Objective To compare the clinical and radiological outcomes of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) and minimally invasive tubular TLIF (MT-TLIF) in treatment of lumbar degenerative diseases. Methods A clinical data of 75 patients with lumbar degenerative diseases, who met the selection criteria between August 2019 and August 2020, was retrospectively analyzed, including 35 patients in the UBE- TLIF group and 40 patients in the MT-TLIF group. There was no significant difference in general data such as gender, age, body mass index, disease type and duration, and surgical segment between the two groups (P>0.05), which was comparable. The operation time, intraoperative blood loss, hemoglobin (Hb) before operation and at 1 day after operation, the length of hospital stay, incidence of complications, and visual analogue scale (VAS) score of low back and leg pain, Oswestry Disability Index (ODI), Short-Form 36 Health Survey Scale (SF-36 scale), intervertebral disc height (IDH), sagittal Cobb angle, lumbar lordosis (LL), and the intervertebral fusion were compared between the two groups. Results Compared with MT-TLIF group, UBE-TLIF group had significantly longer operation time but less intraoperative blood loss and shorter length of hospital stay (P<0.05). The Hb levels in both groups decreased at 1 day after operation, but there was no significant difference in the difference before and after operation between the two groups (P>0.05). All patients were followed up, and the follow-up time was (14.7±2.5) months in the UBE-TLIF group and (15.0±3.4) months in the MT-TLIF group, with no significant difference (t=0.406, P=0.686). In both groups, the VAS score of low back pain, VAS score of leg pain, SF-36 scale, and ODI after operation significantly improved when compared with those before operation (P<0.05). There was no significant difference between 1 month after operation and last follow-up (P>0.05). There was no significant difference in the VAS score of low back pain, VAS score of leg pain, and SF-36 scale between the two groups before and after operation (P>0.05). At 1 month after operation, the ODI in the UBE-TLIF group was significantly better than that in the MT-TLIF group (P<0.05). At 1 month after operation, IDH, Cobb angle, and LL in both groups recovered when compared with those before operation (P<0.05), and were maintained until last follow-up (P>0.05). There was no significant difference in the IDH, Cobb angle, and LL between the two groups at each time point (P>0.05). Thirty-three cases (89.2%) in the UBE-TLIF group and 35 cases (87.5%) in the MT-TLIF group achieved fusion, and the difference was not significant (χ2=0.015, P=0.901). In the UBE-TLIF group, 1 case of intraoperative dural tear and 1 case of postoperative epidural hematoma occurred, with an incidence of 5.7%. In the MT-TLIF group, 1 case of intraoperative dural tear, 1 case of postoperative epidural hematoma, and 1 case of superficial infection of the surgical incision occurred, with an incidence of 7.5%. There was no significant difference in the incidence of complications between the two groups (χ2=1.234, P=1.000). Conclusion Compared with MT-TLIF, UBE-TILF can achieve similar interbody fusion in the treatment of lumbar degenerative diseases, and has the advantages of smaller incision, less bleeding, and shorter length of hospital stay.
