Comparative study of microscope assisted minimally invasive anterior fusion and mobile microendoscopic discectomy assisted fusion for lumbar degenerative diseases_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 XU Baoshan , XU Haiwei , LIU Yue , LI Ning , JIANG Hongfeng , DU Lilong , WANG Tao

Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin, 300211, P. R. China;

Corresponding?author：

XU Baoshan, Email: xubaoshan99@126.com

Keywords：

Lumbar degenerative disease; interbody fusion; microendoscopic discectomy; microscope; anterior surgery

DOI：

10.7507/1002-1892.202202039

Video：

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Objective To investigate the effectiveness of microscope assisted anterior lumbar discectomy and fusion (ALDF) and mobile microendoscopic discectomy assisted lumbar interbody fusion (MMED-LIF) for lumbar degenerative diseases. Methods A clinical data of 163 patients with lumbar degenerative diseases who met the criteria between January 2018 and December 2020 was retrospectively analyzed. Fifty-three cases were treated with microscope assisted ALDF (ALDF group) and 110 cases with MMED-LIF (MMED-LIF group). There was no significant difference between the two groups in terms of gender, age, disease type, surgical segments, preoperative visual analogue scale (VAS) scores of low back pain and leg pain, Oswestry disability index (ODI), intervertebral space height, lordosis angle, and spondylolisthesis rate of the patients with lumbar spondylolisthesis (P>0.05). The operation time, intraoperative blood loss, and hospital stay of the two groups were recorded. The effectiveness was evaluated by VAS scores of low back pain and leg pain and ODI. Postoperative lumbar X-ray films were taken to observe the position of Cage and measure the intervertebral space height, lordosis angle, and spondylolisthesis rate of the patients with lumbar spondylolisthesis. Results The operations were successfully completed in both groups. The operation time, intraoperative blood loss, and hospital stay in ALDF group were less than those in MMED-LIF group (P<0.05). The patients in both groups were followed up 12-36 months, with an average of 24 months. The VAS scores of low back pain and leg pain and ODI after operation were lower than those before operation in the two groups, and showed a continuous downward trend, with significant differences between different time points (P<0.05). There were significant differences between two groups in VAS score of low back pain and ODI (P<0.05) and no significant difference in VAS score of leg pain (P>0.05) at each time point. The improvement rates of VAS score of low back pain and ODI in ALDF group were significantly higher than those in MMED-LIF group (t=7.187, P=0.000; t=2.716, P=0.007), but there was no significant difference in the improvement rate of VAS score of leg pain (t=0.556, P=0.579). The postoperative lumbar X-ray films showed the significant recovery of the intervertebral space height, lordosis angle, and spondylolisthesis rate at 2 days after operation when compared with preoperation (P<0.05), and the improvements were maintained until last follow-up (P>0.05). The improvement rates of intervertebral space height and lordosis angle in ALDF group were significantly higher than those in MMED-LIF group (P<0.05). There was no significant difference in the reduction rate of spondylolisthesis between the two groups (t=1.396, P=0.167). During follow-up, there was no loosening or breakage of the implant and no displacement or sinking of the Cage. Conclusion Under appropriate indications, microscope assisted ALDF and MMED-LIF both can achieve good results for lumbar degenerative diseases. Microscope assisted ALDF was superior to MMED-LIF in the improvement of low back pain and function and the recovery of intervertebral space height and lordosis angle.

Citation： XU Baoshan, XU Haiwei, LIU Yue, LI Ning, JIANG Hongfeng, DU Lilong, WANG Tao. Comparative study of microscope assisted minimally invasive anterior fusion and mobile microendoscopic discectomy assisted fusion for lumbar degenerative diseases. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(6): 672-680. doi: 10.7507/1002-1892.202202039 Copy

