通道下后侧入路MIS-TLIF改良术式治疗退行性腰椎椎管狭窄症:椎旁肌保护及近期临床疗效研究OA

Objective To compare the clinical efficacy and paraspinal muscle-preserving effects of modified channel-assisted minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)with conventional open transforaminal lumbar interbody fusion(O-TLIF)in patients with degenerative lumbar spinal stenosis(DLSS).Methods A total of 82 patients with single-level DLSS who underwent surgical treatment at Nanyang West Henan Jianhe Hospital from January 2023 to June 2025 were retrospectively included.The patients were divided into an observation group(modified MIS-TLIF,n=42)and a control group(O-TLIF,n=40).Follow-up ranged from 6 to 12 months,with a median duration of 9 months.Perioperative indicators,serum creatine kinase(CK),functional cross-sectional area(FCSA)and fat infiltration ratio(FIR)of the multifidus(MF)and erector spinae(ES),visual analog scale(VAS)pain scores,Oswestry Disability Index(ODI),and fusion rate at the final follow-up were compared between the two groups.Results The observation group had less intraoperative blood loss and postoperative drainage and shorter time to ambulation and hospital stay than the control group.At 6 months after surgery and at the final follow-up,MF FCSA and ES FCSA were greater,whereas MF FIR and ES FIR were lower,in the observation group than in the control group.Serum CK at 24 h after surgery was lower in the observation group.Low-back pain VAS scores at 1 week,3 months,and 6 months after surgery and ODI scores at 1 week,3 months,and 6 months were also lower in the observation group,with statistically significant differences(P＜0.05).Repeated-measures analysis of variance showed significant group,time,and group-by-time interaction effects for MF FCSA,MF FIR,ES FCSA,ES FIR,low-back pain VAS scores,and ODI scores(P＜0.05).No statistically significant differences were observed between the two groups in operative time,leg pain VAS scores at any time point,low-back pain VAS score at the final follow-up,ODI score at the final follow-up,fusion rate at the final follow-up,overall complication rate,or surgical satisfaction rate(P＞0.05).Conclusion Modified MIS-TLIF can reduce surgical trauma,preserve the structure and function of the paraspinal muscles,and promote early postoperative recovery in patients with DLSS.