显微镜辅助下改良TLIF单侧入路双侧减压单侧内固定治疗腰椎管狭窄症的中远期疗效

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Abstract Objective To investigate the medium-long-term clinical efficacy of modified transforaminal lumbar interbody fusion (TLIF) by unilateral approach with bilateral decompression and unilateral fixation assisted by microscope for the treatment of lumbar spinal stenosis.Methods We retrospectively analyzed 26 cases (17 males and 9 females) with lumbar spinal stenosis treated underwent modified transforaminal lumbar interbody fusion(TLIF) by unilateral approach with bilateral decompression and unilateral fixation assisted by microscope from August 2010 to February 2018.Their ages ranged from 47 to 71 years old，with a mean age of (61.5±6.28)years old.The operation level was L_3～4 in 4 cases，L_4～5 in 11 cases，L₅S₁ in 9 cases and L_4～5 and L₅S₁ in 2 cases.Clinical outcomes including operation duration，surgical blood loss，post-operative drainage volume and complications were recorded.Low back and lower limb pain were assessed using the visual analogue scale (VAS) and the Oswestry disability index(ODI) assessesed the functional condition of the lumbar spine.Average intervertebral height，lumbar Cobb angle were utilized to evaluate the reduction of intervertebral height and lumbar lordosis.At the last follow-up，Bridwell standard was used to evaluate the interbody fusion，and MacNab standard was used to evaluate the clinical efficacy of patients.Results All patients were followed up for 25 to 98 months，with an average of (61.2±22.9)months.The average operation time was (89.2±19.9)min and the average intraoperative blood loss was (172.9±63.1)mL.The average postoperative drainage volume was (93.0±27.2)mL.VAS score of low back pain，VAS score of lower limb pain and ODI index were significantly decreased compared with those before surgery，with statistical significance (P<0.05).The height of the intervertebral space of the operative segment was significantly increased after operation compared with that before operation，and the difference was statistically significant (P<0.05).The lordosis of lumbar spine was increased after surgery，but the difference was not statistically significant (P＞0.05).In the last follow-up，there were 24 cases (92.3%) of interbody fusion in accordance with Bridwell standard Ⅰ and Ⅱ.According to MacNab standard，19 cases were excellent，5 cases were good，and 2 cases were fair.The excellent and good rate was 92.3%.One patient had cerebrospinal fluid leakage，and the incision healed in grade A after intensive dressing change without any complications such as loosening or fracture of internal fixator.Conclusion The microscopeassisted modified TLIF unilateral approach with bilateral decompression and unilateral fixation can achieve satisfactory medium-long-term clinical effects in the treatment of lumbar spinal stenosis.

Key words： transforaminal lumbar interbody fusion unilateral approach bilateral decompression unilateral fixation lumbar spinal stenosis

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