A comparison of the clinical efficacies of lumbar interbody fusion via percutaneous endoscopic inter-laminar approach and minimally invasive transforaminal approach in the treatment of grade Ⅰ and Ⅱ lumbar spondylolisthesis / 中国脊柱脊髓杂志

ABSTRACT

Objectives:To compare the clinical efficacies of percutaneous endoscopic posterior lumbar inter-body fusion(PE-PLIF)and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in the treat-ment of grade Ⅰ and Ⅱ lumbar spondylolisthesis.Methods:The clinical data of 70 patients with single lev-el lumbar spondylolisthesis treated with PE-PLIF or MIS-TLIF in the Department of Minimally Invasive Spinal Surgery of the Sixth Affiliated Hospital of Xinjiang Medical University between January 2020 and Jan-uary 2022 were analyzed retrospectively,including 33 males and 37 females,aged 59.6±11.0 years old.Ac-cording to different surgical methods,the patients were divided into PE-PLIF group of 36 cases and MIS-TLIF group of 34 cases.The operative time,intraoperativc blood loss,postoperative 3d serum indexes such as creatine kinase(CK),C-reactive protein(CRP)and interleukin-6(IL-6)were collected and compared between groups,as well as low back and leg pain visual analogue scale(VAS)and Oswestry disability index(ODI)be-fore operation,at 1 week,and 3 and 6 months,and 1 year after operation.3D reconstruction CT was used to evaluate interbody fusion according to the Bridwell's fusion grading system at 2 years after operation,and postoperative complications were also documented.Results:PE-PLIF group was significantly less than MIS-TLIF group in intraoperative blood loss(91.6±45.8mL vs 195.5±126.3mL,P=0.000),longer in operative time(227.5±58.0min vs 194.1±55.2min,P=0.016),and lower postoperative 3d CK,CRP,IL-6(P＜0.05).The VAS score and ODI in both groups were significantly improved compared with those before operation,while the VAS score in PE-PLIF group improved more obvious than that in MIS-TLIF group at one week after operation(P=0.02),and no statistically significant difference was there in the VAS scores between groups at other time points(P＞0.05).PE-PLIF group wasn't significantly different from MIS-TLIF group in the fusion conditions at 2 years after operation(86％vs 94％,P=0.430);There were no serious complications requiring revision surgery in both groups.Conclusions:PE-PLIF is less traumatic and relieves low back pain better at early postoperation than MIS-TLIF in the treatment of grade Ⅰ and grade Ⅱ lumbar spondylolisthesis,while PE-PLIF isn't significantly differ from MIS-TLIF in mid-to-long term clinical efficacy.