ObjectiveTo explore the value of modified subcutaneous lumbar spine index (MSLSI) as a predictor for short-term effectiveness of transforaminal lumbar interbody fusion (TLIF) in treatment of lumbar degenerative disease (LDD).MethodsBetween February 2014 and October 2019, 450 patients who were diagnosed as LDD and received single-segment TLIF were included in the study. Based on the MSLSI measured by preoperative lumbar MRI, the patients were sorted from small to large and divided into three groups (n=150). The MSLSI of group A was 0.11-0.49, group B was 0.49-0.73, and group C was 0.73-1.88. There was no significance in gender, age, disease duration, diagnosis, surgical segment, and improved Charlson comorbidity index between groups (P>0.05). There were significant differences in the subcutaneous adipose depth of the L4 vertebral body and body mass index (BMI) between groups (P<0.05). The operation time, intra-operative blood loss, length of incision, drainage tube placement time, drainage volume on the 1st day after operation, drainage volume on the 2nd day after operation, total drainage volume, antibiotic use time after operation, walking exercise time after operation, hospital stay, the incidences of surgical or non-surgical complications in the three groups were compared. Pearson correlation analysis was used to analyze the correlation between MSLSI and BMI, and partial correlation analysis was used to study the relationship between MSLSI, BMI, improved Charlson comorbidity index, subcutaneous adipose depth of the L4 vertebral body and complications. The Receiver Operating Characteristic (ROC) curve was used to evaluate the value of SLSI and MSLSI in predicting the occurrence of complications after TLIF in treatment of LDD.ResultsThere was no significant difference in operation time, length of incision, antibiotic use time after operation, walking exercise time after operation, drainage tube placement time, drainage volume on the 1st day after operation, drainage volume on the 2nd day after operation, and total drainage volume between groups (P>0.05). The amount of intra-operative blood loss in group C was higher than that in groups A and B, and the hospital stay was longer than that in group B, with significant differences (P<0.05). Surgical complications occurred in 22 cases (14.7%), 25 cases (16.7%), and 39 cases (26.0%) of groups A, B, and C, respectively. There was no significant difference in the incidence between groups (χ2=0.826, P=0.662). The incidences of nerve root injury and wound aseptic complications in group C were higher than those in groups A and B, and the incidence of nerve root injury in group B was higher than that in group A, with significant differences (P<0.05). There were 13 cases (8.7%), 7 cases (4.7%), and 11 cases (7.3%) of non-surgical complications in groups A, B, and C, respectively, with no significant difference (χ2=2.128, P=0.345). There was no significant difference in the incidences of cardiovascular complications, urinary system complications, central system complications, and respiratory system complications between groups (P>0.05). There was a correlation between MSLSI and BMI in 450 patients (r=0.619, P=0.047). Partial correlation analysis showed that MSLSI was related to wound aseptic complications (r=0.172, P=0.032), but not related to other surgical and non-surgical complications (P>0.05). There was no correlation between BMI, improved Charlson comorbidity index, subcutaneous adipose depth of the L4 vertebral body and surgical and non-surgical complications (P>0.05). ROC curve analysis showed that the area under ROC curve (AUC) of MSLSI was 0.673 (95%CI 0.546-0.761, P=0.025), and the AUC of SLSI was 0.582 (95%CI 0.472-0.693, P=0.191). ConclusionMSLSI can predict the short-term effectiveness of TLIF in treatment of LDD. Patients with high MSLSI suffer more intra-operative blood loss, longer hospital stay, and higher incidence of nerve root injury and postoperative incision complications.
