Modified transforaminal lumbar interbody fusion for acute and chronic lumbar intervertebral disc injury via minimally invasive expandable access system / 中华创伤杂志

ABSTRACT

Objective To evaluate outcomes of modified transforaminal lumbar interbody fusion (TLIF) assisted by the minimally invasive expandable access system and spinal channel endoscope for acute and chronic lumbar intervertebral disc injury.Methods From March 2013 to November 2014, 45 patients with lumbar intervertebral disc injury were managed with minimally invasive (Group A) or open TLIF (Group B).Location for disc injury was at L3/4 in 5 patients, L4/5 in 28 patients and L5-S1 in 12 patients.Group A composing 12 males and 10 females showed age of (53.70 ±3.59) years (range, 43 to 67 years).Group B composing 14 males and 9 females showed age of (54.80 ± 4.37) years (range, 42 to 68 years).Between-group comparison was conducted with respect to operation time, blood loss, postoperative drainage loss, ambulation time and postoperative complications.Clinical outcomes were evaluated using the visual analogue scale (VAS), Oswestry dysfunction index (ODI), and bone fusion rate.Results Except for the comparable operation time, group A was associated with better results in the blood loss [(152.1 ± 15.5) ml vs (409.9 ± 28.3) ml], drainage volume [(106.1 ± 14.3)mlvs (223.0 ± 19.4)ml], ambulation time[(4.5 ±1.1)d vs (8.9 ±1.4)d] and 1-week postoperative VAS [(3.0±0.7) points vs (4.7 ±0.4) points] (P ＜0.05).At the final follow-up, VAS and ODI of both groups were significantly improved compared to the preoperative levels (P ＜ 0.05), but the differences between groups were insignificant (P ＞0.05).Bone fusion rate in Group A was 95％ (21/22) versus 96％ (22/23) in Group B 6-month postoperatively (P ＞ 0.05).No nerve root injury, intervertebral space infection or other complications occurred.Conclusion Modified TLIF assisted by the minimally invasive expandable access system offers the benefits of less trauma, less bleeding and a quicker recovery for acute and chronic lumbar intervertebral disc injury and has similar long-term clinical outcomes with open TLIF.