Comparative study on effectiveness of modified-transforaminal lumbar interbody fusion and posterior lumbar interbody fusion surgery in treatment of mild to moderate lumbar spondylolisthesis in middle-aged and elderly patients_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Zhijie ,  LIU Bo , LAN Haiyang , YE He , CHEN Jie , XIA Huiqiang , ZHANG Ye , HAN Fei

Department of Orthopaedics, the 1st Affiliated Hospital of Chongqing Medical University, Chongqing Spine Surgical Center, Chongqing, 400042, P.R.China;

Corresponding?author：

LIU Bo, Email: boliucqmu@qq.com

Keywords：

Modified transforaminal lumbar interbody fusion; posterior lumbar interbody fusion; nerve injury; lumbar spondylolisthesis

DOI：

10.7507/1002-1892.201906047

Video：

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Objective To 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.Methods The 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.Results All 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.Conclusion Modified-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.

Citation： YANG Zhijie, LIU Bo, LAN Haiyang, YE He, CHEN Jie, XIA Huiqiang, ZHANG Ye, HAN Fei. Comparative study on effectiveness of modified-transforaminal lumbar interbody fusion and posterior lumbar interbody fusion surgery in treatment of mild to moderate lumbar spondylolisthesis in middle-aged and elderly patients. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(5): 550-556. doi: 10.7507/1002-1892.201906047 Copy

1.	李咸周, 王倩, 張存鑫. 腰椎滑脫癥: 植入物治療現狀及未來發展. 中國組織工程研究, 2019, 23(4): 621-627.
2.	Wang MY, Chang PY, Grossman J. Development of an Enhanced Recovery After Surgery (ERAS) approach for lumbar spinal fusion. J Neurosurg Spine, 2017, 26(4): 411-418.
3.	邢文華, 霍洪軍, 楊學軍, 等. 后路椎間融合術治療連續兩節段雙側峽部裂型腰椎滑脫癥的療效觀察. 中國修復重建外科雜志, 2015, 29(12): 1500-1503.
4.	Okuda S, Fujimori T, Oda T, et al. Patient-based surgical outcomes of posterior lumbar interbody fusion: patient satisfaction analysis. Spine (Phila Pa 1976), 2016, 41(3): E148-E154.
5.	Kolcun JPG, Brusko GD, Basil GW, et al. Endoscopic transforaminal lumbar interbody fusion without general anesthesia: operative and clinical outcomes in 100 consecutive patients with a minimum 1-year follow-up. Neurosurg Focus, 2019, 46(4): E14.
6.	楊俊松, 郝定均, 劉團江, 等. 脊柱機器人與透視輔助下經皮植釘治療腰椎滑脫癥中植釘精度的對比研究. 中國修復重建外科雜志, 2018, 32(11): 1371-1376.
7.	姜建元, 馬昕, 呂飛舟, 等. 改良經椎間孔腰椎椎體間融合術的解剖學研究及臨床意義. 中華外科雜志, 2009, 47(14): 1100-1103.