Objective To compare the clinical and radiological outcomes of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) and minimally invasive tubular TLIF (MT-TLIF) in treatment of lumbar degenerative diseases. Methods A clinical data of 75 patients with lumbar degenerative diseases, who met the selection criteria between August 2019 and August 2020, was retrospectively analyzed, including 35 patients in the UBE- TLIF group and 40 patients in the MT-TLIF group. There was no significant difference in general data such as gender, age, body mass index, disease type and duration, and surgical segment between the two groups (P>0.05), which was comparable. The operation time, intraoperative blood loss, hemoglobin (Hb) before operation and at 1 day after operation, the length of hospital stay, incidence of complications, and visual analogue scale (VAS) score of low back and leg pain, Oswestry Disability Index (ODI), Short-Form 36 Health Survey Scale (SF-36 scale), intervertebral disc height (IDH), sagittal Cobb angle, lumbar lordosis (LL), and the intervertebral fusion were compared between the two groups. Results Compared with MT-TLIF group, UBE-TLIF group had significantly longer operation time but less intraoperative blood loss and shorter length of hospital stay (P<0.05). The Hb levels in both groups decreased at 1 day after operation, but there was no significant difference in the difference before and after operation between the two groups (P>0.05). All patients were followed up, and the follow-up time was (14.7±2.5) months in the UBE-TLIF group and (15.0±3.4) months in the MT-TLIF group, with no significant difference (t=0.406, P=0.686). In both groups, the VAS score of low back pain, VAS score of leg pain, SF-36 scale, and ODI after operation significantly improved when compared with those before operation (P<0.05). There was no significant difference between 1 month after operation and last follow-up (P>0.05). There was no significant difference in the VAS score of low back pain, VAS score of leg pain, and SF-36 scale between the two groups before and after operation (P>0.05). At 1 month after operation, the ODI in the UBE-TLIF group was significantly better than that in the MT-TLIF group (P<0.05). At 1 month after operation, IDH, Cobb angle, and LL in both groups recovered when compared with those before operation (P<0.05), and were maintained until last follow-up (P>0.05). There was no significant difference in the IDH, Cobb angle, and LL between the two groups at each time point (P>0.05). Thirty-three cases (89.2%) in the UBE-TLIF group and 35 cases (87.5%) in the MT-TLIF group achieved fusion, and the difference was not significant (χ2=0.015, P=0.901). In the UBE-TLIF group, 1 case of intraoperative dural tear and 1 case of postoperative epidural hematoma occurred, with an incidence of 5.7%. In the MT-TLIF group, 1 case of intraoperative dural tear, 1 case of postoperative epidural hematoma, and 1 case of superficial infection of the surgical incision occurred, with an incidence of 7.5%. There was no significant difference in the incidence of complications between the two groups (χ2=1.234, P=1.000). Conclusion Compared with MT-TLIF, UBE-TILF can achieve similar interbody fusion in the treatment of lumbar degenerative diseases, and has the advantages of smaller incision, less bleeding, and shorter length of hospital stay.
ObjectiveTo explore the risk factors of coronal imbalance after posterior long-level fixation and fusion for degenerative lumbar scoliosis.MethodsRetrospectivly analyzed the clinical records of 41 patients with degenerative lumbar scoliosis who had received posterior long-level fixation and fusion with selective transforaminal lumbar interbody fusion (TLIF) accompanied by Ponte osteotomy between August 2011 and July 2016. Patients were divided into imbalance group (group A, 11 cases) and balance group (group B, 30 cases) according to state of coronal imbalance measured at last follow-up. The radiographic parameters at preoperation and last follow-up were measured, and the variance of preoperative and last follow-up parameters were calculated. The radiographic parameters included coronal Cobb angle, coronal balance distance (CBD), apical vertebral translation (AVT), apical vertebral rotation (AVR), Cobb angle of lumbar sacral curve (LSC), and L5 tilt angle (L5TA). Univariate analysis was performed for the factors including gender, age, preoperative T value of bone mineral density, number of instrumented vertebra, upper and lower instrumented vertebra, segments of TLIF, decompression, and Ponte osteotomy, as well as the continuous variables of preoperative imaging parameters with significant difference were converted into two-category variables, obtained the influence factors of postoperative coronal imbalance. Multivariate logistic regression analysis was performed to verify the risk factors from the preliminary screened influence