Abstract：【Objective】To investigate the clinical efficacy of transforaminal lumbar interbody fusion (TLIF) assisted by spinal endoscopy in the treatment of obese patients with lumbar disc herniation (LDH).【Methods】A total of 93 obese patients with LDH admitted to our hospital from February 2020 to May 2022 were selected and divided into the observation group (receiving TLIF treatment assisted by spinal endoscopy, n=47) and the control group (receiving traditional posterior open surgery, n=46) according to different surgical methods. The surgical related indicators, visual analog scale (VAS) scores, lumbar spine function [Japanese Orthopaedic Association (JOA) scores and Oswestry Disability Index (ODI) scores], imaging parameters, collapse rate, fusion rate, and incidence of complications were compared between the two groups. 【Results】The observation group had a longer surgery time than the control group (P<0.05), shorter total hospital stay and first time out of bed after surgery compared to the control group (P<0.05), and less intraoperative bleeding compared to the control group (P<0.05). There was no statistically significant difference in ODI scores, lower limb VAS scores, JOA scores, and lumbar VAS scores between the two groups before surgery, 1 day after surgery, and 12 months after surgery (P>0.05). 12 months after surgery, the displacement distance of the top vertebral center and the Cobb angle of the lumbar coronal plane in both groups were lower than before surgery, and the Cobb angle of the lumbar sagittal plane was higher than before surgery, with statistically significant differences (P<0.05). Moreover, the recovery of the displacement distance of the top vertebral center, Cobb angle of the lumbar coronal plane, and Cobb angle of the lumbar sagittal plane in the observation group was better than that in the control group (P<0.05). The collapse rate of the observation group was significantly lower than that of the control group (P<0.05), and the fusion rate was higher than that of the control group (P<0.05). There was no statistically significant difference in the total incidence of complications between the two groups (P>0.05). 【Conclusion】 Compared with traditional posterior open surgery, TLIF assisted by spinal endoscopy is more effective in treating LDH obese patients, with better improvement in imaging parameters, faster recovery, lower risk of fusion device collapse, and higher fusion rate.
[1] RICKERS K W, PEDERSEN P H, TVEDEBRINK T, et al. Comparison of interventions for lumbar disc herniation:a systematic review with network meta-analysis[J].Spine J,2021,21(10):1750-1762. [2] 庄俊杰,祝斌,刘晓光. 脊柱内镜与开放减压融合术对年轻肥胖腰椎间盘突出症病人的疗效对照研究[J].中国疼痛医学杂志,2021,27(1):53-59. [3] WU Y J, ZHU T, FU Z Y. Effects of Different intervertebral space heights on nerve root tension during posterior lumbar interbody fusion[J].Orthop Surg,2023,15(4):1196-1202. [4] ALEX S J, DEVIN C J, PENNINGS J, et al. A novel lumbar total joint replacement may be an improvement over fusion for degenerative lumbar conditions:a comparative analysis of patient-reported outcomes at one year[J].Spine J,2021,21(5):829-840. [5] 何彪,李世伟,谢永波,等. 脊柱内镜辅助斜外侧椎间融合术与经椎间孔腰椎椎体间融合术治疗腰椎不稳伴腰椎间盘突出症的疗效观察[J].中国内镜杂志,2023,29(1):29-37. [6] 中华医学会骨科学分会脊柱外科学组,中华医学会骨科学分会骨科康复学组. 腰椎间盘突出症诊疗指南[J].中华骨科杂志,2020,40(8):477-487. [7] SHAFSHAK T S, ELNEMR R. The visual analogue scale versus numerical rating scale in measuring pain severity and predicting disability in low back pain[J].J Clin Rheumatol,2021,27(7):282-285. [8] HARO H, EBATA S, INOUE G, et al. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of lumbar disc herniation, third edition - secondary publication[J].J Orthop Sci,2022,27(1):31-78. [9] TANG X, SCHALET B D, HUNG M, et al. Linking oswestry disability index to the PROMIS pain interference CAT with equipercentile methods[J].Spine J,2021,21(7):1185. [10] CANSECO J A, KARAMIAN B A, PATEL P D, et al. PEEK versus titanium static interbody cages:a comparison of 1-year clinical and radiographic outcomes for 1-level TLIFs[J].Clin Spine Surg,2021,34(8):483-493. [11] HORNUNG A L, BARAJAS J N, RUDISILL S S, et al. Prediction of lumbar disc herniation resorption in symptomatic patients:a prospective, multi-imaging and clinical phenotype study[J].Spine J,2023,23(2):247-260. [12] LIU G, LIU W X, JIN D J, et al. Clinical outcomes of unilateral biportal endoscopic lumbar interbody fusion (ULIF) compared with conventional posterior lumbar interbody fusion (PLIF)[J].Spine J,2023,23(2):271-280. [13] LI G Q, TONG T, WANG L F. Comparative analysis of the effects of OLIF and TLIF on adjacent segments after treatment of L4 degenerative lumbar spondylolisthesis[J].J Orthop Surg Res,2022,17(1):203. [14] 姜宇,袁磊,郭昭庆,等. 经椎间孔腰椎椎体间融合术治疗经皮内镜腰椎间盘切除术后复发性单节段腰椎间盘突出症[J].中国微创外科杂志,2021,21(1):41-46. [15] 张涛,徐彬.微创经椎间孔与后路腰椎椎体间融合术治疗腰椎退行性疾病的疗效Meta分析[J].重庆医学, 2023, 52(1):151-155.
2024, Vol. 41 
