COMPARISON OF EFFECTIVENESS BETWEEN PARA-MEDIAN INCISION MINIMALLY INVASIVE AND OPEN TRANSFORAMINAL LUMBAR INTERBODY FUSION FOR SINGLE SEGMENTAL LUMBAR DEGENERATIVE DISEASE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

QIQihua , XIAOQiang , DENGLiang , LIChen ,  DONGXieping

No. 2 Department of Orthopaedics, Jiangxi People's Hospital, Nanchang Jiangxi, 330006, P. R. China;

Corresponding author：

DONGXieping, Email: 13576030901@163.com

Keywords：

Lumbar degenerative disease; Para-median incision; Minimally invasive surgery; Open surgery; Transforaminal lumbar interbody fusion

DOI：

10.7507/1002-1892.20150272

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Objective To investigate the advantage and short- and medium-term effectivenesses of paramedian incision minimally invasive transforaminal lumbar interbody fusion (mini-TLIF) by comparing with open TLIF. Methods A retrospective analysis was made on the clinical data of 54 patients with single segmental lumbar degenerative disease who accorded with the inclusion criteria between January 2012 and March 2014. Open TLIF was performed in 26 patients (open group), mini-TLIF in 28 cases (minimally invasive group). There was no significant difference in gender, age, disease duration, etiology, and affected segments between 2 groups (P>0.05). The indexes of surgical trauma, systemic inflammatory response, clinical outcome, and interbody fusion rate were compared between 2 groups. Results Dural rupture occurred in 1 case of open group, L₅ nerve root injury in 1 case of minimally invasive group. All patients obtained primary healing of incision. The operation time, intraoperative blood loss, and postoperative drainage of minimally invasive group were significantly lower than those of open group (P<0.05). C-reactive protein, leucocyte count, and creatine kinase-MM (CK-MM) of open group were significantly higher than those of minimally invasive group at 24 hours after operation (P<0.05). At 7 days after operation, the CK-MM of minimally invasive group was significantly lower than that of open group (P<0.05), but no significant difference was found in C-reactive protein and leucocyte count between 2 groups (P>0.05). The follow-up time was 1.2-3.1 years in open group and 1.4-2.9 years in minimally invasive group. At 1 year after operation, the Oswestry disability index (ODI) and visual analogue scale (VAS) scores were significantly improved in 2 groups (P<0.05). Minimally invasive group was better than open group in ODI and VAS score of back pain (P<0.05), but VAS score of leg pain showed no significant difference (P>0.05). According to the Suk interbody fusion standard, solid fusion was obtained in 18 cases, probable fusion in 4 cases, and nonunion in 4 cases, and the fusion rate was 84.61% in open group; solid fusion was obtained in 21 cases, probable fusion in 3 cases, and nonunion in 4 cases, and the fusion rate was 85.71% in minimally invasive group; and the interbody fusion rates showed no significant difference between 2 groups (χ²=0.072, P=0.821). Conclusion Compared with open TLIF, paramedian incision mini-TLIF has advantages of minimal surgical trauma and little blood loss for single-level lumbar degenerative disease. The short- and medium-term effectivenesses are satisfactory.

Citation： QIQihua, XIAOQiang, DENGLiang, LIChen, DONGXieping. COMPARISON OF EFFECTIVENESS BETWEEN PARA-MEDIAN INCISION MINIMALLY INVASIVE AND OPEN TRANSFORAMINAL LUMBAR INTERBODY FUSION FOR SINGLE SEGMENTAL LUMBAR DEGENERATIVE DISEASE. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(10): 1253-1258. doi: 10.7507/1002-1892.20150272 Copy

