Comparison of minimally invasive transforaminal lumbar interbody fusion between two approaches in treatment of single-segment lumbar spinal stenosis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHONG Rui ^1,2 , WANG Runsheng ¹ , LIU Jianheng ¹ , HAN Zhenchuan ¹ , JIANG Wei ¹ , LIU Qingzu ¹ ,  MAO Keya ¹

1. Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, P.R.China;
2. Department of Spinal Surgery, Sport Hospital Affiliated to Chengdu Sport University, Chengdu Sichuan, 610041, P.R.China;

Corresponding?author：

MAO Keya, Email: maokeya@sina.com

Keywords：

Lumbar spinal stenosis; minimally invasive surgery; decompression; spinal fusion

DOI：

10.7507/1002-1892.201903096

Video：

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Objective To compare the effectiveness of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with bilateral decompression via unilateral approach and bilateral decompression via bilateral approaches in the treatment of single-segment lumbar spinal stenosis.Methods Between February 2015 and January 2017, 70 cases of single-segment lumbar spinal stenosis were treated with MIS-TLIF. The bilateral decompression via unilateral approach (group U) was performed in 36 cases and bilateral decompression via bilateral approaches (group B) in 34 cases. There was no significant difference in age, gender, body mass index, disease duration, distribution of responsibility segments, preoperative visual analogue scale (VAS) score of low back pain and leg pain and Oswestry disability index (ODI) score (P>0.05). The operation time, intraoperative blood loss, hospitalization stay after operation, complications related to operation, incidence of asymptomatic lateral root symptoms, VAS scores of low back pain and leg pain, and ODI score before and after operation were compared between the two groups. X-ray film and CT scan at 12 months after operation were used to assessted the intervertebral bony fusion.Results The operation time and intraoperative blood loss in group U were significantly less than those in group B (P<0.05). There was no significant difference in hospitalization stay after operation between the two groups (t=–0.311, P=0.757). During the operation, 1 case in group U and 2 cases in group B had dural tear. No screw placement related nerve injury or asymptomatic lateral root symptoms occurred after operation. The patients were followed up 24 to 38 months, with an average of 32.8 months in group U and 35.5 months in group B. The VAS scores of low back pain and leg pain at 2 days, 3, 6, and 12 months after operation were significantly lower than that before operation in the two groups (P<0.05), and there was no significant difference between the two groups (P>0.05). The ODI scores at 3, 6 and 12 months after operation were significantly lower than that before operation in the two groups (P<0.05), and there was no significant difference between the two groups (P>0.05). Radiographic examination showed interbody fusion at 12 months after operation in the two groups.Conclusion MIS-TLIF is safe and effective in the treatment of single-segment lumbar spinal stenosis with bilateral decompression via unilateral approach and bilateral decompression via bilateral approaches. Bilateral decompression via unilateral approach takes less operation time and has less intraoperative blood loss.

Citation： ZHONG Rui, WANG Runsheng, LIU Jianheng, HAN Zhenchuan, JIANG Wei, LIU Qingzu, MAO Keya. Comparison of minimally invasive transforaminal lumbar interbody fusion between two approaches in treatment of single-segment lumbar spinal stenosis. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(7): 807-813. doi: 10.7507/1002-1892.201903096 Copy

