Comparative study of microendoscope-assisted and conventional minimally invasive transforaminal lumbar interbody fusion for degenerative lumbar diseases_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

DONG Jianwen , YANG Yang , CHEN Zihao , YU Mingzhu , LIU Bin , WANG Qiyou , XIE Peigen , CHEN Ruiqiang ,  RONG Limin

Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou Guangdong, 510630, P.R.China;

Corresponding author：

RONG Limin, Email: ronglimin@21cn.com

Keywords：

Minimally invasive spine surgery; transforaminal lumbar interbody fusion; microendoscope; lumbar degenerative disease

DOI：

10.7507/1002-1892.201903112

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Objective To analyze the medium and long-term effectiveness of microendoscope-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar degenerative diseases in comparison with conventional tubular retractor-assisted MIS-TLIF. Methods Between November 2008 and March 2013, 53 patients with single segment lumbar degenerative diseases were enrolled. According to the different working channel performed, 28 patients were treated by microendoscope-assisted MIS-TLIF (observation group), while the remaining cases received conventional tubular retractor-assisted MIS-TLIF via Wiltse approach (control group). Preoperative baseline data, including age, gender, body mass index, disease etiology, operated level, the ration for requiring bilateral canal decompression, and preoperative visual analogue scale (VAS) socre of low back pain and leg pain, Japanese Orthopedic Association (JOA) score, Oswestry disability index (ODI) score, showed no significant difference between the two groups (P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy time, postoperative analgesic drug dose, postoperation in-bed time, and perioperative complication incidence were recorded respectively and compared between the two groups. Radiographic evaluation of interbody fusion was performed based on Bridwell grading system at 2 years after operation. VAS scores of low back pain and leg pain, JOA score, and ODI score were assessed before operation, at 2 years after operation, and at last follow-up respectively. Surgical outcome satisfaction was assessed by modified MacNab criteria at last follow-up. Results When compared with those in control group, both intraoperative blood loss and postoperative analgesic drug dose were significantly decreased in observation group (P<0.05); similarly, the operation time and intraoperative fluoroscopy time were also significantly increased in observation group (P<0.05). There was no significant difference of postoperative in-bed time between the two groups (t=–0.812, P=0.420). Both groups were followed up 6-10.3 years, with an average of 7.9 years. Regarding perioperative complication, its incidence was 14.3% and 20.0% in observation group and control group, respectively, showing no significant difference between both groups (χ²=0.306, P=0.580). Specifically, there were intraspinal hematoma formation in 1 case, incision infection in 1 case, urinary infection in 1 case, transient delirium in 1 case in observation group. By contrast, there were dural tear and cerebrospinal fluid leakage in 1 case, urinary infection in 1 case, pneumonia in 1 case, transient delirium in 2 cases in control group. Bridwell criterion was used to judge the intervertebral fusion at 2 years after operation, the fusion rates of observation group and control group were 92.9% and 92.0%, respectively, showing no significant difference (χ²=0.162, P=0.687). At both 2-year postoperatively and last follow-up, the VAS scores of low back pain and leg pain, JOA score, and ODI score were significantly improved when compared with those before operation (P<0.01), whereas no significant difference between the two groups at either time point was found (P>0.05). At last follow-up, the results of patients’ satisfaction with surgery evaluated by modified MacNab criteria, and the excellent and good rates of the observation group and the control group were 96.4% and 92.0%, respectively, showing no significant difference (χ²=0.485, P=0.486). Conclusion The medium and long-term effectiveness of microendoscope-assisted MIS-TLIF are similar to those of conventional tubular retractor-assisted MIS-TLIF for lumbar degenerative diseases. The former operation has the additional advantages in terms of more clear surgical site visually, less intraoperative blood loss, and reduced postoperative analgesic dose, all of which seem more feasible to clinical teaching.

