, but in the long term there is no significant difference between the two procedures.展开更多
Background Transforaminal lumbar interbody fusion （TLIF） through a minimally invasive approach （mTLIF） was introduced to reduce soft tissue injury and speed recovery. Studies with small numbers of patients have be...Background Transforaminal lumbar interbody fusion （TLIF） through a minimally invasive approach （mTLIF） was introduced to reduce soft tissue injury and speed recovery. Studies with small numbers of patients have been carried out, comparing mTLIF with traditional open TLIF （oTLIF）, but inconsistent outcomes were reported.展开更多
As a novel minimally invasive technique,percutaneous endoscopic transforaminal lumbar interbody fusion(PETLIF)has been widely used in the treatment of lumbar degenerative diseases.The purpose of this study was to anal...As a novel minimally invasive technique,percutaneous endoscopic transforaminal lumbar interbody fusion(PETLIF)has been widely used in the treatment of lumbar degenerative diseases.The purpose of this study was to analyze these two operation types’biomechanical performances of PE-TLIF and traditional minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)using the finite element(FE)method.The intact FE models of L4-L5 were established and validated based on the CT images.On this basis,the FE models of MIS-TLIF and PETLIF were established and analyzed.It is demonstrated that for lumbar interbody fusion with the oblique asymmetrically implanted cage under bilateral pedicle screws and rods fixation,such as MIS-TLIF and PE-TLIF,different degrees of articular process resection have no significant effect on the cage subsidence,and the surgical segment can achieve similar stability.In addition,the maximum stress of the L4 inferior endplate of MIS-TLIF and PE-TLIF is greater than that of the L5 superior endplate,which indicates that MIS-TLIF and PE-TLIF can cause cage subsidence in the L4 inferior endplate.展开更多
基金National Natural Science Foundation of China(No.82160435)。
文摘Objective:To analyze the correlation between the amplitude changes of motor evoked potential(MEP),the 3D volume changes of spinal canal measuring by postoperative CT and the improvement rate of clinical symptoms after the spinal canal decompression in minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF),and to explore the predictive value of the changes of both MEP amplitude and spinal canal volume in the assessment of long-term clinical prognosis in MIS-TLIF.Methods:A retrospective study of 68 patients with L4/5 spinal stenosis treated with MIS-TLIF was performed.The changes of both intraoperative MEP amplitude and 3D spinal canal volume during the spinal canal decompression,as well as the visual analogue scale(VAS)and Oswestry dysfunction index(ODI)scores in the long-term follow-up were all recorded.Results:The values of intraoperative MEP amplitude was 159.04%higher in 68 patients with MIS-TLIF after spinal canal decompression(P<0.01).The 3 postoperative 3D spinal canal volume(4.89±1.27)cm increased by 31.22%in comparison 3 with preoperative date(3.78±1.08)cm(P<0.01).The VAS and ODI scores were improved to 78.55%and 80.60%,respectively at the last follow-up(P<0.01).The improvement rate of MEP amplitude on the decompression side was positively correlated with the improvement rate of postoperative spinal canal volume(r=0.272,P=0.025).The improvement rate of postoperative spinal canal volume was positively correlated with the improvement rate of VAS and ODI at the last follow-up(r=0.656,r=0.490,P<0.01).Moreover,the improvement rate of MEP amplitude on the decompression side was also positively correlated with the improvement rate of VAS and ODI at the last follow-up(r=0.322 and 0.235,respectively,P<0.05).Conclusion:The increase of MEP amplitude after spinal canal decompression in patients with lumbar spinal stenosis treated by MIS-TLIF was closely correlated with both of the increase of spinal canal volume and the improvement of clinical symptoms.Therefore,MEP amplitude monitoring was not only the one of the important monitoring methods for predicting the prognosis of MIS-TLIF but also the reliably predictive value in the long-term clinical prognosis in MIS-TLIF.
文摘Background: For decades, traditional open surgical techniques were used to treat lumbar disc herniation and lumbar canal stenosis (LCS). However, seeking for better outcomes for patients and avoiding extensive bony loss with its sequences had raised minimally invasive technique for treating these disorders as an alternative surgery. Methods: This is a retrospective study in which 54 patients of LCS were operated upon via unilateral minimally invasive technique to decompress the canal in a 360 degrees fashion through laminotomy, deroofing of opposite laminar side, sublaminar ligamintectomy, bilateral foraminotomies and discectomy. We used VAS scores and ODI to assess clinical outcomes with a period of one year follow-up. Results: Our results demonstrated that minimally invasive techniques for treating these disorders are effective procedures. Minimally invasive 360 degrees decompression for treating LCS had better outcomes regarding postoperative back pain, smaller incisions, less bony loss and early ambulation. Conclusion: Minimally invasive techniques for treating lumbar canal stenosis of different causes could be considered a better option instead of traditional full laminectomy with better outcomes as regards respecting the anatomical layers such as posterior spinal integrity and musculature, postoperative pain, accompanied with less blood loss, shorter hospital stays, and shorter recovery periods.
