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
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
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 ai...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.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
Objective:To analyze the instrumentation-related complications of patients with lumbar degenerative disc diseases(LDD)who underwent minimally invasive transforaminal lumbar interbody fusion(MISTLIF)and to discuss the ...Objective:To analyze the instrumentation-related complications of patients with lumbar degenerative disc diseases(LDD)who underwent minimally invasive transforaminal lumbar interbody fusion(MISTLIF)and to discuss the potential strategy for the control of these complications.Methods:A total of 87 patients with LDD were treated with the MIS-TLIF procedure.Complications,including malposition or breakage of guide pin,percutaneous pedicle screw(PPS)or cages,neurological deficit,and superior-level facet joint violations,were determined during and after the surgery.Computed tomography(CT)was used to evaluate the PPS accuracy and the superior-level facet joint violations.Results:A total of 386 PPSs were used.During the surgery,3(0.8%)guide pin and 1(0.3%)PPS perforated the anterior wall of the vertebral body,respectively.One(0.3%)PPS was pulled out during the reduction of slip.Malposition of the cages occurred in 6(1.6%)PPSs.These were all adjusted accordingly during the surgery.All the patients received>2 years of follow-up.No loosening or breakage of PPS and cage was observed,but CT showed 27(7.0%)PPSs misplaced.No neurological deficit related to misplaced PPS was observed.The total facet joint violation(FJV)rate was 36.2%,with grade 2 and grade 3 violations is 21(12.1%)and 6(3.4%),respectively.Conclusion:MIS-TLIF has similar instrumentation-related complications with open TLIF.Accurate preoperative evaluation and improved surgical techniques can effectively reduce these instrumentation-related complications.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
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....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.展开更多
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 th...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.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
BACKGROUND Improving the sagittal lumbar-pelvic parameters after fusion surgery is important for improving clinical outcomes.The impact of midline lumbar fusion(MIDLF)on sagittal lumbar-pelvic alignment for the manage...BACKGROUND Improving the sagittal lumbar-pelvic parameters after fusion surgery is important for improving clinical outcomes.The impact of midline lumbar fusion(MIDLF)on sagittal lumbar-pelvic alignment for the management of degenerative lumbar diseases is still unknown.AIM To analyze the effects of short-segment MIDLF and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)on sagittal lumbar-pelvic parameters.METHODS We retrospectively analyzed 63 patients with degenerative lumbar diseases who underwent single-segment MIDLF or MIS-TLIF.The imaging data of patients were collected before surgery and at the final follow-up.The radiological sagittal parameters included the lumbar lordosis(LL),lower LL,L4 slope(L4S),L5 slope(L5S),L5 incidence(L5I),L1 axis and S1 distance(LASD),pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),and PI-LL mismatch(PI-LL).Additionally,the clinical outcomes,including lower back and leg pain visual analog scale(VAS)and Oswestry disability index(ODI)scores,were also analyzed.RESULTS In both groups,LL and Lower LL significantly increased,while L5I and LASD significantly decreased at the final follow-up compared to that recorded prior to operation(P<0.05).In the MIDLF group,L4S significantly decreased compared to that recorded prior to operation(P<0.05),while the mean SS significantly increased and the PT significantly decreased compared to that recorded prior to operation(P<0.05).In the MIS-TLIF group,SS slightly increased and the mean PT value decreased compared to that recorded prior to operation,but without a statistically significant difference(P>0.05).However,the PI-LL in both groups was significantly reduced compared to that recorded prior to operation(P<0.05).There was no significant difference in the sagittal lumbar-pelvic parameters between the two groups prior to operation and at the final follow-up(P>0.05).In addition,the change in sagittal lumbar-pelvic parameters did not differ significantly,except forΔLASD within the two groups(P>0.05).The mean lower back and leg pain VAS and ODI scores in both groups were significantly improved three months after surgery and at the final follow-up.Though the mean ODI score in the MIDLF group three months after surgery was slightly higher than that in the MIS-TLIF group,there was no significant difference between the two groups at the final follow-up.CONCLUSION Short-segment MIDLF and MIS-TLIF can equally improve sagittal lumbar parameters such as LL,Lower LL,L5I,and LASD in the treatment of lumbar degenerative diseases.However,MIDLF had a larger impact on pelvic parameters than MIS-TLIF.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
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.
