[Treatment of degenerative lumbar spondylolisthesis with minimally invasive transforaminal lumbar interbody fusion by microscope-assisted Zista channel].

OBJECTIVE

To investigate the clinical efficacy and advantage of minimally invasive transforaminal lumbar interbody fusion under microscope-assisted Zista channel in the treatment of degreeⅠandⅡdegenerative lumbar spondylolisthesis.

METHODS

The clinical data of 18 patients with degenerative lumbar spondylolisthesis treated by microscope-assisted Zista channel MIS-TLIF operation from January 2017 to March 2018 were analyzed retrospectively. There were 10 males and 8 females with an average age of 59 years (48 to 70). The course of spondylolisthesis ranged from 6 months to 5 years with an average of 33 months. The segment of spondylolisthesis was L in 13 casesand L in 5 cases. According to Meyerding spondylolisthesis criteria, 11 cases were degreeⅠand 7 cases were degreeⅡ. The perioperative observation indexes were recorded. The VAS score and JOA score of lumbago and leg pain before and after operation were compared to evaluate the clinical efficacy. At 12 months after operation, the height of intervertebral space was measured by imaging data, the intervertebral fusion was evaluated by Brantigan-Steffee standard, and the curative effect was evaluated according to the modified Macnab standard.

RESULTS

All the patients completed the operation successfully and were followed up more than 12 months after operation. Operation time was(160.45±34.98) min, intraoperative blood loss was (88.32±21.12) ml, postoperative drainage volume was (50.34 ±18.22)ml, and walking time after operation was (20.65±6.25) h. Preoperative and postoperative at 7 days, 3 months, 12 months, VAS score of low back pain was 7.81±2.16, 4.19±1.17, 2.25±0.62 and 1.53±0.58 respectively, VAS score of leg pain was 8.47± 2.21, 3.45±0.86, 2.31±0.73 and 1.43±0.47, JOA score was 12.01±2.33, 18.56±3.12, 23.54±3.31 and 26.34±2.65. There were significant differences in VAS and JOA scores between preoperative and postoperative (<0.05). The height of intervertebral space increased from (4.46±0.72) mm preoperative to (10.24±1.48) mm at 12 months after operation (<0.05). All operative segments got fusion (16 cases of grade E and 2 cases of grade D). According to Macnab standard, 15 cases obtained excellent results, 2 cases good, 1 case fair.

CONCLUSION

MIS-TLIF under microscope-assisted Zista channel has obvious minimally invasive advantages in the treatment of degreeⅠandⅡdegenerative lumbar spondylolisthesis, and it is a safe and effective method.