1.	Wan ZY, Shan H, Liu TF, et al. Emerging issues questioning the current treatment strategies for lumbar disc herniation. Front Surg, 2022, 9: 814531. doi: 10.3389/fsurg.2022.814531.
2.	Li Z, Li Z, Chen X, et al. Comparison between modified facet joint fusion and posterolateral fusion for the treatment of lumbar degenerative diseases: a retrospective study. BMC Surg, 2022, 22(1): 29. doi: 10.1186/s12893-022-01468-4.
3.	Ohyama S, Aoki Y, Inoue M, et al. Predictors of spontaneous restoration of lumbar lordosis after single-level transforaminal lumbar interbody fusion for degenerative lumbar diseases. Spine Surg Relat Res, 2021, 5(6): 397-404.
4.	Nguyen AQ, Harvey JP, Khanna K, et al. Reasons for revision following stand-alone anterior lumbar interbody fusion and lateral lumbar interbody fusion. J Neurosurg Spine, 2021, 30: 1-7.
5.	Jaeger A, Giber D, Bastard C, et al. Risk factors of instrumentation failure and pseudarthrosis after stand-alone L₅-S₁ anterior lumbar interbody fusion: a retrospective cohort study. J Neurosurg Spine, 2019, 31(3): 338-346.
6.	徐寶山, 許海委, 胡永成, 等. 自錨式前路腰椎間盤切除融合術治療L₅峽部裂性滑脫癥. 中華骨科雜志, 2020, 40(14): 893-901.
7.	徐寶山, 秦可鑫, 張坤生, 等. 微創腰椎前路腹膜外入路的解剖學研究與臨床應用. 中華骨科雜志, 2022, 42(6): 331-340.
8.	許海委, 徐寶山, 劉越, 等. 顯微鏡輔助微創前路腰椎間盤切除零切跡融合治療腰椎退變性疾病. 中華骨科雜志, 2022, 42(7): 395-402.
9.	He LM, Chen KT, Chen CM, et al. Comparison of percutaneous endoscopic and open posterior lumbar interbody fusion for the treatment of single-segmental lumbar degenerative diseases. BMC Musculoskelet Disord, 2022, 23(1): 329. doi: 10.1186/s12891-022-05287-9.
10.	Zheng B, Shaaya E, Feler J, et al. Endoscopic techniques for lumbar interbody fusion: Principles and context. Biomed Res Int, 2022, 2022: 4979231. doi: 10.1155/2022/4979231.
11.	Aihara T, Kojima A, Urushibara M, et al. Long-term reoperation rates and causes for reoperations following lumbar microendoscopic discectomy and decompression: 10-year follow-up. J Clin Neurosci, 2022, 95: 123-128.
12.	Chu PL, Wang T, Zheng JL, et al. Global and current research trends of unilateral biportal endoscopy/biportal endoscopic spinal surgery in the treatment of lumbar degenerative diseases: A bibliometric and visualization study. Orthop Surg, 2022, 14(4): 635-643.
13.	徐寶山, 馬信龍, 胡永成, 等. 可動式椎間盤鏡下椎體間融合術治療腰椎滑脫癥. 中華骨科雜志, 2017, 37(4): 217-225.
14.	譚清實, 徐寶山, 夏群, 等. 腰椎定位器在腰椎間盤鏡手術中的應用. 中華骨科雜志, 2010, 30(3): 308-309.
15.	Elia CJ, Arvind V, Brazdzionis J, et al. 90-day readmission rates for single level anterior lumbosacral interbody fusion: A nationwide readmissions database analysis. Spine (Phila Pa 1976), 2020, 45(14): E864-E870.
16.	Cyriac M, Kyhos J, Iweala U, et al. Anterior lumbar interbody fusion with cement augmentation without posterior fixation to treat isthmic spondylolisthesis in an osteopenic patient-A surgical technique. Int J Spine Surg, 2018, 12(3): 322-327.
17.	Mobbs RJ, Amin T, Phan K, et al. Standalone titanium/polyetheretherketone interbody cage for anterior lumbar interbody fusion: Clinical and radiological results at 24 months. J Craniovertebr Junction Spine, 2022, 13(1): 42-47.
18.	Xu B, Xu H, Zhang H, et al. Interbody fusion and percutaneous reduction for lumbar spondylolisthesis with mobile microendoscopic discectomy technique. Clin Spine Surg, 2020, 33(2): E63-E70.