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.
基金This study was supported by a grant from the National Natural Science Foundation of China
文摘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.
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.
基金supported by the National Natural Science Foundation of China(No.81272024).
文摘Objective:To analyze the instrumentation-related complications of patients with lumbar degenerative disc diseases(LDD)who underwent minimally invasive transforaminal lumbar interbody fusion(MISTLIF)and to discuss the potential strategy for the control of these complications.Methods:A total of 87 patients with LDD were treated with the MIS-TLIF procedure.Complications,including malposition or breakage of guide pin,percutaneous pedicle screw(PPS)or cages,neurological deficit,and superior-level facet joint violations,were determined during and after the surgery.Computed tomography(CT)was used to evaluate the PPS accuracy and the superior-level facet joint violations.Results:A total of 386 PPSs were used.During the surgery,3(0.8%)guide pin and 1(0.3%)PPS perforated the anterior wall of the vertebral body,respectively.One(0.3%)PPS was pulled out during the reduction of slip.Malposition of the cages occurred in 6(1.6%)PPSs.These were all adjusted accordingly during the surgery.All the patients received>2 years of follow-up.No loosening or breakage of PPS and cage was observed,but CT showed 27(7.0%)PPSs misplaced.No neurological deficit related to misplaced PPS was observed.The total facet joint violation(FJV)rate was 36.2%,with grade 2 and grade 3 violations is 21(12.1%)and 6(3.4%),respectively.Conclusion:MIS-TLIF has similar instrumentation-related complications with open TLIF.Accurate preoperative evaluation and improved surgical techniques can effectively reduce these instrumentation-related complications.
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.
文摘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.
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.
文摘BACKGROUND Improving the sagittal lumbar-pelvic parameters after fusion surgery is important for improving clinical outcomes.The impact of midline lumbar fusion(MIDLF)on sagittal lumbar-pelvic alignment for the management of degenerative lumbar diseases is still unknown.AIM To analyze the effects of short-segment MIDLF and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)on sagittal lumbar-pelvic parameters.METHODS We retrospectively analyzed 63 patients with degenerative lumbar diseases who underwent single-segment MIDLF or MIS-TLIF.The imaging data of patients were collected before surgery and at the final follow-up.The radiological sagittal parameters included the lumbar lordosis(LL),lower LL,L4 slope(L4S),L5 slope(L5S),L5 incidence(L5I),L1 axis and S1 distance(LASD),pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),and PI-LL mismatch(PI-LL).Additionally,the clinical outcomes,including lower back and leg pain visual analog scale(VAS)and Oswestry disability index(ODI)scores,were also analyzed.RESULTS In both groups,LL and Lower LL significantly increased,while L5I and LASD significantly decreased at the final follow-up compared to that recorded prior to operation(P<0.05).In the MIDLF group,L4S significantly decreased compared to that recorded prior to operation(P<0.05),while the mean SS significantly increased and the PT significantly decreased compared to that recorded prior to operation(P<0.05).In the MIS-TLIF group,SS slightly increased and the mean PT value decreased compared to that recorded prior to operation,but without a statistically significant difference(P>0.05).However,the PI-LL in both groups was significantly reduced compared to that recorded prior to operation(P<0.05).There was no significant difference in the sagittal lumbar-pelvic parameters between the two groups prior to operation and at the final follow-up(P>0.05).In addition,the change in sagittal lumbar-pelvic parameters did not differ significantly,except forΔLASD within the two groups(P>0.05).The mean lower back and leg pain VAS and ODI scores in both groups were significantly improved three months after surgery and at the final follow-up.Though the mean ODI score in the MIDLF group three months after surgery was slightly higher than that in the MIS-TLIF group,there was no significant difference between the two groups at the final follow-up.CONCLUSION Short-segment MIDLF and MIS-TLIF can equally improve sagittal lumbar parameters such as LL,Lower LL,L5I,and LASD in the treatment of lumbar degenerative diseases.However,MIDLF had a larger impact on pelvic parameters than MIS-TLIF.
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.