Objective To compare the effectiveness between unilateral biportal endoscopic lumbar interbody fusion (ULIF) and endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) in treatment of lumbar spinal stenosis combined with intervertebral disc herniation. Methods A clinical data of 64 patients with lumbar spinal stenosis and intervertebral disc herniation, who were admitted between April 2020 and November 2021 and met the selection criteria, was retrospectively analyzed. Among them, 30 patients were treated with ULIF (ULIF group) and 34 patients with Endo-TLIF (Endo-TLIF group). There was no significant difference in baseline data such as gender, age, disease duration, lesion segment, preoperative visual analogue scale (VAS) score of low back pain and leg pain, Oswestry disability index (ODI), spinal canal area, and intervertebral space height between the two groups (P>0.05). The operation time, intraoperative blood loss, hospital stays, and postoperative complications were compared between the two groups, as well as the VAS scores of low back pain and leg pain, ODI, and imaging measurement indicators (spinal canal area, intervertebral bone graft area, intervertebral space height, and degree of intervertebral fusion according to modified Brantigan score). Results Compared with the Endo-TLIF group, the ULIF group had shorter operation time, but had more intraoperative blood loss and longer hospital stays, with significant differences (P<0.05). The cerebrospinal fluid leakage occurred in 2 cases of Endo-TLIF group and 1 case of ULIF group, and no other complication occurred. There was no significant difference in the incidence of complications between the two groups (P>0.05). All patients in the two groups were followed up 12 months. The VAS scores of lower back pain and leg pain and ODI in the two groups significantly improved when compared with those before operation (P<0.05), and there was no significant difference between different time points after operation (P>0.05). And there was no significant difference between the two groups at each time point after operation (P>0.05). Imaging examination showed that there was no significant difference between the two groups in the change of spinal canal area, the change of intervertebral space height, and intervertebral fusion rate at 6 and 12 months (P>0.05). The intervertebral bone graft area in the ULIF group was significantly larger than that in the Endo-TLIF group (P<0.05). ConclusionFor the patients with lumbar spinal stenosis combined with intervertebral disc herniation, ULIF not only achieves similar effectiveness as Endo-TLIF, but also has advantages such as higher decompression efficiency, flexible surgical instrument operation, more thorough intraoperative intervertebral space management, and shorter operation time.
ObjectiveTo compare the effectiveness and imaging features between implanting single and double Cage into intervertebral body through unilateral transforaminal lumbar interbody fusion (TLIF). MethodsThe clinical data were collected and analyzed from 104 patients who underwent unilateral TLIF between January 2013 and October 2014, who were divided into 2 groups:single Cage was implanted into intervertebral body in 64 cases (76 segments) in traditional group, and double Cage was implanted into intervertebral body in 56 cases (70 segments) in reformative group. There was no significant difference in age, gender, bone mineral density, operation segments between 2 groups (P>0.05). The visual analogue scale (VAS), Oswestry disability index (ODI), and Japanese Orthopedic Association (JOA) scores were used to evaluate the effectiveness; the area of intervertebral bone-graft, fusion rate, height of intervertebral space, and the number of Cage subsidence were measured by CT scan. ResultsAll the patients were followed up 12.85 months on average (range, 9-15 months). The VAS, ODI, and JOA scores were significantly improved at each time point after operation when compared with preoperative values (P<0.05), and no significant difference was found between 2 groups (P>0.05) except VAS and ODI at 12 months after operation (P<0.05). However, the area of intervertebral bone-graft in reformative group[(5.94±1.17) cm2] was significantly larger than that in traditional group[(4.81±0.97) cm2] at 7 days after operation (t=-6.365, P=0.000). At 3 and 12 months after operation, the fusion rate was respectively 84.2% and 92.1% in traditional group and was respectively 88.6% and 94.3% in reformative group. Although the height of intervertebral space were increased when compared with preoperative height, the incidence rates of Cages subsidence in traditional group were 44.74% and 47.37% respectively at 3 and 12 months after operation and were significantly higher those that in reformative group (11.43% and 14.29% respectively) (P<0.05). In addition, the height difference between affected side and normal side in traditional group was significantly larger than that in reformative group (P<0.05). ConclusionBoth single and double Cage implanted into the intervertebral body through unilateral TLIF have good effectiveness. However, double Cage implanted into intervertebral body may hold the height of intervertebral space, reduce the incident rate of Cage subsidence, and prevent sagittal imbalance.
