Correlation study between the changes of motor evoked potential and the improvement of spinal canal volume in minimally invasive transforaminal lumbar interbody fusion

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.

Transforaminal Percutaneous Endoscopic Discectomy using Transforaminal Endoscopic Spine System technique: Pitfalls that a beginner should avoid

Transforaminal Percutaneous Endoscopic Discectomy(TPED) is a minimally invasive technique mainly used for the treatment of lumbar disc herniation from a lateral approach. Performed under local anesthesia, TPED has been proven to be a safe and effective technique which has been also associated with shorter rehabilitation period, reduced blood loss, trauma, and scar tissue compared to conventional procedures. However, the procedure should be performed by a spine surgeon experienced in the specific technique and capable of recognizing or avoiding various challenging conditions. In this review, pitfalls that a novice surgeon has to be mindful of, are reported and analyzed.

Technique of Percutaneous Transforaminal Endoscopic Discectomy for the Treatment of Lumbar Disc Herniation

Percutaneous Transforaminal Endoscopic Discectomy is a minimally invasive surgery with little pain, less blood loss, less hospital stay and the surgery can be done in local anesthesia, which was started during late 20th century. Kambin and Gellmann in 1973 in the United States and Hijikata in Japanin 1977 individually preformed posterolateral percutaneous nucleotomy for the resection of the nucleus pulposus and release of compressed exiting nerve root, which is now spreading through the world and many surgeons are developing their skill but it needs experience and patience for successful outcomes. Along with advanced instruments now the surgery can be performed only giving a small skin incision of 8 - 10 mm and is as effective as the conventional method of surgery and open microdiscectomy surgery for the treatment of symptomatic lumbar disc herniation. In this review, we are explaining the technique of minimally invasive Percutaneous Transforaminal Endoscopic Discectomy surgery along its advantages and complications which can be encountered while performing this technique.

Two-Year Outcomes of Midline lumbar Fusion Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion in the Treatment of L4-L5 Degenerative Disease

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.

Percutaneous Endoscopic Lumbar Spine Surgery for Lumbar Disc Herniation and Lumbar Spine Stenosis: Emphasizing on Clinical Outcomes of Transforaminal Technique

Lumbar Disc Herniation and Lumbar Spine Stenosis are the most common spine diseases which are mainly due to age related Spine degeneration. Diagnosis of both Lumbar Disc Herniation and Lumbar Spine Stenosis depends on clinical findings as well as radiological investigations. Treatment of choice of these conditions is on the basis of the patient conditions. Surgical treatment is the option only when the conservative treatment does not improve the patient’s clinical condition. Advancement and improvement of the technology have resulted in the traditional open surgical treatment into minimal invasive surgery. Intervention of the different surgical instruments with expert spinal surgeons had made percutaneous endoscopic lumbar Spine surgery as one of the preferred choices of surgery for treating Lumbar Disc Herniation and Lumbar Spine Stenosis. The concept of percutaneous endoscopic surgery for lumbar region is to provide surgical options without producing iatrogenic morbidity associated with the open surgical procedures. Conventionally, there are different approaches/techniques for Percutaneous Endoscopic Lumbar Spine Surgery, but in this review we are mainly focusing on the Transforaminal Technique. Regarding the Lumbar Disc Herniation treatment with transforaminal approach, a number of articles have been published due to which we mainly focused on those articles which were published after 2009 onwards. While fewer articles related to Lumbar Spine Stenosis treatment with Transforaminal approach were found, we tried to brief out all those articles. On the basis of comparative study of different surgeries done for Lumbar Disc Herniation and Lumbar Spine Stenosis, Percutaneous Transforaminal endoscopic Lumbar Surgery provides a substantial benefit. Transforaminal approach for treating Lumbar Disc Herniation and Lumbar Spine Stenosis is safe and effective. The Percutaneous Transforaminal Endoscopic Lumbar Surgery has advantage as it is performed under local anesthesia with shorter length of hospitalization and early return to normal life. The clinical outcome of the patient that underwent Percutaneous Transforaminal Endoscopic Lumbar Surgery for Lumbar Disc Herniation and Lumbar Spine Stenosis is quite good in regard of its fewer complication and more benefits.