基金the Returned Overseas Chinese Scholars Startup Fund[No.LXHG2018001]。
文摘Objective We aimed to compare the clinical and radiological outcomes of midline lumbar fusion(MIDLF)versus minimally invasive transforaminal lumbar interbody fusion(MI-TLIF)in patients with degenerative spondylolisthesis and/or stenosis in L4-L5 two years after surgery.Methods Consecutively treated patients with lumbar pathology who underwent MIDLF(n=16)and a historical control group who underwent MI-TLIF(n=34)were included.Clinical symptoms were evaluated using Oswestry Disability Index(ODI),the 36-Item Short-Form Health Survey,and visual analog scale(VAS)scores before surgery and 3,6,12,and 24 months after surgery.Results The mean operative time and hematocrit(HCT,Day 1)were significantly shorter and lower in MIDLF cases(174 min vs.229 min,P<0.001;0.34 vs.0.36,P=0.037).The MI-TLIF group showed better improvement than the MIDLF group in ODI and VAS back and leg pain at 3 months postoperatively.VAS leg pain was higher in MIDLF than in MI-TLIF cases at 6 months.At 24 months follow-up,VAS back pain was higher in MI-TLIF than in MIDLF cases(P=0.018).Conclusion MIDLF is comparable to MI-TLIF at L4-5 in clinical outcomes and fusion rates,and the results verified the meaningful advantage of using MIDLF for the elderly with osteoporosis.
文摘Degenerative disease of the lumbar spine is a common and increasingly prevalent condition that is often implicated as the primary reason for chronic low back pain and the leading cause of disability in the western world. Surgical management of lumbar degenerative disease has historically been approached by way of open surgical procedures aimed at decompressing and/or stabilizing the lumbar spine. Advances in technology andsurgical instrumentation have led to minimally invasive surgical techniques being developed and increasingly used in the treatment of lumbar degenerative disease. Compared to the traditional open spine surgery, minimally invasive techniques require smaller incisions and decrease approach-related morbidity by avoiding muscle crush injury by self-retaining retractors, preventing the disruption of tendon attachment sites of important muscles at the spinous processes, using known anatomic neurovascular and muscle planes, and minimizing collateral soft-tissue injury by limiting the width of the surgical corridor. The theoretical benefits of minimally invasive surgery over traditional open surgery include reduced blood loss, decreased postoperative pain and narcotics use, shorter hospital length of stay, faster recover and quicker return to work and normal activity. This paper describes the different minimally invasive techniques that are currently available for the treatment of degenerative disease of the lumbar spine.
文摘We report a series of patients operated for one or multilevel lumbar spinal stenosis (with and without spondylolisthesis) using the minimal invasive bilateral interlaminar decompression. We discuss our results, comparing this procedure (from a technical point of view) with the muscle-preserving interlaminar decompression (MILD) and the unilateral approach for bilateral decompression (ULBD). Clinical and outcome data of 62 consecutive patients were reviewed, using the Visual Analogue Scale for both low back pain (LBP) and legs pain and the Oswestry Disability Index (ODI) for the degree of disability. Mean age was 68.88 ± 9.54 years and mean follow-up (FU) was 16.38 ± 11.12 months. A statistically significant improvement of LBP, legs pain and ODI was globally observed. At latest FU, patients with multilevel lumbar spinal stenosis significantly improved all scores and patients with spondylolisthesis significantly decreased their disability. No major complications occurred. Two cerebrospinal fluid (CSF) collections were treated conservatively. No wound infection occurred. No progression of spondylolisthesis was observed. No reoperation was needed. Although efficacious in patients with lumbar spinal stenosis, MILD and ULBD can have both some limitations. MILD has been found to decrease lumbar function in multilevel decompression (increasing sagittal translation and lumbar lordosis probably due to the removal of half of the spinous processes) and ULBD shows some disadvantages due to the difficulty of manipulating instruments through a small portal and the inadequate decompression due to a minimal exposure. The minimal invasive bilateral interlaminar decompression (in this technique, the access is bilateral but the supraspinous and interspinous ligaments and the spinous processes are preserved) allows wide access (bilateral exposure) with minimal invasiveness and very low morbidity in patients with lumbar spinal stenosis at one or more levels.
