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[Comparison of treatment with micro endoscopic discectomy and posterior lumbar interbody fusion using single and double B-Twin expandable spinal spacer]

OBJECTIVE: To compare the therapeutic effect of posterior lumbar interbody fusion by single and double B-Twin expandable spinal spacer with micro endoscopic discectomy (MED) for lumbar intervertebral disc protrusion accompanying degenerative instability. METHODS: From March 2006 to May 2008, 45 patients with lumbar intervertebral disc protrusion accompanying degenerative instability were admitted and managed with posterior lumbar interbody fusion by B-Twin expandable spinal spacer with MED. The patients were randomly assigned to treatment with single B-Twin (Single group, n = 24) or double B-Twin (Double group, n = 21). There were 16 males and 8 females, with an average age of 45.5 years (43 – 60 years) in Single group; 13 males and 8 females, with an average age of 43.7 years (44-61 years) in Double group. All the cases suffered from only one level disc protrusion, L(3-4) 2 cases, L(4-5) 29 cases and L(5)-S(1) 14 cases. Clinical outcomes were evaluated with surgical time, blood loss, visual analogue scale (VAS) scores preoperatively, 1, 3, 6 month postoperatively. Oswestry disability questionnaire (ODI) of the preoperative, 1 month postoperative, and latest follow-up and the disk space heights. RESULTS: Forty three patients were followed-up for 1 to 3 years after surgery. The mean surgical time of Double group was longer than Single group [(152 +/- 32) min vs. (91 +/- 15) min, P < 0.01]. The average blood loss in Double group was more than that in Single group [(146 +/- 73) ml vs. (95 +/- 58) ml, P < 0.01]. The mean time of hospital stay in Single group was similar to that in Double group [(11.0 +/- 3.2) d vs. (10.9 +/- 3.3) d, P > 0.05]. Both groups could keep the disk space heights till the last follow-up [(7.7 +/- 1.8) mm vs. (8.5 +/- 1.7) mm]. In the 6 months follow-up post operation, the VAS score decreased from (8.1 +/- 1.8) to (2.0 +/- 1.0) in Single group, and (8.1 +/- 1.9) to (2.1 +/- 1.0) in Double group. At the last follow-up, the ODI decreased from (36 +/- 7)% to (10 +/- 4)% in Single group and (37 +/- 6)% to (9 +/- 4)% in Double group, but there was no significant difference between the two groups (P > 0.05). All the cases achieved fusion at the last follow-up, 3 patients in Single group and 2 patients in Double group suffered from intractable low back pain. One of the fins broke in one patient without any uncomfortable feeling. CONCLUSIONS: Compared with the management of lumbar intervertebral disc protrusion accompanying degenerative instability by double B-Twin expandable spinal spacer with micro endoscopic discectomy, the single B-twin can get similar clinical outcomes, but shorter surgical time, less blood loss and less medical costs

Keywords : Adult,Back,Back Pain,blood,China,Endoscopy,Female,Follow-Up Studies,Humans,Intervertebral Disc,Intervertebral Disc Displacement,Low Back Pain,Lumbar Vertebrae,Male,methods,Middle Aged,Orthopedics,Pain,Patients,Prospective Studies,Spinal Fusion,surgery,Time,Treatment Outcome,Universities,, Treatment,With,Microendoscopic,Discectomy, princess grace hospital fees

Date of Publication : 2010 Nov 1

Authors : Zhang DQ;Yang Q;Jiang CM;Wu CM;Ma K;Tang K;Liu Y;Wang B;

Organisation : Department of Orthopedics, First Hospital of Dalian Medical University, Dalian 116011, China

Journal of Publication : Zhonghua Wai Ke Za Zhi

Pubmed Link : https://www.ncbi.nlm.nih.gov/pubmed/21211259

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