MINIMALLY INVASIVE TRANSFORAMINAL LUMBAR INTERBODY FUSION FOR TREATMENT OF DEGENERATIVE LUMBAR SCOLIOSIS STENOSIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

DING Yue ¹ , HE Shisheng ² , ZHANG Hailong ²

1Department of Orthopaedics, Jinshan Hospital Affiliated to Fudan University, Shanghai, 201508, P.R.China;;
2Department of Orthopaedics, Tenth People’s Hospital Affiliated to Tongji University. Corresponding author: HE Shisheng, E-mail: hss7418@sohu.com;

Corresponding author：

Keywords：

Degenerative lumbar scoliosis; Spinal stenosis; Lumbar fusion; Minimally invasive surgery

DOI：

10.7507/1002-1892.20130095

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Objective To explore the effectiveness of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for degenerative lumbar scoliosis stenosis by expandable tubular retractor. Methods Between April 2009 and October 2010, 39 patients with degenerative lumbar scoliosis stenosis were treated. Of 39 patients, 20 underwent MI-TLIF (group A) and 19 underwent open surgery (group B). There was no significant differences in gender, age, disease duration, range of lumbar degenerative scoliosis, Cobb angle, Oswestry disability index (ODI), and visual analogue scale (VAS) between 2 groups (P gt; 0.05). The operation time, intraoperative blood loss, postoperative independently turning over time, postoperative complication rate, Cobb angle, fusion rates, ODI score, and VAS score were compared between 2 groups. Results The operation time of group A was significantly longer than that of group B (P lt; 0.05), and the intraoperative blood loss of group A was significantly less than that of group B (P lt; 0.05); no significant difference was found in postoperative independently turning over time between 2 groups (t=1.869, P=0.069). The complication rate was 20.0% (4/20) in group A and 26.3% (5/19) in group B, showing no significant difference (χ2=0.219, P=0.640). All patients were followed up 2 years to 3 years and 6 months (mean, 2.9 years). At last follow-up, the fusion rate of bone graft was 92.9% (78/84) in group A and 95.2% (80/84) in group B, showing no significant difference (χ2=0.425, P=0.514). According to the Macnab standard for effectiveness evaluation, the results were excellent in 12 cases, good in 6 cases, fair in 1 case, and poor in 1 case, with an excellent and good rate of 90.0% in group A; the results were excellent in 12 cases, good in 5 cases, and fair in 2 cases, with an excellent and good rate of 89.5% in group B; there was no significant difference between 2 groups (Z= — 0.258, P=0.835). The postoperative VAS score, ODI score, and Cobb angle were significantly improved when compared with preoperative ones in 2 groups (P lt; 0.05); and there was no significant differences between 2 groups at 2 weeks after operation and last follow-up (P gt; 0.05). Conclusion MI-TLIF by expandable tubular retractor is an available clinical choice in treating degenerative lumbar scoliosis stenosis. It can obtain the same effectiveness as the open surgery.

Citation： DING Yue,HE Shisheng,ZHANG Hailong. MINIMALLY INVASIVE TRANSFORAMINAL LUMBAR INTERBODY FUSION FOR TREATMENT OF DEGENERATIVE LUMBAR SCOLIOSIS STENOSIS. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(4): 404-408. doi: 10.7507/1002-1892.20130095 Copy

1.	Akbarnia BA, Ogilvie JW, Hammerberg KW. Debate: degenerative scoliosis: to operate or not operate. Spine (Phila Pa 1976), 2006, 31(19 Suppl): S195-201.
2.	Crawford CH 3rd, Glassman SD. Surgical treatment of lumbar spinal stenosis associated with adult scoliosis. Instr Course Lect, 2009, 58: 669-676.
3.	Ploumis A, Transfledt EE, Denis F. Degenerative lumbar scoliosis associated with spinal stenosis. Spine J, 2007, 7(4): 428-436.
4.	Hey HW, Hee HT. Lumbar degenerative spinal deformity: Surgical options of PLIF, TLIF and MI-TLIF. Indian J Orthop, 2010, 44(2): 159-162.
5.	贺石生, 张海龙, 顾昕, 等. 腰椎微创手术术前定位器的设计及临床应用. 中华骨科杂志, 2011, 31(10): 1170-1171.
6.	Macnab I. Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg (Am), 1971, 53(5): 891-903.
7.	Benglis DM, Elhammady MS, Levi AD, et al. Minimally invasive anterolateral approaches for the treatment of back pain and adult degenerative deformity. Neurosurgery, 2008, 63(3 Suppl): 191-196.
8.	Tsai TH, Huang TY, Lieu AS, et al. Functional outcome analysis: instrumented posterior lumbar interbody fusion for degenerative lumbar scoliosis. Acta Neurochir (Wien), 2011, 153(3): 547-555.
9.	Nasca RJ. Lumbar spinal stenosis: surgical considerations. J South Orthop Assoc, 2002, 11(3): 127-134.
10.	许国华, 叶晓健, 袁文, 等. 腰椎退变性侧弯伴椎管狭窄的外科治疗. 颈腰痛杂志, 2009, 30(4): 294-297.
11.	Frazier DD, Lipson SJ, Fossel AH, et al. Associations between spinal deformity and outcomes after decompression for spinal stenosis. Spine (Phila Pa 1976), 1997, 22(17): 2025-2029.
12.	Transfeldt EE, Topp R, Mehbod AA, et al. Surgical outcomes of decompression, decompression with limited fusion, and decompression with full curve fusion for degenerative scoliosis with radiculopathy. Spine (Phila Pa 1976), 2010, 35(20): 1872-1875.
13.	Truumees E. Spinal stenosis: Pathophysiology, clinical and radiologic classification. Instr Course Lect, 2005, 54: 287-302.
14.	Simmons ED. Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis. Clin Orthop Relat Res, 2001, (384): 45-53.
15.	Liu H, Ishihara H, Kanamori M, et al. Characteristics of nerve root compression caused by degenerative lumbar spinal stenosis with scoliosis. Spine (Phila Pa 1976), 2003, 3(6): 524-529.
16.	Ozgur BM, Yoo K, Rodriguez G, et al. Minimally-invasive technique for transforaminal lumbar interbody fusion (TLIF). Eur Spine J, 2005, 14(9): 887-894.
17.	Scheufler KM, Cyron D, Dohmen H, et al. Less invasive surgical correction of adult degenerative scoliosis. Part II: Complications and clinical outcome. Neurosurgery, 2010, 67(6): 1609-1621.
18.	Li F, Chen Q, Chen W, et al. Posterior-only approach with selective segmental TLIF for degenerative lumbar scoliosis. J Spinal Disord Tech, 2011, 24(5): 308-312.
19.	贺石生. 微创可扩张通道辅助腰椎融合术之管见. 中华骨科杂志, 2011, 31(10): 1022-1023.