1.	F?rsth P, ólafsson G, Carlsson T, et al. A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med, 2016, 374(15): 1413-1423.
2.	Deyo RA, Mirza SK, Martin BI, et al. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA, 2010, 303(13): 1259-1265.
3.	Zhao YZ, Zhu YJ, Zhang H, et al. Comparison of bilateral versus unilateral decompression incision of minimally invasive transforaminal lumbar interbody fusion in two-level degenerative lumbar diseases. Int Orthop, 2018, 42(12): 2835-2842.
4.	Kim JS, Jung B, Lee SH. Instrumented minimally invasive spinal-transforaminal lumbar interbody fusion (MIS-TLIF): minimum 5-year follow-up with clinical and radiologic outcomes. Clin Spine Surg, 2018, 31(6): E302-E309.
5.	Lin JH, Chiang YH. Unilateral approach for bilateral foramen decompression in minimally invasive transforaminal interbody fusion. World Neurosurg, 2014, 82(5): 891-896.
6.	Schizas C, Theumann N, Burn A, et al. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine (Phila Pa 1976), 2010, 35(21): 1919-1924.
7.	王潤生, 毛克亞, 黃承軍, 等. 微創經椎間孔腰椎椎間融合術中橫突定位法置釘的影像學評價. 中國脊柱脊髓雜志, 2018, 28(4): 336-342.
8.	韓振川, 毛克亞, 王博, 等. 微創經椎間孔腰椎椎體間融合術后切口注射羅哌卡因的鎮痛效果. 脊柱外科雜志, 2016, 14(2): 79-82.
9.	毛克亞, 王巖, 肖嵩華, 等. 微創手術治療單節段腰椎管狹窄癥的療效評價. 中國脊柱脊髓雜志, 2011, 21(2): 113-117.
10.	Bridwell KH, Lenke LG, McEnery KW, et al. Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine (Phila Pa 1976), 1995, 20(12): 1410-1418.
11.	Kovacs FM, Urrútia G, Alarcón JD. Surgery versus conservative treatment for symptomatic lumbar spinal stenosis: a systematic review of randomized controlled trials. Spine (Phila Pa 1976), 2011, 36(20): E1335-E1351.
12.	保國鋒, 李衛東, 徐冠華, 等. 經皮椎板間隙入路 270° 椎管減壓治腰椎管狹窄癥. 中國矯形外科雜志, 2017, 25(3): 264-269.
13.	徐寶山, 常峰, 趙劉軍, 等. 經皮椎間孔入路內鏡下治療腰椎管狹窄癥術后再手術的臨床報告. 中華骨科雜志, 2018, 38(8): 485-496.
14.	Bae HW, Rajaee SS, Kanim LE. Nationwide trends in the surgical management of lumbar spinal stenosis. Spine (Phila Pa 1976), 2013, 38(11): 916-926.
15.	Kim JE, Choi DJ. Biportal endoscopic transforaminal lumbar interbody fusion with arthroscopy. Clin Orthop Surg, 2018, 10(2): 248-252.
16.	Ge DH, Stekas ND, Varlotta CG, et al. Comparative analysis of two transforaminal lumbar interbody fusion techniques: open TLIF versus Wiltse MIS TLIF. Spine (Phila Pa 1976), 2019, 44(9): E555-E556.
17.	de Kunder SL, van Kuijk SMJ, Rijkers K, et al. Transforaminal lumbar interbody fusion (TLIF) versus posterior lumbar interbody fusion (PLIF) in lumbar spondylolisthesis: a systematic review and meta-analysis. Spine J, 2017, 17(11): 1712-1721.
18.	Hu W, Tang J, Wu X, et al. Minimally invasive versus open transforaminal lumbar fusion: a systematic review of complications. Int Orthop, 2016, 40(9): 1883-1890.
19.	Tan JH, Liu G, Ng R, et al. Is MIS-TLIF superior to open TLIF in obese patients?: A systematic review and meta-analysis Eur Spine J, 2018, 27(8): 1877-1886.
20.	Khechen B, Haws BE, Patel DV, et al. Comparison of postoperative outcomes between primary MIS TLIF and MIS TLIF with revision decompression. Spine (Phila Pa 1976), 2019, 44(2): 150-156.
21.	劉新宇, 原所茂, 田永昊, 等. 微創經椎間孔腰椎椎間融合在腰椎退行性疾病翻修中的應用. 中華骨科雜志, 2017, 37(3): 137-144.
22.	劉超, 王建, 張正豐, 等. 微創經椎間孔腰椎椎間融合治療腰椎退變性疾病的中遠期療效分析. 中華骨科雜志, 2018, 38(20): 1266-1272.
23.	Qin RQ, Liu B, Zhou P, et al. Minimally invasive versus traditional open transforaminal lumbar interbody fusion for the treatment of single-level spondylolisthesis grades 1 and 2: A systematic review and meta-analysis. World Neurosurgery, 2019, 122: 180-189.
24.	遲成, 張建黨, 鄒德威, 等. 單側癥狀的雙側腰椎神經根管狹窄行單、雙側減壓的前瞻性研究. 中國脊柱脊髓雜志, 2013, 23(4): 325-329.
25.	張磊, 方向前, 趙興, 等. 經椎間孔單側入路雙側減壓融合內固定術治療腰椎管狹窄癥的近期療效觀察. 中國修復重建外科雜志, 2017, 31(5): 519-526.
26.	Kim MC, Park JU, Kim WC, et al. Can unilateral-approach minimally invasive transforaminal lumbar interbody fusion attain indirect contralateral decompression? A preliminary report of 66 MRI analysis Eur S J, 2014, 23(5): 1144-1149.
27.	莢龍, 曾至立, 于研, 等. 固定通道下微創經椎間孔腰椎椎間融合術治療單節段腰椎退行性疾病的臨床療效. 中華骨科雜志, 2018, 38(20): 1258-1265.
28.	Choi WS, Kim JS, Hur JW, et al. Minimally invasive transforaminal lumbar interbody fusion using banana-shaped and straight cages: radiological and clinical results from a prospective randomized clinical trial. Neurosurgery, 2018, 82(3): 289-297.
29.	Sharif S, Afsar A. Learning curve and minimally invasive spine surgery. World Neurosurgery, 2018, 119: 472-478.

