Effectiveness analysis of posterolateral approach lumbar interbody fusion assisted by one-hole split endoscope for L<sub>4, 5</sub> degenerative lumbar spondylolisthesis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Changzhen ¹ , HUANG Weiguo ² , LI Jizheng ³ , GENG Xiaopeng ¹ , DOU Yongfeng ¹ , CAO Shuai ² , HOU Dongpo ² , ZHU Tengyue ⁴ ,  SUN Zhaozhong ¹

1. Department of Spine Surgery, Affiliated Hospital of Binzhou Medical College, Binzhou Shandong, 256603, P. R. China;
2. Department of Orthopedics, Civil Aviation General Hospital, Peking University Affiliated School of Civil Aviation Clinical Medicine, Beijing, 100123, P. R. China;
3. The First Department of Orthopaedics, Yunnan Provincial Hospital of Traditional Chinese Medicine, Kunming Yunnan, 650021, P. R. China;
4. Department of Orthopedics and Traumatology, Department of Traditional Chinese Medicine, the Sixth Medical Center of PLA General Hospital, Beijing, 100048, P. R. China;

Corresponding author：

SUN Zhaozhong, Email: szzbyjzw@126.com

Keywords：

One-hole split endoscope; posterolateral approach lumbar interbody fusion; lumbar spondylolisthesis

DOI：

10.7507/1002-1892.202304098

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Objective To compare the effectiveness of posterolateral approach lumbar interbody fusion assisted by one-hole split endoscope (OSE) and traditional posterior lumbar interbody fusion (PLIF) in the treatment of L_{4, 5} degenerative lumbar spondylolisthesis (DLS). Methods The clinical data of 58 patients with DLS who met the selection criteria admitted between February 2020 and March 2022 were retrospectively analyzed, of which 26 were treated with OSE-assisted posterolateral approach lumbar interbody fusion (OSE group) and 32 were treated with PLIF (PLIF group). There was no significant difference between the two groups in terms of gender, age, body mass index, Meyerding grade, lower limb symptom side, decompression side, stenosis type, and preoperative low back pain visual analogue scale (VAS) score, leg pain VAS score, Oswestry disability index (ODI), and the height of the anterior and posterior margins of the intervertebral space (P>0.05). The operation time, intraoperative blood loss, postoperative hospital stay, and complications were compared between the two groups. The low back pain and leg pain VAS scores and ODI before operation, at 1 month, 6 months after operation, and last follow-up, the height of anterior and posterior margins of the intervertebral space before operation, at 6 months after operation, and last follow-up, the modified MacNab criteria at last follow-up after operation were used to evaluate the effectiveness; and the Bridwell method at last follow-up was used to evaluate the interbody fusion. Results Both groups successfully completed the operation. Compared with the PLIF group, the OSE group showed a decrease in intraoperative blood loss and postoperative hospital stay, but an increase in operation time, with significant differences (P<0.05). In the OSE group, no complication such as nerve root injury and thecal sac tear occurred; in the PLIF group, there were 1 case of thecal sac tear and 1 case of epidural hematoma, which were cured after conservative management. Both groups of patients were followed up 13-20 months with an average of 15.5 months. There was no complication such as loosening, sinking, or displacement of the fusion cage. The low back pain and leg pain VAS scores, ODI, and the height of anterior and posterior margins of the intervertebral space at each time point after operation in both groups were significantly improved when compared with those before operation (P<0.05). Except for the VAS score of lower back pain in the OSE group being significantly better than that in the PLIF group at 1 month after operation (P<0.05), there was no significant difference in all indicators between the two groups at all other time points (P>0.05). At last follow-up, both groups achieved bone fusion, and there was no significant difference in Bridwell interbody fusion and modified MacNab standard evaluation between the two groups (P>0.05). Conclusion OSE-assisted posterolateral approach lumbar interbody fusion for L_{4, 5} DLS, although the operation time is relatively long, but the postoperative hospitalization stay is short, the complications are few, the operation is safe and effective, and the early effectiveness is satisfactory.

Citation： LIU Changzhen, HUANG Weiguo, LI Jizheng, GENG Xiaopeng, DOU Yongfeng, CAO Shuai, HOU Dongpo, ZHU Tengyue, SUN Zhaozhong. Effectiveness analysis of posterolateral approach lumbar interbody fusion assisted by one-hole split endoscope for L_{4, 5} degenerative lumbar spondylolisthesis. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(8): 989-995. doi: 10.7507/1002-1892.202304098 Copy

