ĐÁNH GIÁ KẾT QUẢ PHẪU THUẬT XÂM LẤN TỐI THIỂU HÀN  XƯƠNG LIÊN THÂN ĐỐT SỐNG THẮT LƯNG QUA LỖ LIÊN HỢP

Tuấn Linh Nguyễn; Quốc Việt Trần; Nguyễn Thu Hằng Đinh

doi:10.59354/ydth175.2022.34

Abstract

Objectives: To initially evaluate the results of minimally invasive surgery for lumbar interbody fusion through the intervertebral foramen at Becamex Binh Duong International Hospital.

Subjects: Including 60 patients who underwent minimally invasive surgery for transforminal lumbar interbody fusion through the intervertebral foramen at Becamex Binh Duong International Hospital from November 2018 to February 2021.

Methods: restrospective study with prospective aspects, combined with longitudinal study.

Results: The average surgical time (minutes) was 176.3 ± 36.3 (Min – Max: 80 – 260). The median of blood loss during surgery (ml) was 95 (Q1 – Q3: 57,5 – 187,5).

Regarding the evaluation of postoperative results, the VAS score to assess the level of back pain and leg pain of the patients after surgery were 2.1 ± 0.3 and 0.3 ± 0.7, decreasing compared to before surgery, are 4.4 ± 1.3 and 5.7 ± 1.5. The difference was statistically significant (with p < 0.05). After 6 months of surgery, the VAS score of all patients decreased. VAS (back pain) and VAS (leg pain) scores were 1.2 ± 0.6 and 0.2 ± 0.4, respectively. The difference of VAS scores between 6 months after surgery and before surgery was statistically significant (with p < 0.05). The JOA scores before and 6 months after surgery were 9.8 ± 3.6 and 24.8 ± 2.4. Evaluation of surgical results after 6 months according to recovery rate calculated based on JOA scale, 43 patients (71.7%) recovered excellent and 17 CÔNG TRÌNH NGHIÊN CỨU KHOA HỌC 7 patients (28.3%) recovered well. According to Bridwell fusion assesments, there were 14 patients with grade I fusion, accounting for 23.3%, 45 patients (75%) with grade II fusion and only 1 patient (1.7%) with grade III fusion.

At the time of re-examination after 12 months of surgery, 38/60 patients with enough time had re-examination (accounting for 63.3%). The VAS (back pain) and VAS (leg pain) scores were 0.9 ± 0.6 and 0.08 ± 0.28, respectively. The mean JOA score was 25.2 ± 4.4, with 89.5% of patients achieving very good results and 10.5% of patients achieving good results. Assessing the degree of bone welding according to Bridwell, there were 29/38 patients (76.3%) grade I and 9 patients (23.7%) grade II.

At time of follow-up after 12 months of surgery, 38/60 patients had enough time to come for follow-up examination (accounting for 63.3%). The VAS (back pain) and VAS (leg pain) scores were 0.9 ± 0.6 and 0.08 ± 0.28, respectively. The mean JOA score at 12 months after surgery was 25.2 ± 4.4, with 89.5% of patients achieving excellent results and 10.5% of patients achieving good results. No patient had average or poor postoperative recovery. Assessing the degree of bone fusion according to Bridwell, there were 29/38 patients (76.3%) grade I and 9 patients (23.7%) grade II.

About the complications after the surgery, 1 patient (1.7%) had a screw placed outside the right L5 arch, 1 patient (1.7%) had postoperative wounds hypostasis, 1 patient (1.7 %) had posterior displacement of the graft complication and there was no complications related to infection, damage to large blood vessels in front of the spine, and abdominal organs have not been recorded.

Conclusion: There was a statistically significant difference in the evaluation criteria (average VAS score for back and leg pain, mean JOA score, Bridwell degree of bone fusion) between before surgery and after surgery, 6 months and 12 months after surgery.

References

Cole, C.D., et al., Comparison of low back fusion techniques: transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF) approaches. Curr Rev Musculoskelet Med, 2009. 2: p. 118–126.

Isaac O. Karikari, M. and M. Robert E. Isaacs, Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Review of Techniques and Outcomes. SPINE, 2010. 35(26S): p. S294–S301.

Wang, X., et al., A systematic literature review of time to return to work and narcotic use after lumbar spinal fusion using minimal invasive and open surgery techniques. BMC Health Services Research, 2017. 17.

Nguyễn Vũ, Nghiên cứu điều trị trượt đốt sống thắt lưng bằng phương pháp cố định cột sống qua cuống kết hợp hàn xương liên thân đốt. 2015, Đại học Y Hà Nội. p. 170.

Meng-Ling Lu, M., et al., Comparisons of Lumbar Muscle Performance Between Minimally-Invasive and Open Lumbar Fusion Surgery at 1-Year Follow-Up. Global Spine Journal, 2020: p. 1-7.

Chan Wearn Benedict Peng, M., et al., Clinical and Radiological Outcomes of Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion. SPINE, 2009. 34: p. 1385–1389.

Dương Thanh Tùng, nghiên cứu điều trị trượt đốt sống đoạn thắt lưng – cùng một tầng bằng phẫu thuật vít cuống cung qua da và ghép xương liên thân đốt. 2020, học viện quân y: hà nội.

Seng, C., Five-Year Outcomes of Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion. SPINE, 2013. 38: p. 2049 - 2055.

Nader S. Dahdaleh, M.D., M.S. Alexander T. Nixon, and B.S. Cort D. Lawton, Outcome following unilateral versus bilateral instrumentation in patients undergoing minimally invasive transforaminal lumbar interbody fusion: a single-center randomized prospective study. Neurosurg Focus, 2013. 35

Tsahtsarlis, A. and M. Wood Minimally invasive transforaminal lumber interbody fusion and degenerative lumbar spine disease. Eur Spine J 2012. 21: p. 2300–2305.

Nathaniel W. Jenkins et al, Validation of PROMIS Physical Function in MIS TLIF. SPINE, 2020. 45: p. E1516– E1522.

Walter W. Eckman MD, L.H. PT, and M.M. RN, Same-day Discharge After Minimally Invasive Transforaminal Lumbar Interbody Fusion. Clinical Orthopaedics and Related Research, 2014. 472: p. 1806–1812.