factors and the variance of imaging parameters with significant difference between the two groups.ResultsThe follow-up time of groups A and B was (3.76±1.02) years and (3.56±1.03) years respectively, there was no significant difference between the two groups (t=0.547, P=0.587). The coronal Cobb angle, AVT, LSC Cobb angle, and L5TA in group A were significantly higher than those in group B before operation (P<0.05), and all the imaging parameters in group A were significantly higher than those in group B at last follow-up (P<0.05). There was no significant difference between the two groups in parameters including the variance of coronal Cobb angle, AVT, and LSC Cobb angle before and after operation (P>0.05), and there were significant differences between the two groups in parameters including the variance of CBD, L5TA, and AVR (P<0.05). Univariate analysis showed that preoperative L5TA was the influencing factor of postoperative coronal imbalance (P<0.05). Multivariate logistic regression analysis showed that preoperative L5TA≥15° was an independent risk factor of postoperative coronal imbalance, and variance of pre- and post-operative AVR was a protective factor.ConclusionPreoperative L5TA≥15° is an independent risk factor for coronal imbalance in patients with degenerative lumbar scoliosis after posterior long-level fixation and fusion.
Objective To investigate the short-term effectiveness of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) in the treatment of Meyerding degree Ⅰ or Ⅱ single-segment lumbar spondylolisthesis. MethodsThe clinical data of 26 patients with Meyerding degree Ⅰ or Ⅱ single-segment lumbar spondylolisthesis treated with UBE-TLIF between January 2021 and August 2021 were retrospectively analyzed. Among them, there were 10 males and 16 females with a mean age of 61.5 years (range, 35-76 years). The lesion segment included L3, 4 in 2 cases, L4, 5 in 18 cases, and L5, S1 in 6 cases. There were 17 cases of degenerative spondylolisthesis and 9 cases of isthmic spondylolisthesis; according to the Meyerding classification of spondylolisthesis, 19 cases were grade Ⅰ and 7 cases were grade Ⅱ. Twenty-one cases were complicated with lumbar disc herniation and spinal stenosis and 5 cases with lumbar spinal stenosis. The operation time, hospitalization stay, complications, hemoglobin (Hb) and serum creatine kinase (CK) levels before operation and at 1 day after operation were recorded; lumbar lordosis angle changes and postoperative spondylolisthesis reduction were evaluated by lumbar anteroposterior and lateral X-ray films before operation and at last follow-up; visual analogue scale (VAS) score was used to evaluate the low back pain and leg pain before operation, at 2 days, 1 week, 2 weeks after operation, and at last follow-up; Oswestry disability index (ODI) was used to evaluate the functional recovery of the patients before operation and at last follow-up. ResultsThe operation was successfully completed in all 26 patients, with an average operation time of 181.9 minutes (range, 130-224 minutes) and an average hospitalization stay of 6.3 days (range, 3-9 days). Hb levels were significantly lower and serum CK levels were significantly higher at 1 day after operation when compared with those before operation (t=7.594, P<0.001; t=–15.647, P<0.001). No serious complication occurred during and after operation. CT examination at 3 days after operation showed that the percutaneous screw was not in good position in 1 case, and nerve paralysis (pain, numbness) occurred in 2 cases after operation, which were improved within 2 weeks after operation. All the 26 patients were followed up 6-11 months, with an average of 8.7 months. Complete reduction (the slippage reduction rate was 100%) was achieved in 24 patients (92.3%), and partial reduction (the slippage reduction rate was 87.5%) in 2 patients (7.7%). During the follow-up, there was no complication such as incision infection, fusion Cage subsidence or displacement, and internal fixator loosening. The VAS scores of low back pain and leg pain significantly improved at each time point after operation when compared with those before operation (P<0.05); there was no significant difference in the VAS scores of low back pain and leg pain between at 2 days and 1 week after operation, the VAS scores of low back pain between at 1 week and 2 weeks after operation, and the VAS scores of leg pain between at 2 weeks after operation and last follow-up (P>0.05); but there was significant difference between the other time points after operation (P<0.05). ODI and lumbar lordosis angle significantly improved at last follow-up (P<0.05). Conclusion UBE-TLIF provides favorable short-term effectiveness and obvious advantages of minimally invasive in the treatment of Meyerding degree Ⅰ or Ⅱ single-segment lumbar spondylolisthesis. However, the safety and long-term effectiveness need to be further studied.
