Zhongguo quanke yixue (Dec 2023)
Clinical Efficacy of Percutaneous Endoscopic Posterior Tranforaminal Lumbar Interbody Fusion Combined with Height Adjustable Titanium Fusion Cage in the Treatment of Lumbar Spondylolisthesis with Lumbar Spinal Stenosis
Abstract
Background With the improvement of medical technology, the indications of spinal endoscopy technology are becoming more and more widespread. Percutaneous endoscopic posterior tranforaminal lumbar interbody fusion (Endo-P/TLIF) has been rapidly and widely used in lumbar spondylolisthesis combined with lumbar spinal stenosis, achieving certain efficacy in clinical observation. Compared with traditional fusion cages, height adjustable titanium fusion cage have better distraction effect and can effectively restore intervertebral space height, with obvious efficacy in Endo-P/TLIF surgery. Objective To investigate the application and clinical efficacy of Endo-P/TLIF combined with height adjustable titanium fusion cage in the treatment of lumbar spondylolisthesis with lumbar spinal stenosis. Methods The clinical data of 171 patients with lumbar spondylolisthesis with lumbar spinal stenosis treated at the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine from January 2019 to June 2021 were retrospectively analyzed. The included patients were divided into 35 cases in the Endo-P/TLIF+adjustable fusion cage group, 57 cases in the Endo-P/TLIF+ordinary fusion cage group, 47 cases in the Endo-TLIF+ordinary fusion cage group and 32 cases in the unilateral approach biportal endoscopic (UBE) +ordinary fusion cage group according to the operation mode. The gender, age, intraoperative bleeding, hospital stay, preoperative, immediate postoperative, 6-month postoperative and 12-month postoperative Oswestry disability index (ODI) score, visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, degree of lumbar spondylolisthesis, lumbar lordosis angle, and dural cross-sectional area were compared among the four groups. Results There was no statistically significant difference in gender, age, operative time, intraoperative bleeding, and hospital stay among the four groups of patients (P>0.05). There was no interaction effect of group and time on ODI score, VAS score, JOA score, lumbar lordosis angle, and dural cross-sectional area (P>0.05) ; there was an interaction effect of group and time on the degree of lumbar spondylolisthesis (P<0.05). There was a significant main effect of group on ODI score, JOA score, lumbar lordosis angle, and dural cross-sectional area (P<0.05) ; there was a significant main effect of time on ODI score, VAS score, JOA score, lumbar spondylolisthesis degree, lumbar lordosis angle, and dural cross-sectional area (P<0.05). At the immediate postoperative period, the dural cross-sectional area in the Endo-P/TLIF+adjustable fusion cage group and Endo-P/TLIF+ordinary fusion cage group was higher than that in the Endo-TLIF+ordinary fusion cage group and UBE+ordinary fusion cage group, respectively (P<0.05). At 6 months after surgery, the ODI score in the Endo-P/TLIF+adjustable fusion cage group and Endo-P/TLIF+ordinary fusion cage group was lower than that in the Endo-TLIF+ordinary fusion cage group and UBE+ordinary fusion cage group, respectively (P<0.05). At 12 months after surgery, the ODI score and VAS score of the Endo-P/TLIF+adjustable fusion cage group were lower than those in the other three groups, while the JOA score, lumbar spondylolisthesis degree, and dural cross-sectional area were higher in the Endo-P/TLIF+adjustable fusion cage group than those in the Endo-TLIF+ordinary fusion cage group and UBE+ordinary fusion cage group (P<0.05) . Conclusion As a modified spinal endoscopic interbody fusion, Endo-P/TLIF has the advantages of less trauma, less intraoperative bleeding, shorter hospitalization stay, and complete decompression. The combination of height adjustable titanium fusion cage can restore the height of intervertebral space well with good short-term effect, which is worthy of extensive clinical promotion and application.
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