8.	張紹東, 滕宇飛, 許龍吉, 等. 改良經椎間孔椎體間融合術治療腰椎退行性疾病. 中國矯形外科雜志, 2008, 16(11): 811-814.
9.	張威, 楊克新, 朱立國, 等. Quadrant 通道下 MIS-TLIF 與開放 PLIF 治療腰椎退變性疾病的比較. 中國矯形外科雜志, 2018, 26(19): 1770-1774.
10.	Suk SI, Lee CK, Kim WJ, et al. Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine (Phila Pa 1976), 1997, 22(2): 220-219.
11.	李建江, 鄧樹才, 趙棟, 等. 改良經椎間孔腰椎椎體間融合術治療下腰椎退變性疾患. 中國修復重建外科雜志, 2009, 23(7): 788-792.
12.	Cheng X, Zhang K, Sun X, et al. Clinical and radiographic outcomes of bilateral decompression via a unilateral approach with transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis with stenosis. Spine J, 2017, 17(8): 1127-1133.
13.	de Kunder SL, van Kuijk SMJ, Rijkers K, et al. Transforaminal lumbar interbody fusion (TLIF) versus posterior lumbar interbody fusion (PLIF) in lumbar spondylolisthesis: a systematic review and meta-analysis. Spine J, 2017, 17(11): 1712-1721.
14.	林昊, 何仿, 王雷, 等. 改良經椎間孔椎體間融合術在治療Ⅰ、Ⅱ度腰椎滑脫癥中的運用. 中國矯形外科雜志, 2011, 19(8): 687-688.
15.	Wang MY, Chang HK, Grossman J. Reduced acute care costs with the ERAS^? minimally invasive transforaminal lumbar interbody fusion compared with conventional minimally invasive transforaminal lumbar interbody fusion. Neurosurgery, 2018, 83(4): 827-834.
16.	陳建華, 王盛海, 楊波, 等. 改良 TLIF 治療退變性腰椎滑脫并椎管狹窄癥. 中國骨與關節損傷雜志, 2012, 27(3): 248-249.
17.	Derman PB, Albert TJ. Interbody fusion techniques in the surgical management of degenerative lumbar spondylolisthesis. Curr Rev Musculoskelet Med, 2017, 10(4): 530-538.
18.	Mehta VA, McGirt MJ, Garcés Ambrossi GL, et al. Trans-foraminal versus posterior lumbar interbody fusion: comparison of surgical morbidity. Neurol Res, 2011, 33(1): 38-42.
19.	Liu J, Deng H, Long X, et al. A comparative study of perioperative complications between transforaminal versus posterior lumbar interbody fusion in degenerative lumbar spondylolisthesis. Eur Spine J, 2016, 25(5): 1575-1580.
20.	Lan T, Hu SY, Zhang YT, et al. Comparison between posterior lumbar interbody fusion and transforaminal lumbar interbody fusion for the treatment of lumbar degenerative diseases: A systematic review and Meta-analysis. World Neurosurg, 2018, 112: 86-93.
21.	Qin R, Liu B, Zhou P, et al. Minimally invasive versus traditional open transforaminal lumbar interbody fusion for the treatment of single-level spondylolisthesis grades 1 and 2: A systematic review and Meta-analysis. World Neurosurg, 2019, 122: 180-189.
22.	夏天, 王雷, 董雙海, 等. 經椎間孔擴大減壓結合改良經椎間孔腰椎椎體間融合術治療退變性腰椎管狹窄癥 (22 例 3 年以上隨訪). 中國矯形外科雜志, 2012, 20(24): 2242-2245.