Objective To explore the clinical application value of the spinal robot-assisted surgical system in mild to moderate lumbar spondylolisthesis and evaluate the accuracy of its implantation. Methods The clinical data of 56 patients with Meyerding grade Ⅰ or Ⅱ lumbar spondylolisthesis who underwent minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) between January 2017 and December 2017 were retrospectively analysed. Among them, 28 cases were preoperatively planned with robotic arm and percutaneous pedicle screw placement according to preoperative planning (group A); the other 28 cases underwent fluoroscopy-guided percutaneous pedicle screw placement (group B). There was no significant difference in gender, age, body mass index, slippage type, Meyerding grade, and surgical segmental distribution between the two groups (P>0.05). The screw insertion angle was measured by CT, the accuracy of screw implantation was evaluated by Neo’s criteria, and the invasion of superior articular process was evaluated by Babu’s method. Results One hundred and twelve screws were implanted in the two groups respectively, 5 screws (4.5%) in group A and 26 screws (23.2%) in group B penetrated the lateral wall of pedicle, and the difference was significant (χ2=9.157, P=0.002); the accuracy of nail implantation was assessed according to Neo’s criteria, the results were 107 screws of degree 0, 3 of degree 1, 2 of degree 2 in group A, and 86 screws of degree 0, 16 of degree 1, 6 of degree 2, 4 of degree 3 in group B, showing significant difference between the two groups (Z=4.915, P=0.031). In group B, 20 (17.9%) screws penetrated the superior articular process, while in group A, 80 screws were removed from the decompression side, and only 3 (3.8%) screws penetrated the superior articular process. According to Babu’s method, the degree of screw penetration into the facet joint was assessed. The results were 77 screws of grade 0, 2 of grade 1, 1 of grade 2 in group A, and 92 screws of grade 0, 13 of grade 1, 4 of grade 2, 3 of grade 3 in group B, showing significant difference between the two groups (Z=7.814, P=0.029). The screw insertion angles of groups A and B were (23.5±6.6)° and (18.1±7.5)° respectively, showing significant difference (t=3.100, P=0.003). Conclusion Compared to fluoroscopy-guided percutaneous pedicle screw placement, robot-assisted percutaneous pedicle screw placement has the advantages such as greater accuracy, lower incidence of screw penetration of the pedicle wall and invasion of the facet joints, and has a better screw insertion angle. Combined with MIS-TLIF, robot-assisted percutaneous pedicle screw placement is an effective minimally invasive treatment for lumbar spondylolisthesis.
ObjectiveTo explore the value of modified subcutaneous lumbar spine index (MSLSI) as a predictor for short-term effectiveness of transforaminal lumbar interbody fusion (TLIF) in treatment of lumbar degenerative disease (LDD).MethodsBetween February 2014 and October 2019, 450 patients who were diagnosed as LDD and received single-segment TLIF were included in the study. Based on the MSLSI measured by preoperative lumbar MRI, the patients were sorted from small to large and divided into three groups (n=150). The MSLSI of group A was 0.11-0.49, group B was 0.49-0.73, and group C was 0.73-1.88. There was no significance in gender, age, disease duration, diagnosis, surgical segment, and improved Charlson comorbidity index between groups (P>0.05). There were significant differences in the subcutaneous adipose depth of the L4 vertebral body and body mass index (BMI) between groups (P<0.05). The operation time, intra-operative blood loss, length of incision, drainage tube placement time, drainage volume on the 1st day after operation, drainage volume on the 2nd day after operation, total drainage volume, antibiotic use time after operation, walking exercise time after operation, hospital stay, the incidences of surgical or non-surgical complications in the three groups were compared. Pearson correlation analysis was used to analyze the correlation between MSLSI and BMI, and partial correlation analysis was used to study the relationship between MSLSI, BMI, improved Charlson comorbidity index, subcutaneous adipose depth of the L4 vertebral body and complications. The Receiver Operating Characteristic (ROC) curve was used to evaluate the value of SLSI and MSLSI in predicting the occurrence of complications after TLIF in treatment of LDD.ResultsThere was no significant difference in operation time, length of incision, antibiotic use time after operation, walking exercise time after operation, drainage tube placement time, drainage volume on the 1st day after operation, drainage volume on the 2nd day after operation, and total drainage volume between groups (P>0.05). The amount of intra-operative blood loss in group C was higher than that in groups A and B, and the hospital stay was longer than that in group B, with significant differences (P<0.05). Surgical complications occurred in 22 cases (14.7%), 25 cases (16.7%), and 39 cases (26.0%) of groups A, B, and C, respectively. There was no