A comparison of the bilateral decompression via unilateral approach versus conventional approach transforaminal lumbar interbody fusion for the treatment of lumbar degenerative disc disease in the elderly
Abstract Background:To investigate the early efficacy of the bilateral decompression via unilateral approach versus conventional approach transforaminal lumbar interbody fusion(TLIF)for the treatment of lumbar degenerative disc disease in the patients over 65 years of age, especially in the perioperative factors and the recovery of the soft tissue.Methods:The clinical data from 61 aging patients with lumbar degenerative disease who received surgical treatment were retrospectively analyzed. 31 cases who received the lumbar interbody fusion surgery with bilateral decompression via unilateral approach (BDUA) were compared with 30 cases who received conventional approach transforaminal lumbar interbody fusion. The radiographic parameters were measured using X-ray including lumbar lordosis angle and fusion rate. Japanese Orthopedic Association (JOA), Visual Analogue Scale (VAS) and Oswestry Disability Index(ODI)scores were used to evaluate the clinical outcomes at different time points. Fatty degeneration ratio and area of muscle/vertebral body were used to detect recovery of soft tissue.Results:All 61 patients received the BDUA approach and conventional approach transforaminal lumbar interbody fusion under general anesthesia. The BDUA approach group was found to have significantly less intraoperative blood loss and postoperative drainage compared to conventional approach transforaminal lumbar interbody fusion group. Symptoms of spinal cord and nerve compression were significantly relieved postoperatively, as compared with the preoperative state. However, the opposite side had a lower rate of fatty degeneration comparing to decompression side (P<0.05) six months after surgery in the BDUA group. While there were no significant differences (P>0.05) in two sides of conventional transforaminal lumbar interbody fusion approach group six months after surgery.Conclusions:Bilateral decompression via unilateral approach (BDUA) is able to reduce the intraoperative and postoperative body fluid loss in the elderly. The opposite side of depression in BDUA shows less fatty degeneration, which indicates better recovery of the soft tissue of the aging patients.