Objective To compare the effectiveness between unilateral biportal endoscopic lumbar interbody fusion (ULIF) and endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) in treatment of lumbar spinal stenosis combined with intervertebral disc herniation. Methods A clinical data of 64 patients with lumbar spinal stenosis and intervertebral disc herniation, who were admitted between April 2020 and November 2021 and met the selection criteria, was retrospectively analyzed. Among them, 30 patients were treated with ULIF (ULIF group) and 34 patients with Endo-TLIF (Endo-TLIF group). There was no significant difference in baseline data such as gender, age, disease duration, lesion segment, preoperative visual analogue scale (VAS) score of low back pain and leg pain, Oswestry disability index (ODI), spinal canal area, and intervertebral space height between the two groups (P>0.05). The operation time, intraoperative blood loss, hospital stays, and postoperative complications were compared between the two groups, as well as the VAS scores of low back pain and leg pain, ODI, and imaging measurement indicators (spinal canal area, intervertebral bone graft area, intervertebral space height, and degree of intervertebral fusion according to modified Brantigan score). Results Compared with the Endo-TLIF group, the ULIF group had shorter operation time, but had more intraoperative blood loss and longer hospital stays, with significant differences (P<0.05). The cerebrospinal fluid leakage occurred in 2 cases of Endo-TLIF group and 1 case of ULIF group, and no other complication occurred. There was no significant difference in the incidence of complications between the two groups (P>0.05). All patients in the two groups were followed up 12 months. The VAS scores of lower back pain and leg pain and ODI in the two groups significantly improved when compared with those before operation (P<0.05), and there was no significant difference between different time points after operation (P>0.05). And there was no significant difference between the two groups at each time point after operation (P>0.05). Imaging examination showed that there was no significant difference between the two groups in the change of spinal canal area, the change of intervertebral space height, and intervertebral fusion rate at 6 and 12 months (P>0.05). The intervertebral bone graft area in the ULIF group was significantly larger than that in the Endo-TLIF group (P<0.05). ConclusionFor the patients with lumbar spinal stenosis combined with intervertebral disc herniation, ULIF not only achieves similar effectiveness as Endo-TLIF, but also has advantages such as higher decompression efficiency, flexible surgical instrument operation, more thorough intraoperative intervertebral space management, and shorter operation time.
