Robot-assisted unilateral-decompression minimally invasive transforaminal lumbar interbody fusion for radiographic bilateral lumbar stenosis
10.3969/j.issn.2095-4344.2720
- Author:
Shu Dong JIANG
1
Author Information
1. Department of Spinal Surgery, Chui Yang Liu Hospital Affiliated to Tsinghua University
- Publication Type:Journal Article
- Keywords:
Lumbar stenosis;
Medical robot;
Minimally invasive transforaminal lumbar interbody fusion;
Unilateral decompression
- From:
Chinese Journal of Tissue Engineering Research
2020;24(24):3797-3802
- CountryChina
- Language:Chinese
-
Abstract:
BACKGROUND: In the elderly patients with degenerative lumbar spinal stenosis, bilateral nerve root canal stenosis commonly shows only one side of symptoms. There is still controversy about whether or not decompression is needed on the side without symptoms or with less symptoms and how to operate. OBJECTIVE: To explore the safety and efficacy of robot-assisted unilateral-decompression using minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) technique by investigating a series of cases with the radiographic bilateral lumbar canal stenosis presenting with unilateral symptoms and by comparing clinical decompression effect and imaging changes before and after operation. METHODS: Cases with radiographic bilateral lumbar canal stenosis presenting with unilateral symptoms subjected to unilateral decompression on the affected side, interbody fusion and bilateral fixation after robot-assisted MIS-TLIF in the same treatment group were retrospectively analyzed. Operation time, intraoperative blood loss and complications were recorded. The vertebral canal cross-sectional area, intervertebral foramen height, intervertebral space height, and lumbar lordosis angle were examined before and after surgery. Visual analogue scale scores for low back pain and leg pain were assessed before and after surgery. Oswestry disability index was used to assess lumbar function before and after surgery. Macnab criteria were used to evaluate the efficacy at the final follow-up after surgery. RESULTS AND CONCLUSION: (1) Operation time was 110-235 minutes, averagely 169.4 minutes. Intraoperative blood loss was 70-180 mL, averagely 112.4 mL. (2) After 3-8 months of follow-up, the visual analogue scale scores of low back pain and lower extremity pain 1 month after surgery and in final follow-up were significantly lower than those before operation (both P < 0.01). (3) Oswestry disability index 1 month after surgery and in final follow-up was significantly lower than that before operation (both P < 0.01). (4) In the final follow-up, MacNab criteria results showed that clinical results were excellent in 15 cases, good in 17 cases and average in 3 cases with the excellent and good rate of 91%. (5) Vertebral canal cross-sectional area, intervertebral foramen height, and intervertebral space height were significantly increased after surgery compared with those before surgery (all P < 0.01). Lumbar lordosis angle was increased after surgery compared with that before surgery, but was not significantly different (P > 0.05). (6) It is concluded that robot-assisted unilateral-decompression MIS-TLIF obtained satisfactory effect in bilateral lumbar canal stenosis patients presenting with unilateral symptoms.
