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| PANG Daming, ,,YIN Peng,YANG Jincai.Mid- to long-term clinical efficacy of transforaminal lumbar interbody fusion for the treatment of single-segment lumbar spinal stenosis and changes in paraspinal muscles and adjacent segment facet joints after operation[J].Chinese Journal of Spine and Spinal Cord,2024,(4):372-379. |
| Mid- to long-term clinical efficacy of transforaminal lumbar interbody fusion for the treatment of single-segment lumbar spinal stenosis and changes in paraspinal muscles and adjacent segment facet joints after operation |
| Received:November 28, 2023 Revised:January 17, 2024 |
| English Keywords:Lumbar spinal stenosis Percutaneous endoscopic transforaminal lumbar interbody fusion Paraspinal muscles Facet joints |
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| English Abstract: |
| 【Abstract】 Objectives: The purpose of this study was to investigate the clinical efficacy of percutaneous endoscopic transforaminal lumbar interbody fusion(PE-TLIF) in patients with single-segment lumbar spinal stenosis and explore the changes of paraspinal muscles and adjacent segmental facet joints of operative segement after PE-TLIF. Methods: 28 patients with L4/5 lumbar spinal stenosis treated with PE-TLIF in Beijing Chaoyang Hospital from March 2017 to March 2019 were analyzed retrospectively. The patients consisted of 12 males and 16 females with an average age of 58.0±8.7 years(41-79 years) and were followed up for 40.7±3.6 months(36-58 months). The visual analogue scale(VAS) of low back pain(VAS-LBP) and VAS of leg pain(VAS-LP) were collected at pre-operation, postoperative 1-week follow-up, 3-month follow-up, 12-month follow-up and the final follow-up; Oswestry disability index(ODI) was evaluated at pre-operation, postoperative 3-month follow-up, 12-month follow-up and the final follow-up. CT examination was performed at pre-operation, postoperative 12-month follow-up, 24-month follow-up and the final follow-up, the cross-sectional area(CSA) and fat infiltration(FI) score of multifidus(MF) were measured, and the degeneration degree of adjacent segmental facet joints was evaluated according to the score of facet joint degeneration. The differences of MF CSA and FI score, as well as adjacent segmental facet joint degeneration were compared between preoperation and postoperation. Results: The VAS-LBP score was 3(2, 3) at 1-week follow-up, 1(1, 2) at 3-month follow-up, 1(0, 2) at 12-month follow-up, and 1(0, 1) at the final follow-up, which was significantly improved compared with the preoperative score of 7(7, 8)(P<0.05); the VAS-LP score was 2(1, 3) at 1-week follow-up, 1(1, 2) at 3-month follow-up, 1(0, 1) at 12-month follow-up, and 0(0, 1) at the final follow-up, which were significantly improved compared with the preoperative score of 6(5, 7)(P<0.05); The ODI at 3-month follow-up was 23%(19%, 31%), at 12-month follow-up was 12%(8.5%, 17.5%), and at the final follow-up was 7%(4%, 15.6%), all significantly improved compared with the ODI before operation of 61%(55%, 67%)(P<0.05). The postoperative MF CSAs of 547.12±53.31mm2(12-month follow-up), 558.35±52.37mm2 (24-month follow-up), and 531.21±56.12mm2(final follow-up) were not significantly changed from the preoperative MF CSA of 557.06±46.72mm2(P>0.05). There was no significant difference in FI score between pre-operation of 2(2, 3) and 12-month follow-up of 3(2, 3), 24-month follow-up of 3(2, 3) and the final follow-up of 3(3, 3)(P>0.05). The postoperative facet joint degeneration scores of upper segment facet joint (USFJ) of 5(4, 6) at 12-month follow-up, 5(4, 5) at 24-month follow-up, and 5(4, 6) at final follow-up were not significantly changed from the preoperative 5(4, 6)(P>0.05). And there was no significant difference either in facet joint degeneration score of lower segment facet joint(LSFJ) between pre-operation of 5(4, 6) and 12-month follow-up of 5(4, 5), 24-month follow-up of 5(4, 6) and the final follow-up of 5(4, 7)(P>0.05). Conclusions: PE-TLIF can achieve satisfactory clinical outcomes in the treatment of single-segment lumbar spinal stenosis, which has no significant effect on multifidus in the surgical segment and adjacent segmental facet joints in the mid- to long-term. |
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