Hu Wenlong, He Fei, Sun Kai, Wan Haiwu, Ruan Sijun, Huang Bo
Department of Orthopedic Surgery, Jiujiang University Affiliated Hospital, Jiujiang, China.
Jiujiang Orthopedic Medical Quality Control Center, Jiangxi, China.
Front Surg. 2025 Jan 6;11:1482067. doi: 10.3389/fsurg.2024.1482067. eCollection 2024.
Evaluating the clinical value of the modified single-incision posterior median approach with expandable tubular assistance for lumbar interbody fusion in managing degenerative lumbar spine diseases.
A retrospective analysis was conducted on 121 patients with single-level degenerative lumbar spine disease treated in our spine surgery department from January 2017 to December 2021. Of these, 72 patients underwent a modified single-incision posterior median approach with expandable tubular assistance lumbar interbody fusion (single-incision MIS-TLIF group), while 49 patients received the classic open posterior median incision P-TLIF (open surgery group). We collected basic demographic data including age, gender, BMI, and surgical level. Surgical-related indicators such as operation time, intraoperative blood loss, postoperative drainage, length of hospital stay, hospital costs, and complication rates were compared between the two groups. Laboratory results [whole blood C-reactive protein (CRP), serum creatine kinase (CK)] and clinical outcomes [VAS scores for low back and leg pain, Oswestry Disability Index (ODI), excellent and good rate according to the modified MacNab criteria, and interbody fusion rate according to the Brantigan criteria] were also evaluated.
There were no significant differences in the basic demographics between the two groups. The operation time, postoperative hospital stay, and hospital costs were also similar between the groups. However, significant differences were observed in intraoperative blood loss, postoperative drainage, and complication rates. On postoperative days 1 and 3, whole blood CRP and CK levels showed marked differences between the groups. At 3, 6, and 12 months postoperatively, the single-incision MIS-TLIF group had lower ODI scores and VAS scores for back pain compared to the open surgery group. The excellent and good rate according to the MacNab criteria was higher in the single-incision MIS-TLIF group. There were no significant differences in leg pain VAS scores and interbody fusion rates at 12 months postoperatively between the groups.
The modified single-incision posterior median approach with expandable tubular assistance lumbar interbody fusion is highly effective in treating degenerative lumbar spine diseases. It results in less postoperative pain, faster recovery, and significant improvement in postoperative functional outcomes, making it a valuable treatment option.
评估改良单切口后正中入路联合可扩张通道辅助腰椎椎间融合术治疗退行性腰椎疾病的临床价值。
对2017年1月至2021年12月在我院脊柱外科接受治疗的121例单节段退行性腰椎疾病患者进行回顾性分析。其中，72例患者接受改良单切口后正中入路联合可扩张通道辅助腰椎椎间融合术（单切口微创经椎间孔腰椎椎间融合术组），49例患者接受经典开放后正中切口经椎间孔腰椎椎间融合术（开放手术组）。我们收集了基本人口统计学数据，包括年龄、性别、体重指数和手术节段。比较两组患者的手术相关指标，如手术时间、术中出血量、术后引流量、住院时间、住院费用和并发症发生率。还评估了实验室检查结果[全血C反应蛋白（CRP）、血清肌酸激酶（CK）]和临床结局[腰腿痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、根据改良MacNab标准的优良率以及根据Brantigan标准的椎间融合率]。
两组患者的基本人口统计学数据无显著差异。两组患者的手术时间、术后住院时间和住院费用也相似。然而，术中出血量、术后引流量和并发症发生率存在显著差异。术后第1天和第3天，两组患者的全血CRP和CK水平存在明显差异。术后3、6和12个月，单切口微创经椎间孔腰椎椎间融合术组的ODI评分和腰背痛VAS评分低于开放手术组。根据MacNab标准，单切口微创经椎间孔腰椎椎间融合术组的优良率更高。两组患者术后12个月时腿痛VAS评分和椎间融合率无显著差异。
改良单切口后正中入路联合可扩张通道辅助腰椎椎间融合术治疗退行性腰椎疾病疗效显著。它能减少术后疼痛，加快恢复，显著改善术后功能结局，是一种有价值的治疗选择。
