Middle﹣term Comparison of Two Different Surgical Techniques on the Treatment of Multiple Sege﹣ments Lumbar Disc degeneration Diseases

Abstract：Objective To compare the middle-term outcome of transforaminal lumbar interbody fusion(TLIF)combined with rigid internal fixation or semirigid(dynamic)internal fixation on the treatment of multiple segements lumbar disc degener-ation diseases. Methods Between May 2009 and August 2012,53 patients with symptomatic lumbar disc herniation and adja-cent asymptomatic degenerated segment(AASD)were divided into two groups. 28 patients were treated with single level TLIF (group A),meanwhile 25 patients were treated with TLIF combined with dynamic fixation of AASD. Clinical evaluations in-cluded visual analog scale(vAS),Oswestry disability index(ODI),the MOS item short from health survey(SF-36)and post-operative complications. Stauffer-Coventry criterion was used to assess the satisfaction at the final follow-up. Radiographical e-valuations included X-ray,3-dimensional CT and MRI were used to assess fusion,progression of adjacent segment degenera-tion,disc space height(DSH),intervetebral angle(IvA)and radiological adverse events. Results All patients were followed up 26 ~ 66 months(mean,41months). While no differences in clinical scores(vAS,ODI and SF-36)were observed between groups,improvement from pre-operative conditions was significant(all P ﹤ 0. 05). The satisfaction rate at the final follow-up was 78. 6%(group A)and 84. 0%(group B)respectively(P ﹤ 0. 05). There were no differences in DSH and IvA between two groups fusion segment,while noticeable increasing were found about AASD at group B. The fusion rate at 6 months accord-ing to 3-dimensional CT was 96. 4%(group A)and 96. 0%(group B)respectively(P ﹥ 0. 05). At final follow-up,the mean Pfirrmann score was high at group A than group B(P ﹤ 0. 05),and no implants-related complications and reoperation were re-corded. Conclusion TLIF combined with rigid internal fixation or Waveflex system are both safe and effective technique in treatment of lumbar disc degenerative diseases. Waveflex system can delay adjacent segment degeneration,but the long ﹣ term effectiveness need further observation.