Abstract
Background The objective of this study was to investigate the enhanced recovery clinical effects of an innovative percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) for the treatment of patients with LSS and degenerative instability. Methods From January 2019 to March 2020, 51 patients with single-segment LSS and degenerative instability were prospectively included in our study (ChiCTR1900020679). The Oswestry Disability Index (ODI), the visual analogue scale (VAS) on lumbar and leg pain (VAS-LBP and VAS-LP), serum creatine kinase (CK), the peak intensity of sulphur hexafluoride microbubble contrast agent (PI), and the maximal cross-sectional area of multifidus muscle (Max-CSA) around the surgical incision were assessed preoperatively, postoperatively, and at regular follow-up. Results All patients were followed up. The mean postoperative bedridden time was 20.45 ± 2.66 hours. The ODI, VAS-LBP, and VAS-LP were improved significantly after operation compared to these data before operation in all the patients (P < 0.05). The CK at 1 day after operation was higher compared to the data before the operation (P < 0.05), and there was no significant difference on CK at 1 week after operation (P > 0.05). The PI at 1 week after operation was higher compared to this item before operation (P < 0.05), and there was no significant difference on PI at 1 month or 3 months after operation (P > 0.05). The Max-CSA at 1 week after operation was higher compared to this item before the operation (P < 0.05), and there was no significant difference in Max-CSA at 1 month or 3 months after operation compared with before the operation (P > 0.05). Conclusions Our results and systematic review presented the innovative PE-TLIF technique could obtain satisfactory and effective outcomes for the treatment of patients with LSS and degenerative instability. Our PE-TLIF technique also had the ability to decrease the MF injury and obtain an enhanced recovery.
Highlights
Lumbar spinal stenosis (LSS) is the most common type of lumbar degenerative disease for people with low back pain [1]
Endoscopic lumbar fusion techniques have gradually gained popularity in the past several years, and we have developed an innovative minimally invasive surgery named percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) [9]. e preliminary results of our technique were satisfactory, but the injury of the MF and enhanced recovery were not evaluated in our previous study
From January 2019 to March 2020, 51 patients with singlesegment LSS and degenerative instability were included in our study (ChiCTR1900020679). e eligible criteria were as follows: (1) patients with LSS and degenerative instability on L4/5 level; (2) patients treated by PE-TLIF; (3) no lumbar surgery history; (4) no obvious multifidus muscle injury; and (5) no lumbar deformity. e exclusion criteria were as follows: (1) patients were unable to finish the follow-up; (2) patients with other comorbidity could affect the lumbar fusion; and (3) patients with other comorbidity could affect the serum creatine kinase
Summary
Lumbar spinal stenosis (LSS) is the most common type of lumbar degenerative disease for people with low back pain [1]. Conventional posterior lumbar fusion surgery is considered as the standard operation for patients with LSS [3]. Some studies showed that paravertebral muscle atrophy was clinically related to low back pain [5, 6]. It was reported that the volume of the multifidus muscle was dramatically decreased after the open posterior lumbar fusion [8]. It is necessary to perform a minimally invasive lumbar surgery to decrease the injury of the MF and shorten the postoperative rehabilitation period. We conducted a prospective observation study on the MF injury via contrast-enhanced ultrasonography after PETLIF for the treatment of patients with LSS to provide evidence of obtaining an enhanced recovery. We further investigated the clinical effects of PE-TLIF in order to provide good evidence for clinical practice
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