1.	Lowe TG, Tahernia AD, O'Brien MF, et al. Unilateral transforaminal posterior lumbar interbody fusion (TLIF):indications, technique, and 2-year results. J Spinal Disord Tech, 2002, 15(1):31-38.
2.	郝永宏, 邓树才, 李建江, 等. 经椎间孔腰椎椎体间融合术在腰椎翻修术中的应用. 中国修复重建外科杂志, 2011, 25(1):87-90.
3.	Cincu R, Lorente Fde A, Gomez J, et al. A 10-year follow-up of transpedicular screw fixation and intervertebral autogenous posterior iliac crest bone graft or intervertebral B-Twin system in failed back surgery syndrome. Asian J Neurosurg, 2015, 10(2):75-82.
4.	McKenna PJ, Freeman BJ, Mulholland RC, et al. A prospective, randomised controlled trial of femoral ring allograft versus a titanium cage in circumferential lumbar spinal fusion with minimum 2-year clinical results. Eur Spine J, 2005, 14(8):727-737.
5.	Suk SI, Lee CK, Kim WJ, et al. Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine (Phila Pa 1976), 1997, 22(2):210-220.
6.	肖荣驰, 李强, 唐志宏, 等. 腰椎多节段椎间盘突出症合并腰椎管狭窄症的治疗. 中国修复重建外科杂志, 2008, 22(4):404-407.
7.	Feng Y, Chen L, Gu Y, et al. Restoration of the spinopelvic sagittal balance in isthmic spondylolisthesis:posterior lumbar interbody fusion may be better than posterolateral fusion. Spine J, 2015, 15(7): 1527-1535.
8.	Okuda S, Oda T, Yamasaki R, et al. Posterior lumbar interbody fusion with total facetectomy for low-dysplastic isthmic spondylolisthesis:effects of slip reduction on surgical outcomes: clinical article. J Neurosurg Spine, 2014, 21(2):171-178.
9.	Harms J, Rolinger H. A one-stager procedure in operative treatment of spondylolistheses:dorsal traction-reposition and anterior fusion (author's transl). Z Orthop Ihre Grenzgeb, 1982, 120(3):343-347.
10.	Ulutaş M, Yaldız C, Seçer M, et al. Comparison of Wiltse and classical methods in surgery of lumbar spinal stenosis and spondylolisthesis. Neurol Neurochir Pol, 2015, 49(4):251-257.
11.	黎庆初, 胡辉林, 刘宝戈, 等. 多裂肌间隙入路微创手术治疗腰椎滑脱症. 中国脊柱脊髓杂志, 2011, 21(4):303-307.
12.	Kim KT, Lee SH, Suk KS, et al. The quantitative analysis of tissue injury markers after mini-open lumbar fusion. Spine (Phila Pa 1976), 2006, 31(6):712-716.
13.	Terman SW, Yee TJ, Lau D, et al. Minimally invasive versus open transforaminal lumbar interbody fusion:comparison of clinical outcomes among obese patients. J Neurosurg Spine, 2014, 20(6):644-652.
14.	Villacicencio AT, Burneikiene S, Nelson EL, et al. Safety of transdoraminal lumbar interbody fusion and intervertebral recombinant human bone morphogenetic protein-2. J Neurosurg Spine, 2005, 3(6):436-443.
15.	Stevens KJ, Spencier DB, Griffiths KL, et al. Comparison of minimally invasive and conventional open posterolateral lumbar fusion using magnetic resonance imaging and retract ion pressure studies. Spinal Disord Tech, 2006, 19(2):77-86.
16.	康辉, 蔡贤华, 徐峰, 等. MED、Quadrant、Sextant-R系统联合治疗腰椎滑脱症的临床研究. 中国修复重建外科杂志, 2013, 27(4): 399-403.
17.	Lowe TG, Tahrrina AD. Unilateral transforaminal posterior lumbar interbody fusion. Clin Orthop Relat Res, 2002, (394):64-72.
18.	郑扬, 李危石, 陈仲强, 等. 微创与开放经椎间孔椎体间融合术治疗腰椎单节段退行性疾病的临床疗效比较. 中国脊柱脊髓杂志, 2014, 24(12):1064-1071.
19.	Seng C, Siddiqui MA, Wong KP, et al. Five-year outcomes of minimally invasive versus open transforminal lumbar interbody fusion:a matched-pair comparsion study. Spine (Phila Pa 1976), 2013, 38(23):2049-2055.

