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| YANG Zuqing,JIE Qiang,LI Tianqing.The curative effect of Wiltse approach and transforaminal lumbar interbody fusion for the treatment of lumbar spondylolisthesis[J].Chinese Journal of Spine and Spinal Cord,2015,(6):503-510. |
| The curative effect of Wiltse approach and transforaminal lumbar interbody fusion for the treatment of lumbar spondylolisthesis |
| Received:January 28, 2015 Revised:May 26, 2015 |
| English Keywords:Lumbar spondylolisthesis Transforaminal lumbar interbody fusion Wiltse approach |
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| English Abstract: |
| 【Abstract】 Objectives: To explore the effect of the operation of Wiltse approach and transforaminal lumbar interbody fusion(TLIF) for the treatment of lumbar spondylolisthesis. Methods: 54 patients with lumbar spondylolisthesis between September 2008 and August 2010 in our hospital were randomly divided into the Wiltse approach group(31 cases) and the conventional approach group(23 cases). There were no statistically significant differences in the gender, age, slip degree, segmental distribution and other demographic data between the two groups(P>0.05). The differences of the operation time, intraoperative blood loss and postoperative drainage were compared. The contents of creatine kinase in peripheral blood in the two groups were compared at 1 day of preoperation, 24 hours and 1 week of postoperation. The visual analogue scores(VAS), Oswestry disability index(ODI) and other clinical outcome scores and the slip angle, slip degree, intervertebral disc height and other imaging results were used to assess the effect of the treatment at 1 day of preoperation, 3 days, 3 months, 6 months and 1 year of postoperation. The X-ray and three dimensional CT were used to evaluate lumbar spinal sequence, slippage vertebral reset and intervertebral bone graft fusion at 1 year of postoperation. Results： In the Wiltse approach group, the operation time was 72.6±7.5min(65-85min), the intraoperative blood loss was 86.8±78.9ml(80-175ml), the postoperative drainage was 90.5±56.2ml(85-170ml), the contents of creatine kinase at 24 hours of postoperation was 271.4U/L(260-400U/L); and in the conventional approach group, those data were 79.0±6.7min(75-95min), 285.6±36.4ml(280-330ml), 195.6±20.7ml(190-220ml) and 553.7U/L(500-780U/L), there were statistically significant differences between two groups(P<0.05). There were statistically significant differences in the VAS and ODI at the differrent postoperative time points of the two groups compared with the preoperation(P<0.05). There was statistically significant differences in the VAS of Wiltse approach group(4.5±1.6) compared with the conventional approach group(6.9±2.5) at 3 days of postoperation(P<0.05). There were no statistically significant differences in the VAS and ODI at 3 months, 6 months and 1 year of postoperation between two groups(P>0.05). According to the Bridwell evaluation criteria, grade Ⅰ fusion was in 13 cases(56.5％) and grade Ⅱ fusion in 10 cases(43.5％) in the conventional approach group; Ⅰ in 18 cases(58．1％) and Ⅱ in 13 cases(41.9％) in the Wiltse approach group, there was no significant difference between the two groups(P>0.05). There were no statistically significant difference in the slip angle, slip degree, intervertebral disc height at preoperation and postoperation between the two groups(P>0.05). Conclusions: The safe and effective operation effect acquired by Wiltse approach and TLIF for the treatment of lumbar spondylolisthesis is the same as the effect acquired by the conventional approach group, the operation of Wiltse approach and TLIF is more convenient, less tissue injury, less bleeding, faster recovery. |
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