Objective:

To investigate the effectiveness of microscope assisted anterior lumbar discectomy and fusion (ALDF) and mobile microendoscopic discectomy assisted lumbar interbody fusion (MMED-LIF) for lumbar degenerative diseases.

Methods:

A clinical data of 163 patients with lumbar degenerative diseases who met the criteria between January 2018 and December 2020 was retrospectively analyzed. Fifty-three cases were treated with microscope assisted ALDF (ALDF group) and 110 cases with MMED-LIF (MMED-LIF group). There was no significant difference between the two groups in terms of gender, age, disease type, surgical segments, preoperative visual analogue scale (VAS) scores of low back pain and leg pain, Oswestry disability index (ODI), intervertebral space height, lordosis angle, and spondylolisthesis rate of the patients with lumbar spondylolisthesis ( P>0.05). The operation time, intraoperative blood loss, and hospital stay of the two groups were recorded. The effectiveness was evaluated by VAS scores of low back pain and leg pain and ODI. Postoperative lumbar X-ray films were taken to observe the position of Cage and measure the intervertebral space height, lordosis angle, and spondylolisthesis rate of the patients with lumbar spondylolisthesis.

Results:

The operations were successfully completed in both groups. The operation time, intraoperative blood loss, and hospital stay in ALDF group were less than those in MMED-LIF group ( P<0.05). The patients in both groups were followed up 12-36 months, with an average of 24 months. The VAS scores of low back pain and leg pain and ODI after operation were lower than those before operation in the two groups, and showed a continuous downward trend, with significant differences between different time points ( P<0.05). There were significant differences between two groups in VAS score of low back pain and ODI ( P<0.05) and no significant difference in VAS score of leg pain ( P>0.05) at each time point. The improvement rates of VAS score of low back pain and ODI in ALDF group were significantly higher than those in MMED-LIF group ( t=7.187, P=0.000; t=2.716, P=0.007), but there was no significant difference in the improvement rate of VAS score of leg pain ( t=0.556, P=0.579). The postoperative lumbar X-ray films showed the significant recovery of the intervertebral space height, lordosis angle, and spondylolisthesis rate at 2 days after operation when compared with preoperation ( P<0.05), and the improvements were maintained until last follow-up ( P>0.05). The improvement rates of intervertebral space height and lordosis angle in ALDF group were significantly higher than those in MMED-LIF group ( P<0.05). There was no significant difference in the reduction rate of spondylolisthesis between the two groups ( t=1.396, P=0.167). During follow-up, there was no loosening or breakage of the implant and no displacement or sinking of the Cage.

Conclusion:

Under appropriate indications, microscope assisted ALDF and MMED-LIF both can achieve good results for lumbar degenerative diseases. Microscope assisted ALDF was superior to MMED-LIF in the improvement of low back pain and function and the recovery of intervertebral space height and lordosis angle.

目的:

探讨显微镜辅助前路腰椎间盘切除融合术（anterior lumbar discectomy and fusion，ALDF）和可动式椎间盘镜下椎间融合术（mobile microendoscopic discectomy assisted lumbar interbody fusion，MMED-LIF）治疗腰椎退变性疾病的疗效。.

方法:

回顾性分析2018年1月—2020年12月收治且符合选择标准的163例腰椎退变性疾病患者临床资料。其中，53例采用显微镜辅助ALDF（ALDF组），110例采用MMED-LIF（MMED-LIF组）。两组患者性别、年龄、疾病类型、手术节段以及术前腰痛及腿痛疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、椎间隙高度、前凸角度及腰椎滑脱患者滑脱率等一般资料比较，差异均无统计学意义（ P>0.05），具有可比性。记录两组手术时间、术中出血量、住院时间，采用腰痛和腿痛VAS评分、ODI评价临床疗效；术后复查腰椎X线片，观察椎间融合器有无下沉，并测量椎间隙高度、前凸角度及腰椎滑脱患者滑脱率。.

结果:

两组手术均顺利完成。ALDF组手术时间、术中出血量、住院时间均低于MMED-LIF组（ P<0.05）。两组患者术后均获随访，随访时间12～36个月，平均24个月。术后两组腰痛、腿痛VAS评分以及ODI均较术前降低，且呈持续降低趋势，各时间点间差异均有统计学意义（ P<0.05）。各时间点腰痛VAS评分及ODI组间比较差异有统计学意义（ P<0.05），腿痛VAS评分组间比较差异无统计学意义（ P>0.05）。ALDF组腰痛VAS评分及ODI改善率高于MMED-LIF组（ t=7.187， P=0.000； t=2.716， P=0.007），但腿痛VAS评分改善率差异无统计学意义（ t=0.556， P=0.579）。术后2 d腰椎X线片示椎间隙高度、前凸角度较术前增大（ P<0.05），滑脱不同程度复位（ P<0.05），且维持至末次随访时（ P>0.05）。ALDF组椎间隙高度改善率、前凸角度改善率大于MMED-LIF组（ P<0.05），两组滑脱复位率差异无统计学意义（ t=1.396， P=0.167）。随访期间未见内植物松动、断裂现象，椎间融合器无移位、下沉。.

结论:

在严格把握适应证情况下，显微镜辅助ALDF和MMED-LIF治疗腰椎退变性疾病均可获得良好疗效。但前者术后腰痛和功能改善更显著，椎间隙高度和前凸角度恢复更好。.