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[Preliminary evaluation and clinical application of unilateral decompression, interbody fusion and pedicle screw fixation under endoscopic system].

OBJECTIVE
To explore the feasibility and efficiency of treatment of lumbar degenerative disease with unilateral decompression, interbody fusion and percutaneous pedicle screw fixation assisted by X-Tube systerm for the management of degenerative lumbar disease.


METHODS
A total of 29 patients with degenerative lumbar,disease including 12 males and 17 females with an average age of 52.4 years ranging from 27 to 68 years, underwent minimally invasive posterior lumbar interbody fusion (PLIF) or TLIF assisted by the X-Tube system. The index diagnosis was discogenic low back pain in 11 cases, intervertebral space stenosis with unilateral herniated nucleus pulposus in 15 cases, recurrence after operation of lumbar intervertebral disc herniation in 3 cases. The diseased segment was in L4,5 in 18 cases, L5S1 in 11.


RESULTS
The operative duration were 138 to 190 min (means 145 min); the blood loss was 230 to 560 ml (means 350 ml). Total 29 patients were followed-up from 5 to 19 months (means 9.8 months). The changes the clinical functional outcomes were evaluated according to the VAS pain score and the Oswestry Disability Index questionnaire. The VAS pain score decreased from (7.3 +/- 6.7) preoperatively to (2.3 +/- 0.8) at postoperative one month and (1.3 +/- 0.5) at final follow-up; The average ODI scores decreased from (44.8 +/- 7.1) preoperatively to (16.3 +/- 5.7) at postoperative one month and (2.6 +/- 4.5) at final follow-up. According to the Macnab criteria,the clinical effects were excellent in 19 cases, good in 7 cases and fair in 3 cases. Twenty-five patients were followed-up more than 9 months, 23 cases of them had showed remarkale bony interbody fusion on the X-rays and CT. The outcomes of operation was satisfied.


CONCLUSION
Minimally invasive PLIF assisted by X-Tube system minimize blood loss and tissue trauma, shorten the operative, recovery and bony union time, the short-term outcomes are excellent which make it a valuable alternative to conventional surgical procedures and suitable to segments from L2 to S1. The shortcomings are confined operating space and field of X-Tube system.