1. 李咸周, 王倩, 張存鑫. 腰椎滑脫癥: 植入物治療現狀及未來發展. 中國組織工程研究, 2019, 23(4): 621-627.
2. Wang MY, Chang PY, Grossman J. Development of an Enhanced Recovery After Surgery (ERAS) approach for lumbar spinal fusion. J Neurosurg Spine, 2017, 26(4): 411-418.
3. 邢文華, 霍洪軍, 楊學軍, 等. 后路椎間融合術治療連續兩節段雙側峽部裂型腰椎滑脫癥的療效觀察. 中國修復重建外科雜志, 2015, 29(12): 1500-1503.
4. Okuda S, Fujimori T, Oda T, et al. Patient-based surgical outcomes of posterior lumbar interbody fusion: patient satisfaction analysis. Spine (Phila Pa 1976), 2016, 41(3): E148-E154.
5. Kolcun JPG, Brusko GD, Basil GW, et al. Endoscopic transforaminal lumbar interbody fusion without general anesthesia: operative and clinical outcomes in 100 consecutive patients with a minimum 1-year follow-up. Neurosurg Focus, 2019, 46(4): E14.
6. 楊俊松, 郝定均, 劉團江, 等. 脊柱機器人與透視輔助下經皮植釘治療腰椎滑脫癥中植釘精度的對比研究. 中國修復重建外科雜志, 2018, 32(11): 1371-1376.
7. 姜建元, 馬昕, 呂飛舟, 等. 改良經椎間孔腰椎椎體間融合術的解剖學研究及臨床意義. 中華外科雜志, 2009, 47(14): 1100-1103.
8. 張紹東, 滕宇飛, 許龍吉, 等. 改良經椎間孔椎體間融合術治療腰椎退行性疾病. 中國矯形外科雜志, 2008, 16(11): 811-814.
9. 張威, 楊克新, 朱立國, 等. Quadrant 通道下 MIS-TLIF 與開放 PLIF 治療腰椎退變性疾病的比較. 中國矯形外科雜志, 2018, 26(19): 1770-1774.
10. Suk SI, Lee CK, Kim WJ, et al. Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine (Phila Pa 1976), 1997, 22(2): 220-219.
11. 李建江, 鄧樹才, 趙棟, 等. 改良經椎間孔腰椎椎體間融合術治療下腰椎退變性疾患. 中國修復重建外科雜志, 2009, 23(7): 788-792.
12. Cheng X, Zhang K, Sun X, et al. Clinical and radiographic outcomes of bilateral decompression via a unilateral approach with transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis with stenosis. Spine J, 2017, 17(8): 1127-1133.
13. de Kunder SL, van Kuijk SMJ, Rijkers K, et al. Transforaminal lumbar interbody fusion (TLIF) versus posterior lumbar interbody fusion (PLIF) in lumbar spondylolisthesis: a systematic review and meta-analysis. Spine J, 2017, 17(11): 1712-1721.
14. 林昊, 何仿, 王雷, 等. 改良經椎間孔椎體間融合術在治療Ⅰ、Ⅱ度腰椎滑脫癥中的運用. 中國矯形外科雜志, 2011, 19(8): 687-688.
15. Wang MY, Chang HK, Grossman J. Reduced acute care costs with the ERAS^? minimally invasive transforaminal lumbar interbody fusion compared with conventional minimally invasive transforaminal lumbar interbody fusion. Neurosurgery, 2018, 83(4): 827-834.
16. 陳建華, 王盛海, 楊波, 等. 改良 TLIF 治療退變性腰椎滑脫并椎管狹窄癥. 中國骨與關節損傷雜志, 2012, 27(3): 248-249.
17. Derman PB, Albert TJ. Interbody fusion techniques in the surgical management of degenerative lumbar spondylolisthesis. Curr Rev Musculoskelet Med, 2017, 10(4): 530-538.
18. Mehta VA, McGirt MJ, Garcés Ambrossi GL, et al. Trans-foraminal versus posterior lumbar interbody fusion: comparison of surgical morbidity. Neurol Res, 2011, 33(1): 38-42.
19. Liu J, Deng H, Long X, et al. A comparative study of perioperative complications between transforaminal versus posterior lumbar interbody fusion in degenerative lumbar spondylolisthesis. Eur Spine J, 2016, 25(5): 1575-1580.
20. Lan T, Hu SY, Zhang YT, et al. Comparison between posterior lumbar interbody fusion and transforaminal lumbar interbody fusion for the treatment of lumbar degenerative diseases: A systematic review and Meta-analysis. World Neurosurg, 2018, 112: 86-93.
21. Qin R, Liu B, Zhou P, et al. Minimally invasive versus traditional open transforaminal lumbar interbody fusion for the treatment of single-level spondylolisthesis grades 1 and 2: A systematic review and Meta-analysis. World Neurosurg, 2019, 122: 180-189.
22. 夏天, 王雷, 董雙海, 等. 經椎間孔擴大減壓結合改良經椎間孔腰椎椎體間融合術治療退變性腰椎管狹窄癥 (22 例 3 年以上隨訪). 中國矯形外科雜志, 2012, 20(24): 2242-2245.

Chinese Journal of Reparative and Reconstructive Surgery

Comparative study on effectiveness of modified-transforaminal lumbar interbody fusion and posterior lumbar interbody fusion surgery in treatment of mild to moderate lumbar spondylolisthesis in middle-aged and elderly patients

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