The Clinical Effect of Percutaneous Transforaminal Endoscopic Discectomy in the Treatment of Low Lumbar Single Segment Disc Herniation

Objective: To observe the clinical effect percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of single lumbar disc herniation. Methods: From August 2017 to June 2019, 42 patients with low lumbar single segment lumbar disc herniation were treated with percutaneous transforaminal endoscopic discectomy surgery in our hospital. The operation time, incision size, bleeding volume and hospitalization time were recorded respectively. The patients were evaluated before operation, 1 month and 6 months after operation. Visual analogue scale (VAS) and assessment were used to evaluate the lumbocrural pain. The JOA score and the Oswestry disability index (ODI) were used to evaluate the lumbar function, and the modified macnab score was used to evaluate the clinical effect in the last follow-up. Results: All the 42 patients successfully completed the operation without any other operation. There were no severe complications such as dural injury and nerve root injury. The operation time was (76.98 ± 8.58) min, the incision size was (8.45 ± 1.2) mm, the bleeding volume was (20.14 ± 2.93) ml, and the hospitalization time was (4.55 ± 1.13) d. One month and six months after the operation, the visual analogue scale (VAS), the evaluation of lumbar function (Oswestry) and the disability index (ODI) were significantly improved compared with those before the operation (P Conclusion: The treatment of low lumbar but segmental lumbar disc herniation with percutaneous intervertebral foramen, with small incision, less bleeding and quick recovery, can improve the pain and dysfunction of patients.

Comparison of pain media and inflammatory factors after percutaneous transforaminal endoscopic discectomy and traditional fenestration operation treatment of protrusion of lumbar intervertebral disc

Objective:To compare the differences in pain mediators and inflammatory factors after percutaneous transforaminal endoscopic discectomy and traditional fenestration operation treatment of protrusion of lumbar intervertebral disc. Methods:80 patients with protrusion of lumbar intervertebral disc treated in our hospital between March 2013 and December 2015 were collected and divided into observation group and control group (n=40) according to randomized parallel contrast. Control group received traditional fenestration operation and observation group received percutaneous transforaminal endoscopic discectomy. Before operation and 1 week after operation, fluorescence spectrophotometry was used to determine serum pain medium levels;ELISA was used to determine pro-inflammatory factor and anti-inflammatory factor levels. Results:Before operation, differences in serum pain medium and inflammatory factor levels were not statistically significant between two groups (P>0.05). 1 week after operation, serum pain media norepinephrine (NE), dopamine (DA), 5-hydroxytryptamine (5-HT), prostaglandin E2 (PGE2) and substance P (SP) levels as well as pro-inflammatory factors interleukin-1β(IL-1β), interleukin-6 (IL-6), interleukin-18 (IL-18) and tumor necrosis factor alpha (TNF-α) levels of observation group were lower than those of control group (P<0.05) while serum anti-inflammatory factors interleukin-4 (IL-4), interleukin 10 (IL-10), soluble tumor necrosis factor receptor I (sTNF-RI) levels were higher than those of control group (P<0.05). Conclusions:Percutaneous transforaminal endoscopic discectomy can effectively treat protrusion of lumbar intervertebral disc and is more advantageous in alleviating patients’ perception of pain and reducing inflammation.

Clinical Effect of Lateral Transforaminal Endoscopic Surgery in the Treatment of Lumbar Disc Herniation

Objective:To analyze the efficacy of lateral transforaminal endoscopic surgery in the treatment of lumbar disc herniation.Methods:A total of 44 patients with lumbar disc herniation,treated in Yancheng No.l People's Hospital from January 2019 to June 2020,were randomly divided into two groups;the 24 patients in group A were treated by lateral transforaminal endoscopic surgery,while the 20 patients in group B were treated by routine lamina fenestration and nucleus pulposus surgery.Results:The curative effect of group A(91.67%)was higher than that of group B(85.0%),P>0.05;there was no significant difference in the angle from straight leg raise between group A and group B(P>0.05);the Oswestry Disability Index(ODI)and the visual analogue scale(VAS)of group A were lower than those of group B(P<0.05);the incision length,intraoperative blood loss,and hospital stay of the patients in group A were better than those in group B,P<0.05.Conclusion:Lateral transforaminal endoscopic surgery can significantly reduce pain,improve symptoms,and help to restore normal function in the early stage for patients with lumbar disc herniation.

