[Comparison of minimally invasive using a tubular retraction system versus open transforaminal lumbar interbody fusion for the treatment of lumbar degenerative diseases].

Objective: To compare the clinical effect of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) using a tubular retraction system with traditional transforaminal lumbar interbody fusion (TLIF) for the treatment of lumbar degenerative diseases.

Method: From June 2009 to June 2013, a total of 96 patients in Department of Orthopaedics, Armed Police Jiangxi Corps Hospital, suffering from lumbar degenerative diseases were divided into 2 groups randomly. 42 patients underwent MIS-TLIF using a tubular retraction system. There were 23 males and 19 females with the age of 64.4 ± 4.9. The preoperative diagnosis included lumbar disc herniation with instability (17 cases), lumbar spinal stenosis (13 cases), lumbar degenerative spondylolisthesis (12 cases). 54 patients underwent traditional TLIF. There were 32 males and 22 females with the age of 66.5 ± 7.6. The preoperative diagnosis included lumbar disc herniation with instability (22 cases), lumbar spinal stenosis (17 cases), lumbar degenerative spondylolisthesis (15 cases). The general data, operating time, blood loss and volume of drainage after operation were compared between two groups. VAS, ODI evaluating standards were applied to evaluate the therapeutic effect. The intervertebral fusion were observed by X ray or CT scan.

Results: All patients underwent surgery safely without severe complication occurred. There was no significant difference in operation time between MIS-TLIF group (96±37) min and TLIF group (83 ± 25) min, P>0.05; the blood, volume of drainage after operation in MIS-TLIF group were significantly less than TLIF group (P<0.05). The follow-up time was( 26 ± 7) months in MIS-TLIF group and (27 ± 8) months in TLIF group. Compared with preoperative parameters, the scores of VAS and ODI were significantly decreased after surgery and at the final follow-up in both groups (P<0.05). Compared with TLIF group, VAS in MIS-TLIF group of post-operation and the final follow-up were improved, respectively (P<0.05), but there is no significant difference in ODI score. There occurred cage dislocation with no nerve symptom in MIS-TLIF group in 1 case and fat liquefaction in TLIF group in 1 case. At the follow-up after 6.5 months postoperatively, all the operated segments achieved fusion standard and no internal screw were loose or broken.

Conclusion: MIS-TLIF technique could provide less operation trauma, blood lose and achieve the similar satisfied short-term effect as traditional TLIF.