significant difference in the incidence between groups (χ2=0.826, P=0.662). The incidences of nerve root injury and wound aseptic complications in group C were higher than those in groups A and B, and the incidence of nerve root injury in group B was higher than that in group A, with significant differences (P<0.05). There were 13 cases (8.7%), 7 cases (4.7%), and 11 cases (7.3%) of non-surgical complications in groups A, B, and C, respectively, with no significant difference (χ2=2.128, P=0.345). There was no significant difference in the incidences of cardiovascular complications, urinary system complications, central system complications, and respiratory system complications between groups (P>0.05). There was a correlation between MSLSI and BMI in 450 patients (r=0.619, P=0.047). Partial correlation analysis showed that MSLSI was related to wound aseptic complications (r=0.172, P=0.032), but not related to other surgical and non-surgical complications (P>0.05). There was no correlation between BMI, improved Charlson comorbidity index, subcutaneous adipose depth of the L4 vertebral body and surgical and non-surgical complications (P>0.05). ROC curve analysis showed that the area under ROC curve (AUC) of MSLSI was 0.673 (95%CI 0.546-0.761, P=0.025), and the AUC of SLSI was 0.582 (95%CI 0.472-0.693, P=0.191). ConclusionMSLSI can predict the short-term effectiveness of TLIF in treatment of LDD. Patients with high MSLSI suffer more intra-operative blood loss, longer hospital stay, and higher incidence of nerve root injury and postoperative incision complications.
Objective To investigate the short-term effectiveness of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) in the treatment of Meyerding degree Ⅰ or Ⅱ single-segment lumbar spondylolisthesis. MethodsThe clinical data of 26 patients with Meyerding degree Ⅰ or Ⅱ single-segment lumbar spondylolisthesis treated with UBE-TLIF between January 2021 and August 2021 were retrospectively analyzed. Among them, there were 10 males and 16 females with a mean age of 61.5 years (range, 35-76 years). The lesion segment included L3, 4 in 2 cases, L4, 5 in 18 cases, and L5, S1 in 6 cases. There were 17 cases of degenerative spondylolisthesis and 9 cases of isthmic spondylolisthesis; according to the Meyerding classification of spondylolisthesis, 19 cases were grade Ⅰ and 7 cases were grade Ⅱ. Twenty-one cases were complicated with lumbar disc herniation and spinal stenosis and 5 cases with lumbar spinal stenosis. The operation time, hospitalization stay, complications, hemoglobin (Hb) and serum creatine kinase (CK) levels before operation and at 1 day after operation were recorded; lumbar lordosis angle changes and postoperative spondylolisthesis reduction were evaluated by lumbar anteroposterior and lateral X-ray films before operation and at last follow-up; visual analogue scale (VAS) score was used to evaluate the low back pain and leg pain before operation, at 2 days, 1 week, 2 weeks after operation, and at last follow-up; Oswestry disability index (ODI) was used to evaluate the functional recovery of the patients before operation and at last follow-up. ResultsThe operation was successfully completed in all 26 patients, with an average operation time of 181.9 minutes (range, 130-224 minutes) and an average hospitalization stay of 6.3 days (range, 3-9 days). Hb levels were significantly lower and serum CK levels were significantly higher at 1 day after operation when compared with those before operation (t=7.594, P<0.001; t=–15.647, P<0.001). No serious complication occurred during and after operation. CT examination at 3 days after operation showed that the percutaneous screw was not in good position in 1 case, and nerve paralysis (pain, numbness) occurred in 2 cases after operation, which were improved within 2 weeks after operation. All the 26 patients were followed up 6-11 months, with an average of 8.7 months. Complete reduction (the slippage reduction rate was 100%) was achieved in 24 patients (92.3%), and partial reduction (the slippage reduction rate was 87.5%) in 2 patients (7.7%). During the follow-up, there was no complication such as incision infection, fusion Cage subsidence or displacement, and internal fixator loosening. The VAS scores of low back pain and leg pain significantly improved at each time point after operation when compared with those before operation (P<0.05); there was no significant difference in the VAS scores of low back pain and leg pain between at 2 days and 1 week after operation, the VAS scores of low back pain between at 1 week and 2 weeks after operation, and the VAS scores of leg pain between at 2 weeks after operation and last follow-up (P>0.05); but there was significant difference between the other time points after operation (P<0.05). ODI and lumbar lordosis angle significantly improved at last follow-up (P<0.05). Conclusion UBE-TLIF provides favorable short-term effectiveness and obvious advantages of minimally invasive in the treatment of Meyerding degree Ⅰ or Ⅱ single-segment lumbar spondylolisthesis. However, the safety and long-term effectiveness need to be further studied.