Percutaneous transforaminal endoscopic decompression combined with percutaneous vertebroplasty in treatment of lumbar vertebral body metastases:A case report

BACKGROUND Percutaneous endoscopic lumbar discectomy(PTED)is a procedure that is commonly used to treat lumbar disc herniation and spinal stenosis.Despite its less invasiveness,this surgery is rarely used to treat spinal metastases.Percutaneous vertebroplasty(PVP)has been utilized to treat lumbar vertebral body metastases but it has not proven useful in treating sciatic patients.CASE SUMMARY A 68-year-old woman presented with low back pain and radicular symptoms.She couldn't straighten her legs because of severe pain.Computed tomography(CT)showed a mass lesion in the lung and bone destruction in the L4 vertebrae.The biopsy of the lung lesion revealed adenocarcinoma and the biopsy for L4 vertebrae revealed metastatic adenocarcinoma.PTED paired with PVP was performed on the patient due to the patient's poor overall physical state and short survival time.Transcatheter arterial embolization of vertebral tumors was performed before surgical resection to reduce excessive blood loss during the operation.The incision was scaled up with the TESSY technology.The pain was obviously relieved following the operation and no serious complications occurred.Postoperative CT showed that the decompression around the nerve root was successful,polymethyl methacrylate filling was satisfactory and the tumor tissue around the nerve root was obviously removed.During the 1-year follow-up period,the patient was in a stable condition.CONCLUSION PTED in combination with PVP is an effective and safe treatment for Lumbar single-level Spinal Column metastases with radicular symptoms.Because of the small sample size and short followup time,the long-term clinical efficacy of this method needs to be further confirmed.

Comparison of the pain and inflammatory stress after percutaneous transforaminal endoscope discectomy and open fenestration discectomy

Objective:To study the differences in pain and inflammatory stress after percutaneous transforaminal endoscope discectomy and open fenestration discectomy.Methods: Patients with lumbar intervertebral disc herniation who underwent surgical treatment in our hospital between January 2013 and January 2017 were selected and randomly divided into two groups: Percutaneous transforaminal endoscope discectomy (PTED) group and control group. Patients in PTED group received percutaneous transforaminal endoscope discectomy, while control group received open fenestration discectomy. Serum levels of pain substances SP, NPY, PGE2 and NGF, inflammatory mediators IFN-γ, TNF-α, IL-17 and MMP3 as well as stress response substances Cor, NE, OH-, O2- and MDA of two groups of patients were determined the same day after surgery and 3 days after surgery.Results: The same day after surgery and 3 d after surgery, serum SP, NPY, PGE2, NGF, IFN-γ, TNF-α, IL-17, MMP3, Cor, NE, OH-, O2- and MDA levels of PTED group were significantly lower than those of control group. Conclusion: Percutaneous transforaminal endoscope discectomy for lumbar intervertebral disc herniation causes less postoperative pain and inflammatory stress than open fenestration discectomy.

Preliminary study of transforaminal endoscope in the treatment of spinal metastasis

