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Z Orthop Unfall 2022; 160(06): 670-678
DOI: 10.1055/a-1795-4038
Original Article

Early Clinical Efficacy of Endo-TLIF in the Treatment of Lumbar Disc Herniation

Lumbar Disc Herniation and Lumbar Instability: a Comparative Study with the Traditional Method of TreatmentFrühe klinische Wirksamkeit von Endo-TLIF bei der Behandlung von lumbalen BandscheibenvorfällenBandscheibenvorfall und lumbale Instabilität: eine vergleichende Studie mit der traditionellen Methode der Behandlung
Chunlin Xiao
1   Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical College, Ganzhou, China
,
Wenchao Yin
2   Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical College, Ganzhou, China
,
Kai Zhao
3   Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical College, Ganzhou, China
,
Jiaquan Luo
4   Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical College, Ganzhou, China
,
Weimin Huang
5   Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical College, Ganzhou, China
,
Wuyang Liu 
6   Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical College, Ganzhou, China
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Abstract

Objective We aimed to compare the early clinical efficacy of endoscopy-assisted transforaminal lumbar interbody fusion (Endo-TLIF) and traditional Open-TLIF in the treatment of lumbar disc herniation and lumbar instability.

Methods Forty-six patients with lumbar disc herniation and lumbar instability admitted to the hospital were retrospectively studied from October 11, 2018 to October 11, 2020. Patients (including 17 males and 29 females) were randomly divided into Endo-TLIF and Open-TLIF groups according to the different surgical treatment. Parameters such as intraoperative blood loss, operation time, and intraoperative fluoroscopy time during the surgery as well as preoperative and postoperative lumbar lordosis angle and lumbar clearance height and related complications were recorded in detail.

Results Endo-TLIF significantly reduced intraoperative blood loss and bleeding volume compared with traditional Open-TLIF. The incision length in the Endo-TLIF group was shorter than in the Open-TLIF group and the intraoperative fluoroscopy time was also shorter than in the Open-TLIF group. The bed rest time and hospital discharge time were shortened in Endo-TLIF surgery compared with traditional Open-TLIF surgery. The creatine kinase (CK) values of the Endo-TLIF group were lower than that of the Open-TLIF group on the 1st and 3rd day after operation. Although computed tomography images of the lumbar lordosis angle did not show a significant difference between the Endo-TLIF group (43.97 ± 8.91°) and Open-TLIF group (49.08 ± 9.42°), the visual analogue scale score and Oswestry dysfunction index of lower back pain in the Endo-TLIF group were significantly lower than in the Open-TLIF group at 1 month and half a year after surgery. Complications in the Endo-TLIF group, such as lower limb neurological dysfunction and diseases of the respiratory or urinary system, effectively improved compared with the Open-TLIF group.

Conclusion Endo-TLIF appears to be a safer and more effective option for the treatment of lumbar disc herniation and lumbar instability, with a shorter recovery time, less trauma, less bleeding, no need for postoperative drainage, and less iatrogenic injury.

Zusammenfassung

Ziel Dieser Artikel soll ein Vergleich zwischen der frühen klinischen Wirksamkeit der Endoskopie-unterstützten lumbalen interkorporellen Fusion (Endo-TLIF) und der traditionellen offenen TLIF bei der Behandlung von lumbalem Bandscheibenvorfall und lumbaler Instabilität darstellen.

Methoden Die Studie umfasste 46 Patienten, die mit Bandscheibenvorfall und lumbaler Instabilität ins Krankenhaus eingeliefert wurden. Die Patienten wurden in der Zeit vom 11. Oktober 2018 bis 11. Oktober 2020 retrospektiv untersucht. Die Patienten (darunter 17 Männer und 29 Frauen) wurden nach dem Zufallsprinzip in die Endo-TLIF-Gruppe und die offene TLIF-Gruppe eingeteilt, entsprechend der unterschiedlichen chirurgischen Behandlung. Parameter wie intraoperativer Blutverlust, Operationszeit und intraoperative Durchleuchtungszeit während der Operation sowie prä- und postoperativer Lendenlordosewinkel und Lendenwirbelsäulenhöhe und damit verbundene Komplikationen wurden detailliert erfasst.

Ergebnisse Endo-TLIF reduzierte signifikant den intraoperativen Blutverlust und das Blutungsvolumen im Vergleich zur herkömmlichen offenen TLIF. Die Schnittlänge in der Endo-TLIF-Gruppe war kürzer als in der Offene-TLIF-Gruppe und die intraoperative Durchleuchtungszeit war ebenfalls kürzer als in der Offene-TLIF-Gruppe. Die Bettruhezeit und die Entlassungszeit aus dem Krankenhaus wurden durch Endo-TLIF im Vergleich zur traditionellen offenen TLIF-Operation verkürzt. Die CK-Werte der Endo-TLIF-Gruppe waren am 1. und 3. Tag nach der Operation niedriger als die der Offene-TLIF-Gruppe. CT-Bilder des lumbalen Lordosewinkels zeigten keinen signifikanten Unterschied zwischen der Endo-TLIF-Gruppe (43,97 ± 8,91°) und der Offene-TLIF-Gruppe (49,08 ± 9,42°). Allerdings waren der VAS-Score und der ODI von Kreuzschmerzen (Bewertung einen Monat bzw. ein halbes Jahr nach der Operation) in der Endo-TLIF-Gruppe signifikant niedriger als in der Offene-TLIF-Gruppe. Die Komplikationen in der Endo-TLIF-Gruppe, wie neurologische Dysfunktion der unteren Extremitäten und Erkrankungen der Atemwege oder des Harnsystems, wurden im Vergleich zur Offene-TLIF-Gruppe effektiv verbessert.

Schlussfolgerung Endo-TLIF scheint eine sicherere und effektivere Option für die Behandlung von Bandscheibenvorfall und lumbaler Instabilität zu sein. Endo-TLIF führt zu einer kürzeren Genesungszeit, weniger Traumata, weniger Blutungen und dem Wegfall einer postoperativen Drainage sowie weniger iatrogenen Verletzungen.

Schlüsselwörter

Instabilität des Lendenwirbels - offene Chirurgie - minimalinvasive Chirurgie

Keywords

lumbar disc herniation - minimally invasive surgery - clinical efficacy


Publication History

Received: 07 November 2021

Accepted after revision: 08 March 2022

Article published online:
25 April 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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