ObjectiveTo compare the effectiveness of robot-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open freehand TLIF for the treatment of single-level degenerative lumbar spondylolisthesis (DSL) and analyse the influence on postoperative adjacent segmental degeneration (ASD). Methods The clinical data of 116 patients with L4、5 DLS who were admitted between November 2019 and October 2021 and met the selection criteria were retrospectively analyzed. According to the surgical methods, they were divided into the robotic group (45 cases, who underwent robot-assisted MIS-TLIF) and the open group (71 cases, who underwent open freehand TLIF). There was no significant difference in baseline data such as gender, age, body mass index, DLS Meyerding grading, and preoperative Pfirrmann grading, Weishaupt grading, L3, 4 intervertebral disc height (DH), L3, 4 intervertebral mobility, sagittal parameters [including pelvic incidence (PI), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT)], and Cage height (P>0.05). The grade of facet joint violation (FJV) by pedicle screws on the superior articular process was assessed postoperatively. Sagittal parameters, L3, 4 DH, L3, 4 DH loss, and L3, 4 intervertebral mobility were measured preoperatively and at last follow-up in order to determine whether ASD occurred. Based on the occurrence of postoperative ASD, logistic regression analysis was used to identify the risk factors for ASD after TLIF. Results Patients in both groups were followed up 21-47 months, with a mean of 36.1 months; there was no significant difference in the follow-up time between the two groups (P>0.05). The occurrence of postoperative FJV was significantly better in the robotic group than in the open group (P<0.05). At last follow-up, the difference in the change values of sagittal parameters PI, PT, SS, and LL was not significant when comparing the two groups of patients (P>0.05); the change values of L3, 4 DH and L3, 4 DH loss in the robotic group were smaller than those in the open group, and the change value of L3, 4 intervertebral mobility was larger than that in the open group, and the differences were significant (P<0.05). At last follow-up, ASD occurred in 8 patients (17.8%) in the robotic group and 35 patients (49.3%) in the open group, and the difference in ASD incidence between the two groups was significant (P<0.05). logistic regression analysis showed that open surgery, preoperative Pfirrmann grading Ⅳ-Ⅴ, preoperative Weishaupt grading ≥2, and postoperative FJV grading ≥1 were risk factors for the development of ASD after TLIF (P<0.05). ConclusionCompared with traditional open surgery, orthopedic robot-assisted MIS-TLIF in the treatment of single-level DLS can more accurately insert pedicle screws, reduce the loss of DH and the occurrence of FJV, and effectively reduce the incidence of mid-postoperative ASD. Preoperative disc and synovial joint degeneration in adjacent segments, nonrobotic-assisted minimally invasive therapy, and FJV are risk factors for ASD after TLIF.
