doi: 10.3389/fsurg.2020.596327.
eCollection 2020.
Affiliations
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et al.
Front Surg.
.
Abstract
Introduction: Both lumbar endoscopic unilateral laminotomy bilateral decompression (LE-ULBD) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) have been used to treat one-level lumbar spinal stenosis (LSS) with degenerative spondylolisthesis, while the differences of the clinical outcomes are still uncertain. Methods: Among 60 consecutive patients included, 24 surgeries were performed by LE-ULBD and 36 surgeries were performed by MI-TLIF. Patient demographics, operation characteristics and complications were recorded. Sagittal parameters, including slip percentage (SP) and slip angle (SA) were compared. The visual analog scale (VAS) score, the Oswestry Disability Index (ODI) score, and Macnab criteria were used to evaluate the clinical outcomes. Follow-up examinations were conducted at 3, 6, 12, and 24 months postoperatively. Results: The estimated blood loss, time to ambulation and length of hospitalization of the LE-ULBD group were shorter than the MI-TLIF group. Preoperative and final follow-up SP of the LE-ULBD group was of no significant difference, while final follow-up SP of the MI-TLIF group was significantly improved compared with preoperative SP. The postoperative mean VAS and ODI scores decreased significantly in both LE-ULBD group and MI-TLIF group. According to the modified Macnab criteria, the outcomes rated as excellent/good rate were 95.8 and 97.2%, respectively, in both LE-ULBD group and MI-TLIF group. Intraoperative complication rate of the LE-ULBD and the MI-TLIF group were 4.2 and 0%, respectively. One case of intraoperative epineurium injury was observed in the LE-ULBD group. Postoperative complication rate of the LE-ULBD and the MI-TLIF group were 0 and 5.6%, respectively. One case with transient urinary retention and one case with pleural effusion were observed in the MI-TLIF group. Conclusion: Both LE-ULBD and MI-TLIF are safe and effective to treat one-level LSS with degenerative spondylolisthesis.
Keywords:
degenerative spondylolisthesis; lumbar endoscopic unilateral laminotomy bilateral decompression; lumbar spinal stenosis; minimally invasive; transforaminal lumbar interbody fusion.
Copyright © 2021 Hua, Wang, Ke, Xiang, Wu, Zhang, Li, Yang, Wu and Yang.
Conflict of interest statement
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Figures
Figure 1
Surgical procedures of lumbar endoscopic unilateral laminotomy bilateral decompression (LE-ULBD). (A,B) The inferior edge of the cranial lamina and the base of the spinous process of the ipsilateral side were removed by the endoscopic burr; (C) undercutting of the contralateral cranial lamina was performed; (D) the ipsilateral and contralateral ligamentum flavum was identified and removed piecemeal with endoscopic punches and forceps; (E) the ipsilateral medial facetectomy was performed to decompress the lateral recess and ensure adequate decompression of the traversing nerve root (F) the contralateral medial facetectomy was performed to decompress the lateral recess and ensure adequate decompression of the traversing nerve root.
Figure 2
Lumbar endoscopic unilateral laminotomy bilateral decompression (LE-ULBD) performed on a 77-year-old female patient diagnosed with L4-L5 lumbar spinal stenosis with degenerative spondylolisthesis. (A,B) preoperative anteroposterior and lateral plain radiographs; (C,D) preoperative flexion and extension radiographs; (E) preoperative computed tomography (CT) scans; (F–H) preoperative magnetic resonance imaging (MRI) scans; (I,J) medial facetectomy was performed to decompress the lateral recess and ensure adequate decompression of the traversing nerve root; (K) postoperative CT scans; (L) postoperative MRI scans. Snowflake, nerve root, triangle, dural sac. * is used to tell the readers where is the nerve root.
Figure 3
Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) performed on a 48-year-old female patient diagnosed with L4-L5 lumbar spinal stenosis with degenerative spondylolisthesis. (A,B) preoperative anteroposterior and lateral plain radiographs; (C,D) preoperative flexion and extension radiographs; (E) preoperative computed tomography (CT) scans; (F–H) preoperative magnetic resonance imaging (MRI) scans; (I,J) anteroposterior and lateral plain radiographs 3 days after the surgery; (K,L) CT scans 12 months after the surgery.
Figure 4
Sagittal parameters of degenerative spondylolisthesis. (A) Slip percentage (SP) was measured as a percentage of the distance from the posterior border of the caudal vertebra to the posterior border of the cephalic vertebra (a), normalized to the superior endplate diameter of the caudal vertebra (b); SP = a/b × 100%; (B) slip angle (SA) was measured by Cobb’s angle between the inferior endplate of the cephalic vertebra and superior endplate of caudal vertebra.
Figure 5
The mean visual analog scale (VAS) scores for leg and back pain, and Oswestry disability index (ODI) scores. (A) VAS scores for leg pain; (B) VAS scores for back pain; (C) ODI scores. Pre-op, pre-operative; post-op, post-operative; LE-ULBD, lumbar endoscopic unilateral laminotomy bilateral decompression; MI-TLIF, minimally invasive transforaminal lumbar interbody fusion.
References
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