Analysis of lumbosacral sagittal balance parameter variation in minimally invasive transforaminal lumbar interbody fusion with real-time 3D navigation techniques

Abstract

To explore the dynamic changes of lumbosacral sagittal parameters after real-time three-dimensional navigation assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and traditional open TLIF for treatment of lumbar degenerative disease. The clinical data of 61 patients with lumbar degenerative disease underwent single-segment surgery from September 2017 to September 2019 were retrospectively analyzed. Among them, 31 cases underwent MIS-TLIF with 3D navigation techniques (MIS-TLIF group) and another 30 cases underwent conventional open TLIF (traditional open TLIF group). The basic information, operative time and intraoperative blood loss were collected. The sagittal radiologic parameters were measured before surgery and 3 months after surgery, including lumbar lordosis (LL), segmental lordosis (SL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), anterior disc height (ADH), posterior disc height(PDH).And the average disc height(DH) and pelvic incidence to lumbar lordosis mismatch (PI-LL) were calculated. Operative time and intraoperative blood loss in MIS-TLIF group were significantly less than in traditional open TLIF group(P<0.05). In MIS-TLIF group, LL, SL, PI-LL, and DH were significantly improved at 3 months after surgery (P<0.05), while PI, PT, and SS were not statistically different from those before surgery (P>0.05). LL, PI-LL, and DH of patients in the traditional open TLIF group were significantly improved at 3 months after surgery (P<0.05), while the PI, PT, SS, and SL were not statistically different from those before surgery (P>0.05). LL change showed a significant correlation with SL change (r= 0.433, P<0.001). Change in SL closely correlated to change in ADH (r=0.621, P<0.05) and PDH(r=0.527, P<0.05). Real-time navigation-assisted MIS-TLIF and traditional open TLIF can recover DH in a short term for lumbar degenerative diseases, improve LL and PI-LL, and make the arrangement of the sagittal plane of the lumbosacral region more coordinated after surgery. But only the navigation assisted MIS -TLIF can significantly improve SL. Compared with traditional open TLIF, real-time navigation assisted MIS-TLIF in the treatment of degenerative lumbar diseases has the advantages of short operation time and less intraoperative bleeding.