1. Lowe TG, Tahernia AD, O'Brien MF, et al. Unilateral transforaminal posterior lumbar interbody fusion (TLIF):indications, technique, and 2-year results. J Spinal Disord Tech, 2002, 15(1):31-38.
2. 郝永宏, 邓树才, 李建江, 等. 经椎间孔腰椎椎体间融合术在腰椎翻修术中的应用. 中国修复重建外科杂志, 2011, 25(1):87-90.
3. Cincu R, Lorente Fde A, Gomez J, et al. A 10-year follow-up of transpedicular screw fixation and intervertebral autogenous posterior iliac crest bone graft or intervertebral B-Twin system in failed back surgery syndrome. Asian J Neurosurg, 2015, 10(2):75-82.
4. McKenna PJ, Freeman BJ, Mulholland RC, et al. A prospective, randomised controlled trial of femoral ring allograft versus a titanium cage in circumferential lumbar spinal fusion with minimum 2-year clinical results. Eur Spine J, 2005, 14(8):727-737.
5. Suk SI, Lee CK, Kim WJ, et al. Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine (Phila Pa 1976), 1997, 22(2):210-220.
6. 肖荣驰, 李强, 唐志宏, 等. 腰椎多节段椎间盘突出症合并腰椎管狭窄症的治疗. 中国修复重建外科杂志, 2008, 22(4):404-407.
7. Feng Y, Chen L, Gu Y, et al. Restoration of the spinopelvic sagittal balance in isthmic spondylolisthesis:posterior lumbar interbody fusion may be better than posterolateral fusion. Spine J, 2015, 15(7): 1527-1535.
8. Okuda S, Oda T, Yamasaki R, et al. Posterior lumbar interbody fusion with total facetectomy for low-dysplastic isthmic spondylolisthesis:effects of slip reduction on surgical outcomes: clinical article. J Neurosurg Spine, 2014, 21(2):171-178.
9. Harms J, Rolinger H. A one-stager procedure in operative treatment of spondylolistheses:dorsal traction-reposition and anterior fusion (author's transl). Z Orthop Ihre Grenzgeb, 1982, 120(3):343-347.
10. Ulutaş M, Yaldız C, Seçer M, et al. Comparison of Wiltse and classical methods in surgery of lumbar spinal stenosis and spondylolisthesis. Neurol Neurochir Pol, 2015, 49(4):251-257.
11. 黎庆初, 胡辉林, 刘宝戈, 等. 多裂肌间隙入路微创手术治疗腰椎滑脱症. 中国脊柱脊髓杂志, 2011, 21(4):303-307.
12. Kim KT, Lee SH, Suk KS, et al. The quantitative analysis of tissue injury markers after mini-open lumbar fusion. Spine (Phila Pa 1976), 2006, 31(6):712-716.
13. Terman SW, Yee TJ, Lau D, et al. Minimally invasive versus open transforaminal lumbar interbody fusion:comparison of clinical outcomes among obese patients. J Neurosurg Spine, 2014, 20(6):644-652.
14. Villacicencio AT, Burneikiene S, Nelson EL, et al. Safety of transdoraminal lumbar interbody fusion and intervertebral recombinant human bone morphogenetic protein-2. J Neurosurg Spine, 2005, 3(6):436-443.
15. Stevens KJ, Spencier DB, Griffiths KL, et al. Comparison of minimally invasive and conventional open posterolateral lumbar fusion using magnetic resonance imaging and retract ion pressure studies. Spinal Disord Tech, 2006, 19(2):77-86.
16. 康辉, 蔡贤华, 徐峰, 等. MED、Quadrant、Sextant-R系统联合治疗腰椎滑脱症的临床研究. 中国修复重建外科杂志, 2013, 27(4): 399-403.
17. Lowe TG, Tahrrina AD. Unilateral transforaminal posterior lumbar interbody fusion. Clin Orthop Relat Res, 2002, (394):64-72.
18. 郑扬, 李危石, 陈仲强, 等. 微创与开放经椎间孔椎体间融合术治疗腰椎单节段退行性疾病的临床疗效比较. 中国脊柱脊髓杂志, 2014, 24(12):1064-1071.
19. Seng C, Siddiqui MA, Wong KP, et al. Five-year outcomes of minimally invasive versus open transforminal lumbar interbody fusion:a matched-pair comparsion study. Spine (Phila Pa 1976), 2013, 38(23):2049-2055.

Chinese Journal of Reparative and Reconstructive Surgery

COMPARISON OF EFFECTIVENESS BETWEEN PARA-MEDIAN INCISION MINIMALLY INVASIVE AND OPEN TRANSFORAMINAL LUMBAR INTERBODY FUSION FOR SINGLE SEGMENTAL LUMBAR DEGENERATIVE DISEASE

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