文摘目的探讨皮肤至椎板距离(skr-to-laminal distme,SLD)和皮下脂肪厚度对微创腰椎减压术后的影响。方法选择2021年1月至2023年6月在该院接受微创腰椎减压术的173例患者作为研究对象,收集患者SLD距离和皮下脂肪厚度数据,分别根据中位值分为低值组和高值组,观察两组患者术前、住院及出院资料差异。结果高SLD距离患者与低SLD距离患者的体质量指数(body mass index,BMI)、肥胖、年龄、ASA分级、高血压、糖尿病、饮酒等比较,差异存在统计学意义(P<0.05);两组患者性别、心脏病、脑血管疾病、慢性肾脏病、吸烟、手术类型、相邻节段病变、住院时间、即时并发症、住院并发症、出院并发症、总并发症、术前ODI、术后1年ODI、术前腰痛VAS、术后1年腰痛VAS、术前腿痛VAS、术后1年腿痛VAS比较,差异均无统计学意义(P>0.05)。高皮下脂肪厚度患者和低皮下脂肪厚度患者的BMI、肥胖、年龄、ASA分级、高血压、糖尿病、饮酒比较,差异存在统计学意义(P<0.05);两组患者性别、心脏病、脑血管疾病、慢性肾脏病、吸烟、手术类型、相邻节段病变、住院时间、即时并发症、住院并发症、出院并发症、总并发症、术前ODI、术后1年ODI、术前腰痛VAS、术后1年腰痛VAS、术前腿痛VAS和术后1年腿痛VAS比较,差异均无统计学意义(P>0.05)。Pearson相关性分析显示,SLD距离和皮下脂肪厚度与BMI均存在显著相关性(r=0.703、0.712,P<0.05)。结论手术部位局部软组织厚度对腰椎微创减压术的临床结果无显著影响。
文摘In recent years, a variety of minimally invasive lumbar surgery techniques have achieved desirable efficacy, but some dispute remains regarding the advantages over open surgery. This study aimed to compare minimally invasive lumbar interbody fusion via MAST Quadrant retractor with open surgery in terms of perioperative factors, postoperative back muscle function, and 24-month postoperative follow-up results. Methods From September 2006 to June 2008, patients with single-level degenerative lumbar spine disease who were not responsive to conservative treatment were enrolled in this study. Patients were randomized to undergo either minimally invasive surgery （MIS, transforaminal lumbar interbody fusion via MAST Quadrant retractor, 41 cases） or open surgery （improved transforaminal lumbar interbody fusion, 38 cases）. Results The MIS group had longer intraoperative fluoroscopy time than the open surgery group, and the open surgery group had significantly increased postoperative drainage volume and significantly prolonged postoperative recovery time compared with the MIS group （P 〈0.05 for all）. MRI scanning showed that the T2 relaxation time in the multifidus muscle was significantly shorter in the MIS group than in the open surgery group at 3 months after surgery （P 〈0.01）. Surface electromyography of the sacrospinalis muscle showed that the average discharge amplitude and frequency were significantly higher in the MIS group than in the open surgery group （P 〈0.01）. The Oswestry disability index and visual analog scale scores were better at 3, 6, 12 and 24 months postoperatively than preoperatively in both groups. Both groups of patients met the imaging convergence criteria at the last follow-up. Conclusions MIS can effectively reduce sacrospinalis muscle injury compared with open surgery, which is conducive to early functional recovery. In the short term, MIS is superior to open surgery, but in the long term there is no significant difference between the two procedures.
文摘Background Transforaminal lumbar interbody fusion （TLIF） through a minimally invasive approach （mTLIF） was introduced to reduce soft tissue injury and speed recovery. Studies with small numbers of patients have been carried out, comparing mTLIF with traditional open TLIF （oTLIF）, but inconsistent outcomes were reported.
基金the National Natural Science Foundation of China(No.11972242,11632013)China Postdoctoral Science Foundation(2020M680913)Shanxi Province Medical Science and Technology Innovation Team Construction Plan(2020TD13).
文摘As a novel minimally invasive technique,percutaneous endoscopic transforaminal lumbar interbody fusion(PETLIF)has been widely used in the treatment of lumbar degenerative diseases.The purpose of this study was to analyze these two operation types’biomechanical performances of PE-TLIF and traditional minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)using the finite element(FE)method.The intact FE models of L4-L5 were established and validated based on the CT images.On this basis,the FE models of MIS-TLIF and PETLIF were established and analyzed.It is demonstrated that for lumbar interbody fusion with the oblique asymmetrically implanted cage under bilateral pedicle screws and rods fixation,such as MIS-TLIF and PE-TLIF,different degrees of articular process resection have no significant effect on the cage subsidence,and the surgical segment can achieve similar stability.In addition,the maximum stress of the L4 inferior endplate of MIS-TLIF and PE-TLIF is greater than that of the L5 superior endplate,which indicates that MIS-TLIF and PE-TLIF can cause cage subsidence in the L4 inferior endplate.
