[Degenerative lumbar spondylolisthesis treated by posterolateral transarticular puncture lumbar interbody fusion under full visual endoscopy].

Abstract

Objective: To explore clinical effect of percutaneous endoscopic posterolateral trans-facet lumbar interbody fusion (PE-PTLIF) in treating degenerative lumbar spondylolisthesis.

Methods: The data of 38 patients with degenerative lumbar spondylolisthesis treated with PE-PTLIF from December 2019 to June 2021 were retrospectively analyzed, including 18 males and 20 females, aged from 39 to 75 years old with an average of (60.2±8.9) years old;1 patient with L_3,4, 23 patients with L_4,5, 14 patients with L₅S₁;29 patients with degreeⅠand 9 patients with degreeⅡaccording to Meyerding grading. Operative time, intraoperative blood loss, drainage volume, postoperative hospital stay and complcations were observed, visual analogue scale (VAS) was used to evaluate degree of lumbar and leg pain before operation, 3 d and 3, 6 and 12 months after operation, respectively. Oswestry disability index (ODI) was used to evaluate degree of low back pain dysfunction before operation, 3, 6 and 12 months after operation. The modified MacNab standard was used to evaluate clinical efficacy at 12 months after operation. Dural sac cross-sectional area (DSCSA), intervertebral disc height (IDH), lumbar spondylolisthesis rate (SR), lumbar lordosis angle (LL) and segmental lordosis angle (SL) were compared before operation and 12 months after operation. Interbody fusion at 12 months was evaluated according to Bridwell intervertebral fusion standard.

Results: All patients were followed up for 13 to 28 months with an average of (18.47±4.12) months. The operative time was (181.68±19.34) min, intraoperative blood loss was (152.87±57.03) ml, drainage volume was (48.18±11.43) ml, and postoperative hospital stay was (9.45±2.18) d and 3 patients occurred complications. VAS of lumbar pain before operation, 3 days, 3, 6 and 12 months after operation were (6.68±1.16), (4.32±1.13), (2.18±0.70), (1.89±0.56) and (1.57±0.72), respectively. VAS of leg pain were (6.24±1.42), (2.95±1.09), (1.76±0.71), (1.68±0.74) and (1.26±0.69) respectively. Preoperative and postoperative 3, 6 and 12 months of ODI were (63.21±11.21) %, (25.24±6.46) %, (20.97±6.26) % and (17.73±5.88) %, respectively. Postoperative VAS of lumbar and leg pain and ODI were significantly lower than those of preoperative time points (P<0.05). According to the modified MacNab standard, 23 patients got excellent result, 10 good, 3 fair, and 2 poor at 12 months after operation. Postoperative DSCSA, IDH, SR, LL and SL at 12 months were (128.32±21.95) mm², (11.19±1.66) mm, (4.44±2.19)%, (49.32±5.63)°, (9.16±1.90)°, respectively, and were improved compared with preoperative [(58.36±18.11) mm², (8.19±2.06) mm (18.43±4.78) %, (42.38±4.94) ° and (8.06±2.06) °] (P<0.05). Thirty-four patients obtained gradeⅠfusion, 3 patients woth gradⅡfusion and 1 patient with grade Ⅲ fusion at 12 months after operation according to Bridwell intervertebral fusion standard.

Conclusion: PE-PTLIF could provide effective method for the treatment of gradeⅠand gradeⅡdegenerative lumbar spondylolisthesis. It has advantages of less bleeding, sufficient decompression, fast postoperative recovery and high fusion rate, which could effectively relieve lumbar and leg pain, restore vertebral space height and improve lumbar sagittal balance. PE-PTLIF is a safe and minimally invasive surgery.