1. Akbarnia BA, Ogilvie JW, Hammerberg KW. Debate: degenerative scoliosis: to operate or not operate. Spine (Phila Pa 1976), 2006, 31(19 Suppl): S195-201.
2. Crawford CH 3rd, Glassman SD. Surgical treatment of lumbar spinal stenosis associated with adult scoliosis. Instr Course Lect, 2009, 58: 669-676.
3. Ploumis A, Transfledt EE, Denis F. Degenerative lumbar scoliosis associated with spinal stenosis. Spine J, 2007, 7(4): 428-436.
4. Hey HW, Hee HT. Lumbar degenerative spinal deformity: Surgical options of PLIF, TLIF and MI-TLIF. Indian J Orthop, 2010, 44(2): 159-162.
5. 贺石生, 张海龙, 顾昕, 等. 腰椎微创手术术前定位器的设计及临床应用. 中华骨科杂志, 2011, 31(10): 1170-1171.
6. Macnab I. Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg (Am), 1971, 53(5): 891-903.
7. Benglis DM, Elhammady MS, Levi AD, et al. Minimally invasive anterolateral approaches for the treatment of back pain and adult degenerative deformity. Neurosurgery, 2008, 63(3 Suppl): 191-196.
8. Tsai TH, Huang TY, Lieu AS, et al. Functional outcome analysis: instrumented posterior lumbar interbody fusion for degenerative lumbar scoliosis. Acta Neurochir (Wien), 2011, 153(3): 547-555.
9. Nasca RJ. Lumbar spinal stenosis: surgical considerations. J South Orthop Assoc, 2002, 11(3): 127-134.
10. 许国华, 叶晓健, 袁文, 等. 腰椎退变性侧弯伴椎管狭窄的外科治疗. 颈腰痛杂志, 2009, 30(4): 294-297.
11. Frazier DD, Lipson SJ, Fossel AH, et al. Associations between spinal deformity and outcomes after decompression for spinal stenosis. Spine (Phila Pa 1976), 1997, 22(17): 2025-2029.
12. Transfeldt EE, Topp R, Mehbod AA, et al. Surgical outcomes of decompression, decompression with limited fusion, and decompression with full curve fusion for degenerative scoliosis with radiculopathy. Spine (Phila Pa 1976), 2010, 35(20): 1872-1875.
13. Truumees E. Spinal stenosis: Pathophysiology, clinical and radiologic classification. Instr Course Lect, 2005, 54: 287-302.
14. Simmons ED. Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis. Clin Orthop Relat Res, 2001, (384): 45-53.
15. Liu H, Ishihara H, Kanamori M, et al. Characteristics of nerve root compression caused by degenerative lumbar spinal stenosis with scoliosis. Spine (Phila Pa 1976), 2003, 3(6): 524-529.
16. Ozgur BM, Yoo K, Rodriguez G, et al. Minimally-invasive technique for transforaminal lumbar interbody fusion (TLIF). Eur Spine J, 2005, 14(9): 887-894.
17. Scheufler KM, Cyron D, Dohmen H, et al. Less invasive surgical correction of adult degenerative scoliosis. Part II: Complications and clinical outcome. Neurosurgery, 2010, 67(6): 1609-1621.
18. Li F, Chen Q, Chen W, et al. Posterior-only approach with selective segmental TLIF for degenerative lumbar scoliosis. J Spinal Disord Tech, 2011, 24(5): 308-312.
19. 贺石生. 微创可扩张通道辅助腰椎融合术之管见. 中华骨科杂志, 2011, 31(10): 1022-1023.

Chinese Journal of Reparative and Reconstructive Surgery

MINIMALLY INVASIVE TRANSFORAMINAL LUMBAR INTERBODY FUSION FOR TREATMENT OF DEGENERATIVE LUMBAR SCOLIOSIS STENOSIS

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