1. F?rsth P, ólafsson G, Carlsson T, et al. A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med, 2016, 374(15): 1413-1423.
2. Deyo RA, Mirza SK, Martin BI, et al. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA, 2010, 303(13): 1259-1265.
3. Zhao YZ, Zhu YJ, Zhang H, et al. Comparison of bilateral versus unilateral decompression incision of minimally invasive transforaminal lumbar interbody fusion in two-level degenerative lumbar diseases. Int Orthop, 2018, 42(12): 2835-2842.
4. Kim JS, Jung B, Lee SH. Instrumented minimally invasive spinal-transforaminal lumbar interbody fusion (MIS-TLIF): minimum 5-year follow-up with clinical and radiologic outcomes. Clin Spine Surg, 2018, 31(6): E302-E309.
5. Lin JH, Chiang YH. Unilateral approach for bilateral foramen decompression in minimally invasive transforaminal interbody fusion. World Neurosurg, 2014, 82(5): 891-896.
6. Schizas C, Theumann N, Burn A, et al. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine (Phila Pa 1976), 2010, 35(21): 1919-1924.
7. 王潤生, 毛克亞, 黃承軍, 等. 微創經椎間孔腰椎椎間融合術中橫突定位法置釘的影像學評價. 中國脊柱脊髓雜志, 2018, 28(4): 336-342.
8. 韓振川, 毛克亞, 王博, 等. 微創經椎間孔腰椎椎體間融合術后切口注射羅哌卡因的鎮痛效果. 脊柱外科雜志, 2016, 14(2): 79-82.
9. 毛克亞, 王巖, 肖嵩華, 等. 微創手術治療單節段腰椎管狹窄癥的療效評價. 中國脊柱脊髓雜志, 2011, 21(2): 113-117.
10. Bridwell KH, Lenke LG, McEnery KW, et al. Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine (Phila Pa 1976), 1995, 20(12): 1410-1418.
11. Kovacs FM, Urrútia G, Alarcón JD. Surgery versus conservative treatment for symptomatic lumbar spinal stenosis: a systematic review of randomized controlled trials. Spine (Phila Pa 1976), 2011, 36(20): E1335-E1351.
12. 保國鋒, 李衛東, 徐冠華, 等. 經皮椎板間隙入路 270° 椎管減壓治腰椎管狹窄癥. 中國矯形外科雜志, 2017, 25(3): 264-269.
13. 徐寶山, 常峰, 趙劉軍, 等. 經皮椎間孔入路內鏡下治療腰椎管狹窄癥術后再手術的臨床報告. 中華骨科雜志, 2018, 38(8): 485-496.
14. Bae HW, Rajaee SS, Kanim LE. Nationwide trends in the surgical management of lumbar spinal stenosis. Spine (Phila Pa 1976), 2013, 38(11): 916-926.
15. Kim JE, Choi DJ. Biportal endoscopic transforaminal lumbar interbody fusion with arthroscopy. Clin Orthop Surg, 2018, 10(2): 248-252.
16. Ge DH, Stekas ND, Varlotta CG, et al. Comparative analysis of two transforaminal lumbar interbody fusion techniques: open TLIF versus Wiltse MIS TLIF. Spine (Phila Pa 1976), 2019, 44(9): E555-E556.
