Objective: To compare the short-term effects of modified transforaminal lumbar interbody fusion with limited decompression and posterior lumbar interbody fusion in the treatment of lumbar spinal stenosis with instability.Methods: 93 cases of lumbar spinal stenosis with instability were analyzed retrospectively. They were divided into two groups,including 47 cases underwent modified TLIF and 46 cases underwent PILF.The operaion time,average blood loss, the visual analogue score(VAS), the Japanese orthopedic association(JOA) score, incidence of complications and the effect of fusion were compared between the two groups.Results: The operaion time and average blood loss of modified TLIF group were significantly lower than those in the PLIF group(P<0.05). The VAS of low back and leg pain and the JOA score were improved in the two groups compared with preoperation at each follow up(P<0.05). There were no significant differences in VAS of low back and leg pain between the two groups at three months postoperation or six months postoperation(P>0.05), but the VAS of low back pain was lower in the modified TLIF group than that in the PLIF group at one month postoperatively(P<0.05). No statistical significance existed in the postoperative fusion rate at the latest follow up between the two groups(P>0.05). The incidence of complications in the modified TLIF group was 8.51%, while the PILF group was 23.91%. The incidence of complications in the modified TLIF group was significantly lower than that of the PILF group(P<0.05). There were three cases with nerve root injury,and one cases with cerebrospinal fluid leakage in the modified TLIF group, while four cases with nerve root injury, two cases with cerebrospinal fluid leakage, one case with dural tear, three cases of lumbar back muscle with fatigue and one case with acute urine retention.Conclusion: The modified TLIF with personalized decompression gets the satisfied effect just as PLIF in the treatment of lumbar spinal stenosis with instability. But it has less damage, less internal environment interference, fewer postoperative complications and it accords with the concept of precise decompression and minimally invasive surgery. |
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