Citation： DONG Jianwen, YANG Yang, CHEN Zihao, YU Mingzhu, LIU Bin, WANG Qiyou, XIE Peigen, CHEN Ruiqiang, RONG Limin. Comparative study of microendoscope-assisted and conventional minimally invasive transforaminal lumbar interbody fusion for degenerative lumbar diseases. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(7): 814-821. doi: 10.7507/1002-1892.201903112 Copy

1.	Oppenheimer JH, DeCastro I, McDonnell DE. Minimally invasive spine technology and minimally invasive spine surgery: a historical review. Neurosurg Focus, 2009, 27(3): E9.
2.	Schwender JD, Holly LT, Rouben DP, et al. Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. J Spinal Disord Tech, 2005, 18(Suppl): S1-S6.
3.	Seng C, Siddiqui MA, Wong KP, et al. Five-year outcomes of minimally invasive versus open transforaminal lumbar interbody fusion: a matched-pair comparison study. Spine (Phila Pa 1976), 2013, 38(23): 2049-2055.
4.	Perez-Cruet MJ, Hussain NS, White GZ, et al. Quality-of-life outcomes with minimally invasive transforaminal lumbar interbody fusion based on long-term analysis of 304 consecutive patients. Spine (Phila Pa 1976), 2014, 39(3): E191-E198.
5.	Cheng JS, Park P, Le H, et al. Short-term and long-term outcomes of minimally invasive and open transforaminal lumbar interbody fusions: is there a difference? Neurosurg Focus, 2013, 35(2): E6.
6.	Bevevino AJ, Kang DG, Lehman RA Jr, et al. Systematic review and meta-analysis of minimally invasive transforaminal lumbar interbody fusion rates performed without posterolateral fusion. J Clin Neurosci, 2014, 21(10): 1686-1690.
7.	张磊, 方向前, 赵兴, 等. 经椎间孔单侧入路双侧减压融合内固定术治疗腰椎管狭窄症的近期疗效观察. 中国修复重建外科杂志, 2017, 31(5): 519-526.
8.	Tay KS, Bassi A, Yeo W, et al. Intraoperative reduction does not result in better outcomes in low-grade lumbar spondylolisthesis with neurogenic symptoms after minimally invasive transforaminal lumbar interbody fusion-a 5-year follow-up study. Spine J, 2016, 16(2): 182-190.
9.	Sihvonen T, Herno A, Paljärvi L, et al. Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine (Phila Pa 1976), 1993, 18(5): 575-581.
10.	Vialle R, Wicart P, Drain O, et al. The Wiltse paraspinal approach to the lumbar spine revisited: an anatomic study. Clin Orthop Relat Res, 2006, 445: 175-180.
11.	Tsutsumimoto T, Shimogata M, Ohta H, et al. Mini-open versus conventional open posterior lumbar interbody fusion for the treatment of lumbar degenerative spondylolisthesis: comparison of paraspinal muscle damage and slip reduction. Spine (Phila Pa 1976), 2009, 34(18): 1923-1928.