17. de Kunder SL, van Kuijk SMJ, Rijkers K, et al. Transforaminal lumbar interbody fusion (TLIF) versus posterior lumbar interbody fusion (PLIF) in lumbar spondylolisthesis: a systematic review and meta-analysis. Spine J, 2017, 17(11): 1712-1721.
18. Hu W, Tang J, Wu X, et al. Minimally invasive versus open transforaminal lumbar fusion: a systematic review of complications. Int Orthop, 2016, 40(9): 1883-1890.
19. Tan JH, Liu G, Ng R, et al. Is MIS-TLIF superior to open TLIF in obese patients?: A systematic review and meta-analysis Eur Spine J, 2018, 27(8): 1877-1886.
20. Khechen B, Haws BE, Patel DV, et al. Comparison of postoperative outcomes between primary MIS TLIF and MIS TLIF with revision decompression. Spine (Phila Pa 1976), 2019, 44(2): 150-156.
21. 劉新宇, 原所茂, 田永昊, 等. 微創經椎間孔腰椎椎間融合在腰椎退行性疾病翻修中的應用. 中華骨科雜志, 2017, 37(3): 137-144.
22. 劉超, 王建, 張正豐, 等. 微創經椎間孔腰椎椎間融合治療腰椎退變性疾病的中遠期療效分析. 中華骨科雜志, 2018, 38(20): 1266-1272.
23. Qin RQ, Liu B, Zhou P, et al. Minimally invasive versus traditional open transforaminal lumbar interbody fusion for the treatment of single-level spondylolisthesis grades 1 and 2: A systematic review and meta-analysis. World Neurosurgery, 2019, 122: 180-189.
24. 遲成, 張建黨, 鄒德威, 等. 單側癥狀的雙側腰椎神經根管狹窄行單、雙側減壓的前瞻性研究. 中國脊柱脊髓雜志, 2013, 23(4): 325-329.
25. 張磊, 方向前, 趙興, 等. 經椎間孔單側入路雙側減壓融合內固定術治療腰椎管狹窄癥的近期療效觀察. 中國修復重建外科雜志, 2017, 31(5): 519-526.
26. Kim MC, Park JU, Kim WC, et al. Can unilateral-approach minimally invasive transforaminal lumbar interbody fusion attain indirect contralateral decompression? A preliminary report of 66 MRI analysis Eur S J, 2014, 23(5): 1144-1149.
27. 莢龍, 曾至立, 于研, 等. 固定通道下微創經椎間孔腰椎椎間融合術治療單節段腰椎退行性疾病的臨床療效. 中華骨科雜志, 2018, 38(20): 1258-1265.
28. Choi WS, Kim JS, Hur JW, et al. Minimally invasive transforaminal lumbar interbody fusion using banana-shaped and straight cages: radiological and clinical results from a prospective randomized clinical trial. Neurosurgery, 2018, 82(3): 289-297.
29. Sharif S, Afsar A. Learning curve and minimally invasive spine surgery. World Neurosurgery, 2018, 119: 472-478.

Chinese Journal of Reparative and Reconstructive Surgery

Comparison of minimally invasive transforaminal lumbar interbody fusion between two approaches in treatment of single-segment lumbar spinal stenosis

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