Treatment of degenerative lumbar spondylolisthesis by using minimally invasive transforaminal lumbar interbody fusion and percutaneous pedicle screw fixation

Abstract

Objective To discuss clinical therapeutic effects of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) combined with percutaneous pedicle screw fixation for degenerative lumbar spondylolisthesis (DLS).  Methods A total of 32 DLS patients treated by MIS-TLIF and percutaneous pedicle screw fixation from January 2013 to September 2015 in Xuanwu Hospital, Capital Medical University were retrospectively reviewed. Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) scores were assessed and compared between preoperation and one week, 3 months after operation and in the last follow-up. Lumbar lordosis angle, coronal Cobb angle, coronal and sagittal body shifting, complication, the degree of spondylolisthesis (Meyerding classification) and the rate of spondylolisthesis were measured according to preoperative and postoperative spinal X-ray examination. Fusion rate was evaluated according to X-rays or CT in the last follow-up, and MRI was used to assess the degree of decompression.  Results Thirty-two patients were under test with mean operation time 160 min, intraoperative blood loss 120 ml, postoperative hospital stay 7.22 d and follow-up 10.83 months. Decompression and fusion levels ranged from L2-S1 and interbody fusion was performed in 32 patients and 41 levels were fused. Compared with preoperation, the VAS and ODI scores were significantly increased at one week, 3 months after operation and in the last follow-up (P = 0.000, for all), while SF-36 score (P = 0.002, 0.000, 0.000), lumbar lordotic angle (P = 0.000, for all), coronal Cobb angle (P = 0.000, for all) and slippage rate (P = 0.000, for all) were significantly decreased. The fusion rate was 92.22%, and the improvement rate of ODI was (80.51 ± 6.02)% in the last follow-up. There were 3 cases appeared complications, including one case of infection and 2 cases of cerebrospinal fluid (CSF) fistula, and were cured after treatment. Neurological defects, internal fixation failure, breakage of pedicle screw or titanium rod, or Cage displacement were not found in 32 cases. There was no death.  Conclusions MIS-TLIF combined with percutaneous pedicle screw fixation is an effective technique for treatment of DLS patients, with less injury, less intraoperative blood loss, low complication incidence rate, good scoliosis correction and definite therapeutic effects, even this method needs more operation time, longer learning curve and more radiation.

DOI: 10.3969/j.issn.1672-6731.2016.03.003