Objective:To investigate the therapeutic effect of transforaminal endoscope in patients with spinal metastases.Methods:Clinical data of 28 patients with spinal metastases admitted to our hospital from May 2015 to May 2019 were retrospectively collected.According to different surgical methods,they were divided into control group(20 cases)and experimental group(8 cases),among which control group was treated with traditional open palliative decompression,while the experimental group was treated with transforaminal endoscopic decompression.The surgery and recovery indicators were compared between the two groups,including surgery time,incision length,postoperative drainage volume,out of bed activity time,length of hospital stay,the Japanese Orthopaedic Association(JOA)scores of 7 days after surgery,pain degree,complications(wound infection,transient reduction of muscle strength,hypoproteinemia with wound drainage and delayed healing),and activity of daily living.Results:The surgery time,incision length,postoperative drainage volume,out of bed activity time,and postoperative length of hospital stay of the experimental group were all less than those of the control group,and the JOA score of 7 days after surgery was higher than that of the control group,showing statistically significant differences(P<0.05).VAS scores of the experimental group on the day 1 and day 7 after surgery were lower than those of the control group,with statistically significant differences(P<0.05).The incidence of complications in the experimental group was slightly lower than that in the control group,but the difference was not significant(P>0.05).Conclusions:Transforaminal endoscope used in suitable patients with spinal metastases can greatly reduce the incision length,soft tissue and bone tissue damages,and postoperative drainage,promote early mobilization and early discharge,and reduce a series of complications due to hemorrhage and hypoproteinemia,which has a better early clinical effect in comparison with the traditional open palliative decompression.

Transforaminal Endoscope for the Treatment of Thoracic Disc Herniation

Objective:Transforaminal endoscope was used in the treatment of thoracic disc herniation and the therapeutic effect was discussed.Methods:Sixteen patients with thoracic disc herniation admitted to our hospital from October 2018 to May 2019 were divided into control group and observation group according to the random number table method,with 8 patients in each group.The control group was treated with posterior laminectomy approach,and the observation group was treated with transforaminal endoscope.The surgery-related conditions(intraoperative blood loss,surgery time,and postoperative drainage volume),VAS score,JOA score and postoperative complications were compared and analyzed.Results:There was no statistically significant difference between the two groups in the total effective rate and preoperative VAS score(P>0.05).Compared with the control group,the observation group had shorter surgery time and incision length,less postoperative drainage volume,and higher VAS score 3 days after surgery,JOA score on day 7 after surgery,and JOA score 3 months after surgery,showing statistically significant differences(P<0.05).There was no significant difference in the complications between the two groups(X2=1.067,P=0.833).Conclusions:Transforaminal endoscope had a good clinical effect with small incision and injury in the treatment of patients with thoracic disc herniation.

Comparison between Minimally Invasive Transforaminal Lumbar Interbody Fusion and Conventional Open Transforaminal Lumbar Interbody Fusion： An Updated Meta-analysis

Background： The previous studies agree that minimally invasive transforaminal lumbar interbody fusion （MIS-TLIF） has better function outcomes, less blood loss, and shorter hospital stay, when compared to open-TLIF. However, there are no significance differences on operative time, complication, and reoperation rate between the two procedures. This could be from less relative literatures and lower grade evidence. The further meta-analysis is needed with more and higher grade evidences to compare the above two TLIF procedures. Methods： Prospective and retrospective studies that compared open-TLIF and MIS-TLIF were identified by searching the Medline, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, and VIP database （the literature search comprised Medical Subject Heading terms and key words or Emtree term）. The retrieval time ranged from the date when the database was founded to January 2015. Pooled risk ratios （RRs） and weighted mean differences （WMDs） with 95% confidence intervals were calculated for the clinical outcomes and perioperative data. Results： Twenty-four studies （n =1967 patients） were included in this review （n =951, open-TLIF, n 1016, MIS-TLIF）. MIS-TLIF was associated with a significant decrease in the visual analog score （VAS）-back pain score （WMD 0.44; P= 0.001）, Oswestry Disabilities Index （WMD 1.57; P =0.005）, early ambulation （WMD = -1.77; P = 0.0001）, less blood loss （WMD = -265.59; P 〈 0.00001）, and a shorter hospital stay （WMD =-1.89; P 〈 0.0001）. However, there were no significant differences in the fusion rate （RR =0.99; P = 0.34）, VAS-leg pain （WMD = -0.10; P = 0.26）, complication rate （RR = 0.84; P = 0.35）, operation time （WMD = 5.23; P = 0.82）, or reoperation rate （RR = 0.73; P = 0.32）. Conclusions： MIS-TLIF resulted in a similar fusion rate with better functional outcome, less blood loss, shorter ambulation, and hospital stay; furthermore, it did not increase the complication or reoperation rate based on the existing evidence.