1.	Wang PT, Zhang JN, Liu TJ, et al. Comparison of degenerative lumbar spondylolisthesis and isthmic lumbar spondylolisthesis: effect of pedicle screw placement on proximal facet invasion in surgical treatment. BMC Musculoskelet Disord, 2022, 23(1): 6.
2.	胡向阳, 胡可君, 朱慧强, 等. 内镜与开放后路椎间融合术治疗腰椎退行疾病. 中国矫形外科杂志, 2023, 31(7): 607-612.
3.	Boonsirikamchai W, Phisalpapra P, Kositamongkol C, et al. Lateral lumbar interbody fusion (LLIF) reduces total lifetime cost compared with posterior lumbar interbody fusion (PLIF) for single-level lumbar spinal fusion surgery: a cost-utility analysis in Thailand. J Orthop Surg Res, 2023, 18(1): 115.
4.	Fenton-White HA. Trailblazing: the historical development of the posterior lumbar interbody fusion (PLIF). Spine J, 2021, 21(9): 1528-1541.
5.	Sriphirom P, Siramanakul C, Chaipanha P, et al. Clinical outcomes of interlaminar percutaneous endoscopic decompression for degenerative lumbar spondylolisthesis with spinal stenosis. Brain Sci, 2021, 11(1): 83.
6.	Kwon JW, Park Y, Lee BH, et al. Ten-year outcomes of minimally invasive versus open transforaminal lumbar interbody fusion in patients with single-level lumbar spondylolisthesis. Spine (Phila Pa 1976), 2022, 47(11): 773-780.
7.	余洋, 王永涛, 谢一舟, 等. 单侧双通道脊柱内镜与3D显微镜辅助经椎间孔腰椎椎体间融合术治疗腰椎滑脱症的中期疗效比较. 中国修复重建外科杂志, 2023, 37(1): 52-58.
8.	Chen H, Zhang H, Yang E, et al. Percutaneous bilateral endoscopic lumbar interbody fusion: Technical note and preliminary results. Biomed Res Int, 2022, 2022: 2227679.
9.	Ruetten S, Komp M, Merk H, et al. Use of newly developed instruments and endoscopes: full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach. J Neurosurg Spine, 2007, 6(6): 521-530.
10.	Wu W, Yang S, Diao W, et al. Analysis of clinical efficacy of endo-LIF in the treatment of single-segment lumbar degenerative diseases. J Clin Neurosci, 2020, 71: 51-57.
11.	Youn MS, Shin JK, Goh TS, et al. Full endoscopic lumbar interbody fusion (FELIF): technical note. Eur Spine J, 2018, 27(8): 1949-1955.
12.	吕剑伟, 朱斌, 钟华璋, 等. 单侧双通道内镜下经椎间孔腰椎椎间融合术治疗腰椎退行性疾病的早期疗效分析. 中国脊柱脊髓杂志, 2022, 32(7): 586-594.
13.	Kang YN, Ho YW, Chu W, et al. Effects and safety of lumbar fusion techniques in lumbar spondylolisthesis: A network meta-analysis of randomized controlled trials. Global Spine J, 2022, 12(3): 493-502.
14.	Wang L, Li H, Zhao Y, et al. Ligamentum-preserved/temporary preserved minimally invasive transforaminal lumbar interbody fusion for lumbar spondylolisthesis: Technical note and 2-year follow-up. Spine (Phila Pa 1976), 2022, 47(8): E328-E336.
15.	Chan AK, Mummaneni PV, Burke JF, et al. Does reduction of the Meyerding grade correlate with outcomes in patients undergoing decompression and fusion for grade Ⅰ degenerative lumbar spondylolisthesis? J Neurosurg Spine, 2021.
16.	Soriano Sánchez JA, Soriano Solís S, Soto García ME, et al. Radiological diagnostic accuracy study comparing Lenke, Bridwell, BSF, and CT-HU fusion grading scales for minimally invasive lumbar interbody fusion spine surgery and its correlation to clinical outcome. Medicine (Baltimore), 2020, 99(21): e19979.
17.	White CA, Patel AV, Butler LR, et al. Comparison of patient preference, understanding, and sentiment for minimally invasive versus open spine surgery. Spine (Phila Pa 1976), 2022, 47(4): 309-316.
18.	Mooney J, Michalopoulos GD, Alvi MA, et al. Minimally invasive versus open lumbar spinal fusion: a matched study investigating patient-reported and surgical outcomes. J Neurosurg Spine, 2021, 36(5): 753-766.
19.	Fukushima M, Ohtomo N, Noma M, et al. Microendoscope-assisted versus open posterior lumbar interbody fusion for lumbar degenerative disease: A multicenter retrospective cohort study. Medicina (Kaunas), 2021, 57(2): 150.
20.	杨进, 孔清泉, 吴浩, 等. 重度腰椎滑脱手术的L₅神经根牵张损伤机制. 中国矫形外科杂志, 2021, 29(17): 1573-1578.
21.	刘玖行, 熊小春, 贾高永, 等. 腰椎滑脱症镜下与开放经椎间孔融合术比较. 中国矫形外科杂志, 2023, 31(1): 21-25.