ObjectiveTo compare the effectiveness of modified transforaminal lumbar interbody fusion (modified-TLIF) and posterior lumbar interbody fusion (PLIF) for mild to moderate lumbar spondylolisthesis in middle-aged and elderly patients.MethodsThe clinical data of 106 patients with mild to moderate lumbar spondylolisthesis (Meyerding classification≤Ⅱ degree) who met the selection criteria between January 2015 and January 2017 were retrospectively analysed. All patients were divided into modified-TLIF group (54 cases) and PLIF group (52 cases) according to the different surgical methods. There was no significant difference in preoperative clinical data of gender, age, disease duration, sliding vertebra, Meyerding grade, and slippage type between the two groups (P>0.05). The intraoperative blood loss, operation time, postoperative drainage volume, postoperative bed time, hospital stay, and complications of the two groups were recorded and compared. The improvement of pain and function were evaluated by the visual analogue scale (VAS) score and Japanese Orthopedic Association (JOA) score at preoperation, 1 week, and 1, 6, 12 months after operation, and last follow-up, respectively. The effect of slip correction was evaluated by slip angle and intervertebral altitude at preoperation and last follow-up, and the effectiveness of fusion was evaluated according to Suk criteria.ResultsAll patients were followed up, the modified-TLIF group was followed up 25-36 months (mean, 32.7 months), the PLIF group was followed up 24-38 months (mean, 33.3 months). The intraoperative blood loss, operation time, postoperative drainage volume, postoperative bed time, and hospital stay of the modified-TLIF group were significantly less than those of the PLIF group (P<0.05). The VAS score and JOA score of both groups were significantly improved at each time point after operation (P<0.05); the scores of the modified-TLIF group were significantly better than those of the PLIF group at 1 and 6 months after operation (P<0.05). The slip angle and intervertebral altitude of both groups were obviously improved at last follow-up (P<0.05), and there was no significant difference between the two groups at preoperation and last follow-up (P>0.05). At last follow-up, the fusion rate of the modified-TLIF group and the PLIF group was 96.3% (52/54) and 98.1% (51/52), respectively, and no significant difference was found between the two groups (χ2=0.000, P=1.000). About complications, there was no significant difference between the two groups in nerve injury on the opposite side within a week, incision infection, and pulmonary infection (P>0.05). No case of nerve injury on the operation side within a week or dural laceration occurred in the modified-TLIF group, while 8 cases (15.4%, P=0.002) and 4 cases (7.7%, P=0.054) occurred in the PLIF group respectively.ConclusionModified-TLIF and PLIF are effective in the treatment of mild to moderate lumbar spondylolisthesis in middle-aged and elderly patients. However, modified-TLIF has relatively less trauma, lower blood loss, lower drainage volume, lower incidence of dural laceration and nerve injury, which promotes enhanced recovery after surgery.
Objective To compare the effectiveness of percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) and Wiltse-approach TLIF (W-TLIF) in the treatment of lumbar spondylolisthesis. MethodsThe clinical data of 47 patients with lumbar spondylolisthesis who met the selection criteria between July 2018 and June 2019 were retrospectively analyzed, in which 21 patients were treated with PE-TLIF (PE-TLIF group) and 26 patients were treated with W-TLIF (W-TLIF group). There was no significant difference between the two groups in age, gender, disease duration, level of spondylolisthesis vertebrae, spondylolisthesis degree, spondylolisthesis type, and preoperative visual analogue scale (VAS) score of low back pain and leg pain, lumbar Japanese Orthopaedic Association (JOA) score, and the disc height (DH), segmental lordosis (SL), and Taillard index (TI) of the operated vertebrae (P>0.05). The operation time, intraoperative blood loss, postoperative drainage, postoperative bedridden time, and complications were compared between the two groups. The VAS score and JOA score were used to evaluate the improvement of pain and function. At last follow-up, DH, SL, and TI of operated vertebrae were measured by X-ray films, and lumbar CT was performed to evaluate the interbody fusion. Results Compared with W-TLIF group, the operation