12.	Dong J, Rong L, Feng F, et al. Unilateral pedicle screw fixation through a tubular retractor via the Wiltse approach compared with conventional bilateral pedicle screw fixation for single-segment degenerative lumbar instability: a prospective randomized study. J Neurosurg Spine, 2014, 20(1): 53-59.
13.	郜德龙, 方忠, 孙允龙, 等. 同种异体骨Cage在经椎间孔腰椎椎间融合手术中的应用. 中国修复重建外科杂志, 2018, 32(7): 927-932.
14.	Lee JC, Jang HD, Shin BJ. Learning curve and clinical outcomes of minimally invasive transforaminal lumbar interbody fusion: our experience in 86 consecutive cases. Spine (Phila Pa 1976), 2012, 37(18): 1548-1557.
15.	Silva PS, Pereira P, Monteiro P, et al. Learning curve and complications of minimally invasive transforaminal lumbar interbody fusion. Neurosurg Focus, 2013, 35(2): E7.
16.	Goh GS, Liow MHL, Yeo W, et al. The influence of body mass index on functional outcomes, satisfaction and return to work after single-level minimally-invasive transforaminal lumbar interbody fusion: a five-year follow-up study. Spine (Phila Pa 1976), 2018. [Epub ahead of print].
17.	Isaacs RE, Podichetty VK, Santiago P, et al. Minimally invasive microendoscopy-assisted transforaminal lumbar interbody fusion with instrumentation. J Neurosurg Spine, 2005, 3(2): 98-105.
18.	周跃, 王健, 初同伟, 等. 内窥镜下经 X-Tube 单侧和双侧腰椎椎弓根螺钉固定的疗效评价. 中华创伤杂志, 2007, 23(9): 654-658.
19.	戎利民, 刘斌, 谢沛根, 等. 显微内镜辅助经皮微创椎间孔入路腰椎椎体间融合术治疗腰椎退行性疾病. 中国骨与关节外科, 2012, 5(2): 120-125.
20.	Wu H, Yu WD, Jiang R, et al. Treatment of multilevel degenerative lumbar spinal stenosis with spondylolisthesis using a combination of microendoscopic discectomy and minimally invasive transforaminal lumbar interbody fusion. Exp Ther Med, 2013, 5(2): 567-571.
21.	Yang Y, Liu B, Rong LM, et al. Microendoscopy-assisted minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative disease: short-term and medium-term outcomes. Int J Clin Exp Med, 2015, 8(11): 21319-21326.
22.	Yang Y, Liu ZY, Zhang LM, et al. Microendoscopy-assisted minimally invasive versus open transforaminal lumbar interbody fusion for lumbar degenerative diseases: 5-year outcomes. World Neurosurg, 2018, 116: e602-e610.
23.	Yang Yang, Liangming Zhang, Bin Liu, et al. Learning curve of microendoscopy-assisted minimally invasive transforaminal lumbar interbody fusion: 65 consecutive cases of one surgeon. Int J Clin Exp Med, 2017, 10(6): 9424-9431.
24.	Yang Y, Liu ZY, Zhang LM, et al. Risk factor of contralateral radiculopathy following microendoscopy-assisted minimally invasive transforaminal lumbar interbody fusion. Eur Spine J, 2018, 27(8): 1925-1932.
25.	Yang Y, Zhang L, Liu B, et al. Hidden and overall haemorrhage following minimally invasive and open transforaminal lumbar interbody fusion. J Orthop Traumatol, 2017, 18(4): 395-400.