Mast Quadrant-assisted Minimally Invasive Modified Transforaminal Lumbar Interbody Fusion： Single Incision Versus Double Incision

Background： The concept of minimally invasive techniques is to make every effort to reduce tissue damage. Certainly, reducing skin incision is an important part of these techniques. This study aimed to investigate the clinical feasibility of Mast Quadrant-assisted modified transforaminal lumbar interbody fusion （TLIF） with a small single posterior median incision. Methods： During the period of March 2011 to March 2012, 34 patients with single-segment degenerative lumbar disease underwent the minimally invasive modified TLIF assisted by Mast Quadrant with a small single posterior median incision （single incision group）. The cases in this group were compared to 37 patients with single-segment degenerative lumbar disease in the double incision group. The perioperative conditions of patients in these two groups were statistically analyzed and compared. The Oswestry Disability Index （ODI） scores, Visual Analog Scale （VAS） scores, and sacrospinalis muscle damage evaluation indicators before operation and 3, 12 months postoperation were compared. Results： A total of 31 and 35 cases in the single incision and double incision groups, respectively, completed at least 12 months of systemic follow-up. The differences in perioperative conditions between the two groups were not statistically significant. The incision length of the single incision group was significantly shorter than that of the double incision group （P 〈 0.01）. The ODI and VAS scores of patients in both groups improved significantly at 3 and 12 months postoperation. However, these two indicators at 3 and 12 months postoperation and the sacrospinalis muscle damage evaluation indicators at 3 months postoperation did not differ significantly between the two groups （P _〉 0.05）. Conclusions： Mast Quadrant-assisted modified TLIF with a small single posterior median incision has excellent clinical feasibility compared to minimally invasive TLIF with a double paramedian incision.

Clinical results and intramedullary signal changes of posterior decompression with transforaminal interbody fusion for thoracic myelopathy caused by combined ossification of the posterior longitudinal ligament and ligamentum flavum

Background Surgical treatment of thoracic myelopathy caused by ossification of the posterior longitudinal ligament （OPLL） and ossification of the ligamentum flavum （OLF） is technically demanding, and the results tend to be unfavorable. Various operative approaches and treatment strategies have been attempted, and posterior decompression with transforaminal thoracic interbody fusion （PTTIF） may be the optimal method with which the anterior-posterior compression was removed in one step. It is comparatively less traumatic with fewer serious complications.

Comparing minimally invasive and open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease： a meta-analysis

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.

Complications and clinical outcomes of minimally invasive transforaminal lumbar interbody fusion for the treatment of one- or two.-level degenerative disc diseases of the lumbar spine in patients older than 65 years

Background Minimally invasive transforaminal lumbar interbody fusion （MIS-TLIF） has been successfully used to treat degenerative diseases of the lumbar spine. There are few reports comparing the complications and clinical outcomes in older patients who have undergone one- or two-level MIS-TLIF with those of younger patients. The aim of this study was to investigate the clinical outcomes of MIS-TLIF in the treatment of degenerative disc disease of lumbar spine of the patients older than 65 years, with an emphasis on perioperative complications compared to the younger patients. Methods One hundred and fifty-one consecutive cases of one- or two-level degenerative disc disease of lumbar spine treated with MIS-TLIF were reviewed for the radiological and clinical outcomes. They were divided into elderly group （age 〉65 years old） and younger group （age 〈65 years old）, and were followed for at least 6 months. Radiographs were obtained before and after surgery, 3 months postoperatively, and at the final follow-up to determine the presence of fusion, hardware-related problems. The clinical outcomes were evaluated using the Oswestry Disability Index （ODI） before and after surgery, and at the final follow-up. The visual analogue scale （VAS） score of back and leg pain were evaluated as well. The intra-operative data and peri-operative complications were recorded. Results The mean age of these patients at operation was （57.7±14.2） years （range 26-82 years）. Of 151 patients, 62 were 65 years or older. The elderly patients had more comorbidities and more porportion of lumbar canal stenosis. The overall fusion rate was 88.4% at the final follow-up, with no significant difference between younger and elderly patients. The ODI, the VAS of back pain and radicular pain of both young and elderly group were significantly improved after surgery and at the final follow-up, without significant difference between two groups. There were 16 complications with an incidence of 10.6%, including 7 major complications and 9 minor complications. There was no significant difference of the incidence of complications between two groups. The incidence of dura tear was significantly related to bilateral deompression. Conclusions The clinical and radiological outcomes of MIS-TLIF in the treatment of one- or two-level degenerative disc diseases of lumbar spine in the elderly patients were satisfactory. Though there are more pre-operative comorbidities, with proper patient selection, the elderly patients are not at increased risk of perioperative complications compared to younger patients. Screw malposition and dura tear, which are the most frequent complications, were more related to the surgical technique and should be avoided.

