Polyaxial pedicle screw via minimally invasive intermuscular space approach in treatment of lumbarspondyloIisthesis: short-term efficacy and safety

Xu Jia-xin

doi:10.3969/j.issn.2095-4344.0115

Abstract：BACKGROUND: Traditional posterior lumbar interbody fusion has been proven to be effective for the treatment of lumbar spondylolisthesis. The traditional surgery has a high requirement for internal fixation instruments, and it is difficult to popularize, and it has the disadvantage of serious injury to back muscles. OBJECTIVE:To investigate the short-term efficacy and safety of polyaxial pedicle screw via minimally invasive intermuscular space approach in treatment of lumbar spondylolisthesis. METHODS: Totally 96 patients with lumbar spondylolisthesis received diagnosis and surgery in Third Hospital, Hebei Medical University from August 2015 to August 2016. They were divided into traditional surgery group and minimally invasive polyaxial pedicle screw group by random number table, with 48 cases in each group. Traditional surgery group received midline incision pedicle screw insertion through traditional lumbar posterior approach. Minimally invasive polyaxial pedicle screw group received minimally invasive polyaxial pedicle screw insertion through bilateral posterior lumbar intermuscular approach. Operation time and intraoperative blood loss were compared between the two groups. At 6 months after follow-up, Visual Analogue Scale scores and Oswestry Disability Index were recorded before surgery, 1 and 3 days, 2 weeks, 1, 3 and 6 months after surgery between the two groups. The reduction rate of spondylolisthesis, fusion rate, and incidence of complications after surgery were analyzed 1, 3 and 6 months after surgery. RESULTS AND CONCLUSION: (1) The perioperative indexes in minimally invasive polyaxial pedicle screw group were significantly better than those in traditional surgery group (P < 0.05). (2) Visual Analogue Scale scores and Oswestry Disability Index were significantly lower in the minimally invasive polyaxial pedicle screw group than those in traditional surgery group at 3 days, 2 weeks, 1, 3 and 6 months after surgery (P < 0.05). (3) The reduction rate and the fusion rate were significantly higher in the spondylolisthesis in minimally invasive polyaxial pedicle screw group than those in traditional surgery group at 1, 3 and 6 months after surgery (P < 0.05). (4) The incidence was significantly lower in the minimally invasive polyaxial pedicle screw group than in the traditional surgery group(4% versus 17%;P<0.05).(5)Results indicated that polyaxial pedicle screw via minimally invasive intermuscular space approach in treatment of lumbar spondylolisthesis is safe and reasonable, which can improve perioperative indexes, reduce lumbar disability and relieve patients' pain.