1. Wang PT, Zhang JN, Liu TJ, et al. Comparison of degenerative lumbar spondylolisthesis and isthmic lumbar spondylolisthesis: effect of pedicle screw placement on proximal facet invasion in surgical treatment. BMC Musculoskelet Disord, 2022, 23(1): 6.
2. 胡向阳, 胡可君, 朱慧强, 等. 内镜与开放后路椎间融合术治疗腰椎退行疾病. 中国矫形外科杂志, 2023, 31(7): 607-612.
3. Boonsirikamchai W, Phisalpapra P, Kositamongkol C, et al. Lateral lumbar interbody fusion (LLIF) reduces total lifetime cost compared with posterior lumbar interbody fusion (PLIF) for single-level lumbar spinal fusion surgery: a cost-utility analysis in Thailand. J Orthop Surg Res, 2023, 18(1): 115.
4. Fenton-White HA. Trailblazing: the historical development of the posterior lumbar interbody fusion (PLIF). Spine J, 2021, 21(9): 1528-1541.
5. Sriphirom P, Siramanakul C, Chaipanha P, et al. Clinical outcomes of interlaminar percutaneous endoscopic decompression for degenerative lumbar spondylolisthesis with spinal stenosis. Brain Sci, 2021, 11(1): 83.
6. Kwon JW, Park Y, Lee BH, et al. Ten-year outcomes of minimally invasive versus open transforaminal lumbar interbody fusion in patients with single-level lumbar spondylolisthesis. Spine (Phila Pa 1976), 2022, 47(11): 773-780.
7. 余洋, 王永涛, 谢一舟, 等. 单侧双通道脊柱内镜与3D显微镜辅助经椎间孔腰椎椎体间融合术治疗腰椎滑脱症的中期疗效比较. 中国修复重建外科杂志, 2023, 37(1): 52-58.
8. Chen H, Zhang H, Yang E, et al. Percutaneous bilateral endoscopic lumbar interbody fusion: Technical note and preliminary results. Biomed Res Int, 2022, 2022: 2227679.
9. Ruetten S, Komp M, Merk H, et al. Use of newly developed instruments and endoscopes: full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach. J Neurosurg Spine, 2007, 6(6): 521-530.
10. Wu W, Yang S, Diao W, et al. Analysis of clinical efficacy of endo-LIF in the treatment of single-segment lumbar degenerative diseases. J Clin Neurosci, 2020, 71: 51-57.
11. Youn MS, Shin JK, Goh TS, et al. Full endoscopic lumbar interbody fusion (FELIF): technical note. Eur Spine J, 2018, 27(8): 1949-1955.
12. 吕剑伟, 朱斌, 钟华璋, 等. 单侧双通道内镜下经椎间孔腰椎椎间融合术治疗腰椎退行性疾病的早期疗效分析. 中国脊柱脊髓杂志, 2022, 32(7): 586-594.
13. Kang YN, Ho YW, Chu W, et al. Effects and safety of lumbar fusion techniques in lumbar spondylolisthesis: A network meta-analysis of randomized controlled trials. Global Spine J, 2022, 12(3): 493-502.
14. Wang L, Li H, Zhao Y, et al. Ligamentum-preserved/temporary preserved minimally invasive transforaminal lumbar interbody fusion for lumbar spondylolisthesis: Technical note and 2-year follow-up. Spine (Phila Pa 1976), 2022, 47(8): E328-E336.
15. Chan AK, Mummaneni PV, Burke JF, et al. Does reduction of the Meyerding grade correlate with outcomes in patients undergoing decompression and fusion for grade Ⅰ degenerative lumbar spondylolisthesis? J Neurosurg Spine, 2021.
16. Soriano Sánchez JA, Soriano Solís S, Soto García ME, et al. Radiological diagnostic accuracy study comparing Lenke, Bridwell, BSF, and CT-HU fusion grading scales for minimally invasive lumbar interbody fusion spine surgery and its correlation to clinical outcome. Medicine (Baltimore), 2020, 99(21): e19979.
17. White CA, Patel AV, Butler LR, et al. Comparison of patient preference, understanding, and sentiment for minimally invasive versus open spine surgery. Spine (Phila Pa 1976), 2022, 47(4): 309-316.
18. Mooney J, Michalopoulos GD, Alvi MA, et al. Minimally invasive versus open lumbar spinal fusion: a matched study investigating patient-reported and surgical outcomes. J Neurosurg Spine, 2021, 36(5): 753-766.
19. Fukushima M, Ohtomo N, Noma M, et al. Microendoscope-assisted versus open posterior lumbar interbody fusion for lumbar degenerative disease: A multicenter retrospective cohort study. Medicina (Kaunas), 2021, 57(2): 150.
20. 杨进, 孔清泉, 吴浩, 等. 重度腰椎滑脱手术的L₅神经根牵张损伤机制. 中国矫形外科杂志, 2021, 29(17): 1573-1578.
21. 刘玖行, 熊小春, 贾高永, 等. 腰椎滑脱症镜下与开放经椎间孔融合术比较. 中国矫形外科杂志, 2023, 31(1): 21-25.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness analysis of posterolateral approach lumbar interbody fusion assisted by one-hole split endoscope for L_{4, 5} degenerative lumbar spondylolisthesis

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Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness analysis of posterolateral approach lumbar interbody fusion assisted by one-hole split endoscope for L4, 5 degenerative lumbar spondylolisthesis

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Effectiveness analysis of posterolateral approach lumbar interbody fusion assisted by one-hole split endoscope for L_{4, 5} degenerative lumbar spondylolisthesis