ObjectiveTo investigate the clinical results and complication prevention of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of single-segment severe lumbar spinal stenosis (LSS).MethodsThe clinical data of 112 patients with severe LSS treated with MIS-TLIF between January 2010 and January 2017 were retrospectively analyzed. There were 43 males and 69 females, aged 52-81 years, with an average age of 65.3 years. The disease duration ranged from 4 to 126 months, with an average of 10.5 months. Clinical manifestations: 104 cases of low back pain, 91 cases of nervous intermittent claudication of both lower limbs, 21 cases of unilateral nerve root pain and/or numbness, and 5 cases of cauda equina nerve injury. The 112 cases were all severe central spinal stenosis, including 32 cases with lateral recess stenosis, 20 cases with foramen stenosis, 9 cases with ossification of ligamentum flavum, 38 cases with disc herniation; 14 cases with two complications and 5 cases with three. Stenosis segment: L3, 4 in 6 cases, L4, 5 in 89 cases, and L5, S1 in 17 cases. Surgical methods included bilateral decompression through bilateral approach (60 cases), bilateral decompression through unilateral approach (15 cases), and unilateral decompression (37 cases). The operation time, intraoperative blood loss, visual analogue scale (VAS) score of low back pain and leg pain, Oswestry disability index (ODI) score, fusion rate, and surgical complications were recorded. At last follow-up, the lumbar fusion was evaluated by Bridwell method, grades Ⅰ and Ⅱ were expressed as fusion.ResultsThe operation time was 83-186 minutes (mean, 126.8 minutes), and the intraoperative blood loss was 65-630 mL (mean, 163.1 mL). All the 112 patients were followed up 25-49 months, with an average of 35.1 months. The VAS score of low back pain and leg pain and ODI score at each time point after operation were significantly improved when compared with preoperative scores (P<0.05). There was no significant difference between the VAS score of low back pain and leg pain and ODI score at the other time points except 1 month after operation (P<0.05). At last follow-up, 2 cases of cauda equina nerve injury recovered and 3 cases partially recovered. According to Bridwell classification criteria, 58 cases were grade Ⅰ, 47 cases were grade Ⅱ, and 7 cases were grade Ⅲ. The fusion rate was 93.8%. Perioperative complications included 5 cases of incision complications (superficial infection in 3 cases, hematoma formation in 2 cases), 19 cases of internal fixator complications (intraoperative end plate fracture in 8 cases, fusion cage sinking in 11 cases at last follow-up), and 15 cases of neurological complications (dural sac tear in 10 cases, transient neurological symptoms of lower extremities aggravated in 5 cases). Conclusion MIS-TLIF treatment of single-level severe LSS can achieve good clinical results, while there is a risk of serious complications. Full understanding of the clinical and imaging features of the disease and reasonable and careful operation are helpful to control the occurrence of cauda equina nerve damage.
Objective To analyze the medium and long-term effectiveness of microendoscope-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar degenerative diseases in comparison with conventional tubular retractor-assisted MIS-TLIF. Methods Between November 2008 and March 2013, 53 patients with single segment lumbar degenerative diseases were enrolled. According to the different working channel performed, 28 patients were treated by microendoscope-assisted MIS-TLIF (observation group), while the remaining cases received conventional tubular retractor-assisted MIS-TLIF via Wiltse approach (control group). Preoperative baseline data, including age, gender, body mass index, disease etiology, operated level, the ration for requiring bilateral canal decompression, and preoperative visual analogue scale (VAS) socre of low back pain and leg pain, Japanese Orthopedic Association (JOA) score, Oswestry disability index (ODI) score, showed no significant difference between the two groups (P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy time, postoperative analgesic drug dose, postoperation in-bed time, and perioperative complication incidence were recorded respectively and compared between the two groups. Radiographic evaluation of interbody fusion was performed based on Bridwell grading system at 2 years after operation. VAS scores of low back pain and leg pain, JOA score, and ODI score were assessed before operation, at 2 years after operation, and at last follow-up respectively. Surgical outcome satisfaction was assessed by modified MacNab criteria at last follow-up. Results When compared with those in control group, both intraoperative blood loss and postoperative analgesic drug dose were significantly decreased in observation group (P<0.05); similarly, the operation time and intraoperative fluoroscopy time were also significantly increased in observation group (P<0.05). There was no significant difference of postoperative in-bed time between the two groups (t=–0.812, P=0.420). Both groups were followed up 6-10.3 years, with an average of 7.9 years. Regarding perioperative complication, its incidence was 14.3% and 20.0% in observation group and control group, respectively, showing no significant difference between both groups (χ2=0.306, P=0.580). Specifically, there were intraspinal hematoma formation in 1 case, incision infection in 1 case, urinary infection in 1 case, transient delirium in 1 case in observation group. By contrast, there were dural tear and cerebrospinal fluid leakage in 1 case, urinary infection in 1 case, pneumonia in 1 case, transient delirium in 2 cases in control group. Bridwell criterion was used to judge the intervertebral fusion at 2 years after operation, the fusion rates of observation group and control group were 92.9% and 92.0%, respectively, showing no significant difference (χ2=0.162, P=0.687). At both 2-year postoperatively and last follow-up, the VAS scores of low back pain and leg pain, JOA score, and ODI score were significantly improved when compared with those before operation (P<0.01), whereas no significant difference between the two groups at either time point was found (P>0.05). At last follow-up, the results of patients’ satisfaction with surgery evaluated by modified MacNab criteria, and the excellent and good rates of the observation group and the control group were 96.4% and 92.0%, respectively, showing no significant difference (χ2=0.485, P=0.486). Conclusion The medium and long-term effectiveness of microendoscope-assisted MIS-TLIF are similar to those of conventional tubular retractor-assisted MIS-TLIF for lumbar degenerative diseases. The former operation has the additional advantages in terms of more clear surgical site visually, less intraoperative blood loss, and reduced postoperative analgesic dose, all of which seem more feasible to clinical teaching.