1. Oppenheimer JH, DeCastro I, McDonnell DE. Minimally invasive spine technology and minimally invasive spine surgery: a historical review. Neurosurg Focus, 2009, 27(3): E9.
2. Schwender JD, Holly LT, Rouben DP, et al. Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. J Spinal Disord Tech, 2005, 18(Suppl): S1-S6.
3. Seng C, Siddiqui MA, Wong KP, et al. Five-year outcomes of minimally invasive versus open transforaminal lumbar interbody fusion: a matched-pair comparison study. Spine (Phila Pa 1976), 2013, 38(23): 2049-2055.
4. Perez-Cruet MJ, Hussain NS, White GZ, et al. Quality-of-life outcomes with minimally invasive transforaminal lumbar interbody fusion based on long-term analysis of 304 consecutive patients. Spine (Phila Pa 1976), 2014, 39(3): E191-E198.
5. Cheng JS, Park P, Le H, et al. Short-term and long-term outcomes of minimally invasive and open transforaminal lumbar interbody fusions: is there a difference? Neurosurg Focus, 2013, 35(2): E6.
6. Bevevino AJ, Kang DG, Lehman RA Jr, et al. Systematic review and meta-analysis of minimally invasive transforaminal lumbar interbody fusion rates performed without posterolateral fusion. J Clin Neurosci, 2014, 21(10): 1686-1690.
7. 张磊, 方向前, 赵兴, 等. 经椎间孔单侧入路双侧减压融合内固定术治疗腰椎管狭窄症的近期疗效观察. 中国修复重建外科杂志, 2017, 31(5): 519-526.
8. Tay KS, Bassi A, Yeo W, et al. Intraoperative reduction does not result in better outcomes in low-grade lumbar spondylolisthesis with neurogenic symptoms after minimally invasive transforaminal lumbar interbody fusion-a 5-year follow-up study. Spine J, 2016, 16(2): 182-190.
9. Sihvonen T, Herno A, Paljärvi L, et al. Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine (Phila Pa 1976), 1993, 18(5): 575-581.
10. Vialle R, Wicart P, Drain O, et al. The Wiltse paraspinal approach to the lumbar spine revisited: an anatomic study. Clin Orthop Relat Res, 2006, 445: 175-180.
11. Tsutsumimoto T, Shimogata M, Ohta H, et al. Mini-open versus conventional open posterior lumbar interbody fusion for the treatment of lumbar degenerative spondylolisthesis: comparison of paraspinal muscle damage and slip reduction. Spine (Phila Pa 1976), 2009, 34(18): 1923-1928.
12. Dong J, Rong L, Feng F, et al. Unilateral pedicle screw fixation through a tubular retractor via the Wiltse approach compared with conventional bilateral pedicle screw fixation for single-segment degenerative lumbar instability: a prospective randomized study. J Neurosurg Spine, 2014, 20(1): 53-59.
13. 郜德龙, 方忠, 孙允龙, 等. 同种异体骨Cage在经椎间孔腰椎椎间融合手术中的应用. 中国修复重建外科杂志, 2018, 32(7): 927-932.
14. Lee JC, Jang HD, Shin BJ. Learning curve and clinical outcomes of minimally invasive transforaminal lumbar interbody fusion: our experience in 86 consecutive cases. Spine (Phila Pa 1976), 2012, 37(18): 1548-1557.
15. Silva PS, Pereira P, Monteiro P, et al. Learning curve and complications of minimally invasive transforaminal lumbar interbody fusion. Neurosurg Focus, 2013, 35(2): E7.
16. Goh GS, Liow MHL, Yeo W, et al. The influence of body mass index on functional outcomes, satisfaction and return to work after single-level minimally-invasive transforaminal lumbar interbody fusion: a five-year follow-up study. Spine (Phila Pa 1976), 2018. [Epub ahead of print].
17. Isaacs RE, Podichetty VK, Santiago P, et al. Minimally invasive microendoscopy-assisted transforaminal lumbar interbody fusion with instrumentation. J Neurosurg Spine, 2005, 3(2): 98-105.
18. 周跃, 王健, 初同伟, 等. 内窥镜下经 X-Tube 单侧和双侧腰椎椎弓根螺钉固定的疗效评价. 中华创伤杂志, 2007, 23(9): 654-658.
19. 戎利民, 刘斌, 谢沛根, 等. 显微内镜辅助经皮微创椎间孔入路腰椎椎体间融合术治疗腰椎退行性疾病. 中国骨与关节外科, 2012, 5(2): 120-125.
20. Wu H, Yu WD, Jiang R, et al. Treatment of multilevel degenerative lumbar spinal stenosis with spondylolisthesis using a combination of microendoscopic discectomy and minimally invasive transforaminal lumbar interbody fusion. Exp Ther Med, 2013, 5(2): 567-571.
21. Yang Y, Liu B, Rong LM, et al. Microendoscopy-assisted minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative disease: short-term and medium-term outcomes. Int J Clin Exp Med, 2015, 8(11): 21319-21326.
22. Yang Y, Liu ZY, Zhang LM, et al. Microendoscopy-assisted minimally invasive versus open transforaminal lumbar interbody fusion for lumbar degenerative diseases: 5-year outcomes. World Neurosurg, 2018, 116: e602-e610.
23. Yang Yang, Liangming Zhang, Bin Liu, et al. Learning curve of microendoscopy-assisted minimally invasive transforaminal lumbar interbody fusion: 65 consecutive cases of one surgeon. Int J Clin Exp Med, 2017, 10(6): 9424-9431.
24. Yang Y, Liu ZY, Zhang LM, et al. Risk factor of contralateral radiculopathy following microendoscopy-assisted minimally invasive transforaminal lumbar interbody fusion. Eur Spine J, 2018, 27(8): 1925-1932.
25. Yang Y, Zhang L, Liu B, et al. Hidden and overall haemorrhage following minimally invasive and open transforaminal lumbar interbody fusion. J Orthop Traumatol, 2017, 18(4): 395-400.

Chinese Journal of Reparative and Reconstructive Surgery

Comparative study of microendoscope-assisted and conventional minimally invasive transforaminal lumbar interbody fusion for degenerative lumbar diseases

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