time in PE-TLIF group was significantly longer, but the intraoperative blood loss and postoperative drainage were significantly less, and the postoperative bedridden time was significantly shorter (P<0.05). There were 2 cases of transient lower limb radiating pain in PE-TLIF group and 1 case of superficial incision infection in W-TLIF group. There was no significant difference in the incidence of complications (9.5% vs. 3.8%) between the two groups (χ2=0.037, P=0.848). The patients in both groups were followed up 12-24 months, with an average of 17.3 months in PE-TLIF group and 17.7 months in W-TLIF group. The VAS scores of low back pain and leg pain, and the JOA scores of the two groups significantly improved at each time point after operation when compared with those before operation (P<0.05). Compared with W-TLIF group, the VAS scores of low back pain in PE-TLIF group significantly lower at 3 days and 3 months after operation (P<0.05), and the JOA score of PE-TLIF group was significantly higher at 3 months after operation (P<0.05), and there was no significant difference in each score at any other time point between the two groups (P>0.05). At last follow-up, the DH, SL, and TI of operated vertebrae of the two groups significantly improved when compared with those before operation (P<0.05), and there was no significant difference in the differences of each parameter between the two groups (P>0.05). According to Suk’s standard, the fusion rates of PE-TLIF group and W-TLIF group were 90.5% (19/21) and 92.3% (24/26), respectively, with no significant difference (χ2=0.000, P=1.000). At last follow-up, there was no case of Cage sunk into the adjacent vertebral body, or dislodgement of Cage anteriorly or posteriorly in both groups. Conclusion PE-TLIF and W-TLIF are both effective in the treatment of grade Ⅰ and Ⅱ lumbar spondylolisthesis. Although the operation time is prolonged, PE-TLIF has less intraoperative blood loss and postoperative drainage, shorter postoperative bedridden time, and can get more obvious short-term improvement of low back pain and function.
ObjectiveTo compare the effect of intravenous 20% mannitol or dexamethasone (DM) on low back and leg pain after minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). MethodsBetween October 2012 and September 2013, 100 patients with degenerative lumbar diseases underwent MI-TLIF and percutaneous pedicle screw fixation. All patients were randomly divided into 3 groups:34 patients received intravenous 20% mannitol after operation (mannitol group); 32 patients received intravenous DM after operation (DM group); and 34 patients received neither dehydrating agent nor steroid after operation (control group). There was no significant difference in gender, age, disease duration, clinical symptoms, lesion types, and lesion segments between groups (P>0.05). The serum levels of inflammatory factors[tumor necrosis factor α (TNF-α), interleukin 1β (IL-1β), and IL-6] were measured by ELISA at pre-operation and 3, 24, 48, 72, and 96 hours after operation. Low back and leg pain was determined by using visual analogue scale (VAS) score after operation. ResultsAll procedures were smoothly performed without major complications of nerve root injury, hematoma, or infection. There was no significant difference in operation time and intraoperative blood loss between groups (P>0.05). The VAS score of low back pain showed no significant difference between groups at all time points after operation (P>0.05); the VAS score of leg pain in the DM group was significantly lower than that in the control group at all time points (P<0.05), and than those in the mannitol group at 3, 24, 48, and 96 hours after operation (P<0.05). The serum level of TNF-α in the DM group was significantly lower than that in the control group at all time points (P<0.05), and than that in the mannitol group at 3, 48, 72, and 96 hours after operation (P<0.05). The serum level of IL-1β in the DM group was significantly lower than that in the control group at 3, 24, 48, and 72 hours after operation (P<0.05), and than that in the mannitol group at all time points after operation (P<0.05). The serum level of IL-6 in the DM group was significantly lower than that in the control group at 3 and 24 hours after operation (P<0.05), and than that in the mannitol group at 3, 24, and 48 hours after operation (P<0.05). ConclusionIntravenous 20% mannitol may has no effect on postoperative low back and leg pain, while DM can markedly relieve leg pain after MI-TLIF.