1. Wan ZY, Shan H, Liu TF, et al. Emerging issues questioning the current treatment strategies for lumbar disc herniation. Front Surg, 2022, 9: 814531. doi: 10.3389/fsurg.2022.814531.
2. Li Z, Li Z, Chen X, et al. Comparison between modified facet joint fusion and posterolateral fusion for the treatment of lumbar degenerative diseases: a retrospective study. BMC Surg, 2022, 22(1): 29. doi: 10.1186/s12893-022-01468-4.
3. Ohyama S, Aoki Y, Inoue M, et al. Predictors of spontaneous restoration of lumbar lordosis after single-level transforaminal lumbar interbody fusion for degenerative lumbar diseases. Spine Surg Relat Res, 2021, 5(6): 397-404.
4. Nguyen AQ, Harvey JP, Khanna K, et al. Reasons for revision following stand-alone anterior lumbar interbody fusion and lateral lumbar interbody fusion. J Neurosurg Spine, 2021, 30: 1-7.
5. Jaeger A, Giber D, Bastard C, et al. Risk factors of instrumentation failure and pseudarthrosis after stand-alone L₅-S₁ anterior lumbar interbody fusion: a retrospective cohort study. J Neurosurg Spine, 2019, 31(3): 338-346.
6. 徐寶山, 許海委, 胡永成, 等. 自錨式前路腰椎間盤切除融合術治療L₅峽部裂性滑脫癥. 中華骨科雜志, 2020, 40(14): 893-901.
7. 徐寶山, 秦可鑫, 張坤生, 等. 微創腰椎前路腹膜外入路的解剖學研究與臨床應用. 中華骨科雜志, 2022, 42(6): 331-340.
8. 許海委, 徐寶山, 劉越, 等. 顯微鏡輔助微創前路腰椎間盤切除零切跡融合治療腰椎退變性疾病. 中華骨科雜志, 2022, 42(7): 395-402.
9. He LM, Chen KT, Chen CM, et al. Comparison of percutaneous endoscopic and open posterior lumbar interbody fusion for the treatment of single-segmental lumbar degenerative diseases. BMC Musculoskelet Disord, 2022, 23(1): 329. doi: 10.1186/s12891-022-05287-9.
10. Zheng B, Shaaya E, Feler J, et al. Endoscopic techniques for lumbar interbody fusion: Principles and context. Biomed Res Int, 2022, 2022: 4979231. doi: 10.1155/2022/4979231.
11. Aihara T, Kojima A, Urushibara M, et al. Long-term reoperation rates and causes for reoperations following lumbar microendoscopic discectomy and decompression: 10-year follow-up. J Clin Neurosci, 2022, 95: 123-128.
12. Chu PL, Wang T, Zheng JL, et al. Global and current research trends of unilateral biportal endoscopy/biportal endoscopic spinal surgery in the treatment of lumbar degenerative diseases: A bibliometric and visualization study. Orthop Surg, 2022, 14(4): 635-643.
13. 徐寶山, 馬信龍, 胡永成, 等. 可動式椎間盤鏡下椎體間融合術治療腰椎滑脫癥. 中華骨科雜志, 2017, 37(4): 217-225.
14. 譚清實, 徐寶山, 夏群, 等. 腰椎定位器在腰椎間盤鏡手術中的應用. 中華骨科雜志, 2010, 30(3): 308-309.
15. Elia CJ, Arvind V, Brazdzionis J, et al. 90-day readmission rates for single level anterior lumbosacral interbody fusion: A nationwide readmissions database analysis. Spine (Phila Pa 1976), 2020, 45(14): E864-E870.
16. Cyriac M, Kyhos J, Iweala U, et al. Anterior lumbar interbody fusion with cement augmentation without posterior fixation to treat isthmic spondylolisthesis in an osteopenic patient-A surgical technique. Int J Spine Surg, 2018, 12(3): 322-327.
17. Mobbs RJ, Amin T, Phan K, et al. Standalone titanium/polyetheretherketone interbody cage for anterior lumbar interbody fusion: Clinical and radiological results at 24 months. J Craniovertebr Junction Spine, 2022, 13(1): 42-47.
18. Xu B, Xu H, Zhang H, et al. Interbody fusion and percutaneous reduction for lumbar spondylolisthesis with mobile microendoscopic discectomy technique. Clin Spine Surg, 2020, 33(2): E63-E70.

Chinese Journal of Reparative and Reconstructive Surgery

Comparative study of microscope assisted minimally invasive anterior fusion and mobile microendoscopic discectomy assisted fusion for lumbar degenerative diseases

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