ObjectiveTo compare the effect of intravenous 20% mannitol or dexamethasone (DM) on low back and leg pain after minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). MethodsBetween October 2012 and September 2013, 100 patients with degenerative lumbar diseases underwent MI-TLIF and percutaneous pedicle screw fixation. All patients were randomly divided into 3 groups:34 patients received intravenous 20% mannitol after operation (mannitol group); 32 patients received intravenous DM after operation (DM group); and 34 patients received neither dehydrating agent nor steroid after operation (control group). There was no significant difference in gender, age, disease duration, clinical symptoms, lesion types, and lesion segments between groups (P>0.05). The serum levels of inflammatory factors[tumor necrosis factor α (TNF-α), interleukin 1β (IL-1β), and IL-6] were measured by ELISA at pre-operation and 3, 24, 48, 72, and 96 hours after operation. Low back and leg pain was determined by using visual analogue scale (VAS) score after operation. ResultsAll procedures were smoothly performed without major complications of nerve root injury, hematoma, or infection. There was no significant difference in operation time and intraoperative blood loss between groups (P>0.05). The VAS score of low back pain showed no significant difference between groups at all time points after operation (P>0.05); the VAS score of leg pain in the DM group was significantly lower than that in the control group at all time points (P<0.05), and than those in the mannitol group at 3, 24, 48, and 96 hours after operation (P<0.05). The serum level of TNF-α in the DM group was significantly lower than that in the control group at all time points (P<0.05), and than that in the mannitol group at 3, 48, 72, and 96 hours after operation (P<0.05). The serum level of IL-1β in the DM group was significantly lower than that in the control group at 3, 24, 48, and 72 hours after operation (P<0.05), and than that in the mannitol group at all time points after operation (P<0.05). The serum level of IL-6 in the DM group was significantly lower than that in the control group at 3 and 24 hours after operation (P<0.05), and than that in the mannitol group at 3, 24, and 48 hours after operation (P<0.05). ConclusionIntravenous 20% mannitol may has no effect on postoperative low back and leg pain, while DM can markedly relieve leg pain after MI-TLIF.