Minimally invasive transforaminal lumbar interbody fusion aided with computer-assisted spinal navigation system combined with electromyography monitoring

Background Minimally invasive techniques are gaining wide-spread application in lumbar fusion surgery, because they may have advantage over conventional open surgery in approach-related morbidity. This research was aimed to evaluate the safety and accuracy of the techniques of minimally invasive transforaminal lumbar interbody fusion by using a computer-assisted spinal navigation system combined with electromyography monitoring. Methods Sixteen patients underwent minimally invasive transforaminal lumbar interbody fusion. A computer-assisted spinal navigation system and electromyography were used for guiding pedicle screw placement. The operative duration, blood loss, complications, and fluoroscopic time were recorded. Clinical outcome was assessed by Visual Analog Scale and Oswestry Disability Index. Radiographic images were obtained to evaluate the accuracy of pedicle screw placement and fusion rates. Results The Visual Analog Scale and Oswestry Disability Index scores were vastly improved postoperatively. A total of 64 pedicle screws were implanted and three were regarded as misplacement by post-operative CT scan. Three screw trajectories were adjusted according to intra-operative stimulus-evoked electromyography monitoring. The average fluoroscopy time in each patient was 31.8 seconds, which equals to 7.9 seconds per pedicle screw. No patients had instrument related neurological complications, infection, implant failure or revision. Successful fusion was found in all patients. Conclusions The combination of navigation system and real-time electromyography monitoring can make the minimally invasive operation more safe and accurate while decreasing radiation exposure time of the medical staff and patient and minimizing the chance and the degree of the pedicle screw misplacement.

Transforaminal Lumbar Interbody Fusion for Traumatic Lumbar Spondylolisthesis

To evaluate the clinical outcome,effectiveness and safety of the surgical management of traumatic lumbar spondylolisthesis with transforaminal lumbar interbody fusion (TLIF) with short segmental instrumentation fixation.A retrospective review of a consecutive series of 24 patients with traumatic lumbar spondylolisthesis treated with TLIF procedure was carried out.Intraoperative spinal cord monitoring was used to confirm the peripheral neural function intact during the reduction of the spondylolisthesis.Preoperative clinical and radiographic evaluation of all cases were originally collected prospectively.Data regarding blood loss,operative time,duration of hospital stay,radiographic fusion,instrumentation failure and clinical result were collected and observed at regular follow-up periods.All patients were engaged in high-energy accidents in the lower back and 16 patients had concomitant injuries.The mean operative time was 124 min,mean blood loss was 350 mL,and mean hospital stay was 6.5 days.There were no complications such as incision infection,cerebrospinal fluide (CSF) leakage and nerve root injury and so on.All patients demonstrated a solid lumbar interbody fusion within 4 months,and no evidence of spondylolisthesis correction loss,instrumentation failure and loosing.They all were completely asymptomatic,with normal neurologic findings,and had resumed their previous level of physical activities on the final follow-up.Meticulous clinical examination and careful imaging assessment could assist an early diagonosis in cases of traumatic lumbar spondylolisthesis.Performing open reduction and the TLIF procedure as soon as possible could restore segmental stability and painless function.The TLIF procedure was a safe,effective technique to treat traumatic lumbar spondylolisthesis.

Biomechanical evaluation of two fusion techniques based on finite element analysis:Percutaneous endoscopic and minimally invasive transforaminal lumbar interbody fusion

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.