MIS-TLIF治疗经皮椎间孔镜术后复发性腰椎间盘突出症的临床疗效研究OACSTPCD

Background The effective revision treatment for patients who experience recurrent lumbar disc herniation(RLDH)after percutaneous endoscopic lumbar discectomy(PELD)is a significant concern among spine surgeons.However,there are few clinical researches on the use of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)for treating RLDH post-PELD both domestically and internationally.Objective To compare the clinical outcomes and complication rates of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)and posterior lumbar interbody fusion(PLIF)in the treatment of recurrent lumbar disc herniation(RLDH)following percutaneous endoscopic lumbar discectomy(PELD).Methods A retrospective analysis was conducted on the clinical data about 61 patients with recurrent lumbar disc herniation(RLDH)after percutaneous endoscopic lumbar discectomy(PELD)treated in the Department of Spinal Surgery,the First Medical Center,Chinese PLA General Hospital from January 2017 to December 2020.Among these,30 patients underwent minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)and were classified as MIS-TLIF group,while 31 patients underwent posterior lumbar interbody fusion(PLIF)and were classified as PLIF group.The surgical duration,intraoperative blood loss,postoperative hospitalization duration,and complications were compared between the two groups.Postoperative lumbar function improvement and clinical efficacy were assessed using Japanese Orthopaedic Association Scores(JOA),Visual Analogue Scale(VAS)for back and leg pain,and Oswestry Disability Index(ODI).The modified MacNab criteria were employed to evaluate the clinical outcomes of both groups at the final follow-up.Results In this study,there was no statistically significant difference in baseline characteristics between the two groups(P>0.05).At 1-month postoperative follow-up,the primary outcome measure and lumbar VAS score was significantly lower in the MIS-TLIF group compared to the PLIF group(2.2±0.7 vs 3.1±0.8,P<0.001).At 6-month and 1-year postoperative follow-ups,the lumbar VAS scores in the MIS-TLIF group remained consistently lower than those in the PLIF group(6 months postoperatively:2.0±0.7 vs 2.5±0.7,P=0.007;1 year postoperatively:1.7±0.7 vs 2.3±0.7,P=0.001).Moreover,the MIS-TLIF group showed significantly lower intraoperative blood loss(M[IQR]:105[60-257]mL vs 170[75-360]mL,P=0.022)and shorter postoperative hospital stay([4.2±1.8]d vs[5.3±1.9]d,P=0.024)compared to the PLIF group.In terms of functional assessment,the MIS-TLIF group had significantly better JOA functional scores at 6 months and 1 year postoperatively compared to the PLIF group(6 months postoperatively:18.0±1.7 vs 16.6±1.3,P=0.001;1 year postoperatively:20.6±2.3 vs 19.0±1.7,P=0.002).Additionally,the ODI scores in the MIS-TLIF group were significantly lower than those in the PLIF group at 1 month,6 months,and 1 year postoperatively(1 month postoperatively:18.0±2.1 vs 19.3±1.6,P=0.008;6 months postoperatively:13.4±3.1 vs 15.1±2.0,P=0.015;1 year postoperatively:8.9±3.4 vs 11.2±2.7,P=0.005).Conclusion MIS-TLIF for treating PELD postoperative RLDH have advantages such as minimal iatrogenic injury,shorter hospital stays,and faster postoperative functional recovery.Additionally,its early clinical outcomes are better than those of traditional PLIF.