ObjectiveTo compare the effectiveness and imaging features between implanting single and double Cage into intervertebral body through unilateral transforaminal lumbar interbody fusion (TLIF). MethodsThe clinical data were collected and analyzed from 104 patients who underwent unilateral TLIF between January 2013 and October 2014, who were divided into 2 groups:single Cage was implanted into intervertebral body in 64 cases (76 segments) in traditional group, and double Cage was implanted into intervertebral body in 56 cases (70 segments) in reformative group. There was no significant difference in age, gender, bone mineral density, operation segments between 2 groups (P>0.05). The visual analogue scale (VAS), Oswestry disability index (ODI), and Japanese Orthopedic Association (JOA) scores were used to evaluate the effectiveness; the area of intervertebral bone-graft, fusion rate, height of intervertebral space, and the number of Cage subsidence were measured by CT scan. ResultsAll the patients were followed up 12.85 months on average (range, 9-15 months). The VAS, ODI, and JOA scores were significantly improved at each time point after operation when compared with preoperative values (P<0.05), and no significant difference was found between 2 groups (P>0.05) except VAS and ODI at 12 months after operation (P<0.05). However, the area of intervertebral bone-graft in reformative group[(5.94±1.17) cm2] was significantly larger than that in traditional group[(4.81±0.97) cm2] at 7 days after operation (t=-6.365, P=0.000). At 3 and 12 months after operation, the fusion rate was respectively 84.2% and 92.1% in traditional group and was respectively 88.6% and 94.3% in reformative group. Although the height of intervertebral space were increased when compared with preoperative height, the incidence rates of Cages subsidence in traditional group were 44.74% and 47.37% respectively at 3 and 12 months after operation and were significantly higher those that in reformative group (11.43% and 14.29% respectively) (P<0.05). In addition, the height difference between affected side and normal side in traditional group was significantly larger than that in reformative group (P<0.05). ConclusionBoth single and double Cage implanted into the intervertebral body through unilateral TLIF have good effectiveness. However, double Cage implanted into intervertebral body may hold the height of intervertebral space, reduce the incident rate of Cage subsidence, and prevent sagittal imbalance.
ObjectiveTo observe the difference between crenel lateral interbody fusion (CLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of degenerative lumbar spondylolisthesis (DLS) combined with lumbar spinal stenosis (LSS).MethodsThe clinical data of DLS combined with LSS patients meeting the selection criteria admitted between May 2018 and May 2019 were retrospectively analyzed. According to different surgical methods, the patients were divided into CLIF group (33 cases) and TLIF group (32 cases). There were no significant differences (P>0.05) between the two groups in gender, age, disease duration, lesion segments, lumbar bone mineral density, degree of lumbar spondylolisthesis, and preoperative visual analogue scale (VAS) score, Oswestry disability index (ODI), intervertebral space height, intervertebral foramen height, lumbar lordosis (LL), and segmental lordosis (SL). The operation time, intraoperative blood loss, and perioperative complications were recorded and compared between the two groups. Lumbar CT scan was performed at last follow-up to compare the intervertebral fusion rate between the two groups. Intervertebral space height, intervertebral foramen height, LL, and SL were measured before operation, at 2 weeks, 3 months after operation, and at last follow-up. VAS score and ODI were used to evaluate the pain and improvement of the quality of life of the patients.ResultsThere were no neurological and vascular complications in the two groups. The operation time and intraoperative blood loss in CLIF group were significantly less than those in TLIF group (P<0.05). Patients in both groups were followed up for a median time of 18 months. All the incisions healed by first intention except 1 incision in TLIF group because of poor blood glucose control. No complications such as bedsore, falling pneumonia, and deep venous thrombosis were found in both groups. At last follow-up, the intervertebral fusion rates in CLIF and TLIF group were 90.91% (30/33) and 93.75% (30/32), respectively, showing no significant difference (χ2=0.185, P=0.667). The VAS score, ODI, intervertebral space height, intervertebral foramen height, LL, and SL were significantly improved in both groups at each time point after operation (P<0.05). Except that VAS score in CLIF group was significantly lower than that in TLIF group at 2 weeks after operation (Z=−4.303, P=0.000), there were no significant differences in VAS score and ODI between the two groups at other time points (P>0.05). The intervertebral space height, intervertebral foramen height, LL, and SL in CLIF group were significantly higher than those in TLIF group at each time point after operation, and the differences were significant (P<0.05).ConclusionCLIF in the treatment of DLS combined with LSS can achieve the similar effectiveness with traditional TLIF, and has such advantages as minimal invasion and faster recovery.