A Novel Inextensible Endoscopic Tube Versus Traditional Extensible Retractor System in Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Prospective Observation Study.

腰椎 减压 椎间盘切除术 脊柱融合术
作者
Junlong Wu,Chao Zhang,Kang Lu,Changqing Li,Yue Zhou
出处
期刊:Pain Physician [American Society of Interventional Pain Physicians]
卷期号:22 (6) 被引量:3
标识
DOI:10.36076/ppj/2019.22.e587
摘要

BACKGROUND Currently, various retractor systems are widely used for access to the lumbar spine in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Nevertheless, studies concerning the comparison of extensible retractor and inextensible tube systems are quite rare. OBJECTIVES This article was to compare perioperative characteristics, clinical outcomes, and multifidus muscle injury of obconic inextensible tube versus extensible retractor system for single-level MIS-TLIF. STUDY DESIGN A prospective observational study on 91 patients with a mean follow-up of 20.0 ± 4.1 months. SETTING This study was conducted by a university-affiliated hospital in a major Chinese city. METHODS From April 2015 to May 2016, 91 consecutive patients who underwent MIS-TLIF procedure using an obconic inextensible endoscopic tube or extensible retractor system were enrolled in this study. Operation parameters such as incision length, blood loss, postoperative drainage volume, surgical time, analgesic use rate, time to ambulation, and postoperative hospitalization days were evaluated. The concentration of white blood cells, interleukin-6, interleukin-8, tumor necrosis factor alpha, and creatine phosphokinase (CPK)-MM of the enrolled patients were measured for postoperative traumatic stress and muscle injury. Multifidus muscle edema and atrophy were evaluated by T2-weighted magnetic resonance imaging (MRI) at 3 different time points (preoperative, postoperative, and 1-year follow-up). Clinical outcomes such as Visual Analog Scale (VAS) score, Japanese Orthopedic Association (JOA) score, Oswestry Disability Index (ODI) score, fusion rates, and MacNab criteria were assessed for patients' symptoms. RESULTS In terms of baseline characteristics, the 2 groups were similar regarding sample size, gender, age, symptoms duration, operation level, body mass index, physical examination, and all the clinical outcomes measures (P > 0.05). Perioperative analysis showed that the inextensible group had comparative incision length, blood loss, operation time, time to ambulation, and postoperative hospitalization (P > 0.05). The inextensible tubular group had less postoperative drainage volume and analgesic use rate (P < 0.05). The concentration level of CPK-MM and c-reactive protein (CRP) was lower in the inextensible tubular group compared with the extensible retractor group.No significant difference was found between the 2 groups regarding MRI T2 signal intensity ratio of multifidus muscle at the immediate postoperative period. The MRI T2 signal intensity ratio of multifidus muscle was lower in the inextensible tubular group than the extensible retractor group at the 1-year follow-up period. The VAS scores for low back pain and leg pain improved significantly in both groups after surgery, as did the JOA and ODI scores. However, there were no significant differences between the 2 groups regarding the preoperative and final follow-up VAS, JOA, and ODI scores, fusion rates, and the distribution of the MacNab criteria. LIMITATIONS This was not a randomized controlled trail, which could provide more evidence-based medicine conclusions. CONCLUSIONS The obconic inextensible endoscopic tube system via the transforaminal approach for lumbar interbody fusion is a safe and sufficient technique. When compared with the extensible retractor system, it has comparable clinical outcomes, with additional significant benefits of less postoperative drainage volume and analgesic use rate, less multifidus muscle injury in terms of lower CPK-MM levels at immediate postoperative period, less change in CRP, and less change in MRI T2 signal intensity ratio of multifidus muscles at 1-year follow-up. KEY WORDS Minimally invasive, endoscopic, lumbar interbody fusion, tubular, multifidus muscle.

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
刚刚
2秒前
weilu发布了新的文献求助10
2秒前
3秒前
嘟嘟发布了新的文献求助10
4秒前
陈开山完成签到,获得积分10
4秒前
梨理栗发布了新的文献求助10
4秒前
4秒前
alex发布了新的文献求助10
5秒前
5秒前
LaTeXer应助隐形夕阳采纳,获得50
5秒前
lw发布了新的文献求助10
6秒前
6秒前
英姑应助Janusfaces采纳,获得10
6秒前
6秒前
plasmid完成签到,获得积分10
7秒前
Ava应助咕噜咕噜咕嘟咕嘟采纳,获得10
7秒前
8秒前
SHAO应助一块司康饼采纳,获得100
8秒前
嗯哼发布了新的文献求助10
8秒前
Rondab应助mariawang采纳,获得10
10秒前
MchemG应助酷酷的紫南采纳,获得30
11秒前
1111发布了新的文献求助10
11秒前
11秒前
continue发布了新的文献求助10
12秒前
zhangtong发布了新的文献求助10
12秒前
嘟嘟完成签到,获得积分10
12秒前
wdy111应助葡萄味的果茶采纳,获得20
13秒前
悦耳代真完成签到,获得积分10
13秒前
ysx完成签到,获得积分10
13秒前
14秒前
Orange应助淡淡夕阳采纳,获得10
14秒前
14秒前
yar重新开启了yl文献应助
15秒前
16秒前
16秒前
zhoup完成签到,获得积分20
17秒前
宝海青完成签到,获得积分10
17秒前
李健应助缓慢的含双采纳,获得10
17秒前
yqb完成签到,获得积分10
18秒前
高分求助中
A new approach to the extrapolation of accelerated life test data 1000
ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition 500
‘Unruly’ Children: Historical Fieldnotes and Learning Morality in a Taiwan Village (New Departures in Anthropology) 400
Indomethacinのヒトにおける経皮吸収 400
Phylogenetic study of the order Polydesmida (Myriapoda: Diplopoda) 370
基于可调谐半导体激光吸收光谱技术泄漏气体检测系统的研究 350
Robot-supported joining of reinforcement textiles with one-sided sewing heads 320
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3988732
求助须知:如何正确求助?哪些是违规求助? 3531027
关于积分的说明 11252281
捐赠科研通 3269732
什么是DOI,文献DOI怎么找? 1804764
邀请新用户注册赠送积分活动 881869
科研通“疑难数据库(出版商)”最低求助积分说明 809021