Effect Comparison Of MIS-TLIF Under MEDand Quadrant Modes in The Treatment of Lumbar Spinal Stenosis

Abstract

Lumbar spinal stenosis is one of the common causes of low back and leg pain. Lumbar intervertebral disc degeneration leads to the decrease of intervertebral height, the limitation of vertebral activity, and the biomechanical changes of the lumbar spine, which in turn makes the lumbar anterior convex angle and sacral inclination angle smaller, and the pelvic inclination angle larger, affecting the stress distribution of the lumbar spine aggravating the intervertebral disc degeneration. If the spinal canal stenosis is not corrected for a long time, can cause the cauda equina nerve, nerve root compression, resulting in neurogenic intermittent claudication. If the spinal canal stenosis is not corrected for a long time, can cause the cauda equina nerve, nerve root compression, resulting in neurogenic intermittent claudication. Surgery can correct lumbar stenosis and reconstruct lumbar stability. But the traditional lumbar fusion trauma is huge, even can aggravate pain, spinal canal stenosis. Therefore, more and more patients are more inclined to MIS-TLIF treatment with less surgical trauma. For single-segment lumbar spinal stenosis, MIS-TLIF has the same effect as open surgery in restoring lumbar interbody height and improving lumbar-pelvis balance. Objective Discussion on the effect difference of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of lumbar spinal stenosis by Quadrant and MED methods. Methods A total of 96patients with lumbar spinal stenosis who were scheduled to undergo MIS-TLIF surgery in Our Hospital from January 2017 to October 2020 were selected and divided into group A and group B according to the surgical channel selection scheme, with 48 cases in each group. The patients in group A were treater with MED channel, and the patients in group B were treated with Quadrant channel. The degree of surgical trauma, VAS score before and postoperative, JOA score, lumbar-pelvic imaging parameters and surgical complications were compared between the two methods. Results The operation time of the A group was shorter than that of the group B(P﹤0.05).  The blood loss, exposure time under X line, drainage flow and down-ground time in A group were lower than those in B group, which had statistical significance（P<0.05）；A and B groups of patients were compared, the difference was not statistically significant （P>0.05）；Preoperative, Comparison of VAS scores between A and B groups, the difference was not statistically significant （P>0.05）.  On the first day of postoperative, the VAS score of group A was lower than that of groupB, which had statistical significance (P﹤0.05).  Preoperative, Comparison of JOA scores between A and B groups, the difference was not statistically significant （P>0.05）； Comparison of JOA scores between 1 month ,3 months and 6 months in Postoperative, the difference was not statistically significant （P>0.05）. The JOA scores of the two groups at 1 month, 3 months and 6 months postoperative were significantly lower than those Preoperative (P﹤0.05).  Six months postoperative, the lumbar anterior convex angle, segmental anterior convex angle and intervertebral height of the two groups were significantly higher than those Preoperative (P<0.05), and the pelvic inclination angle of the two groups was lower than that Preoperative (P<0.05). Conclusion MIS-TLIF in the treatment of patients with lumbar spinal stenosis using MED channel or Quadrant channel operation has curative effect, and there is little difference in the recovery of lumbar-pelvis imaging parameters, but the former has the advantages of less surgical trauma and lower postoperative pain.