Minimum Invasive Stabilizing and Decompressive-Stabilizing Methods of Surgical Treatment for Degenerative-Dystrophic Lesions of Spine

Abstract

Results of randomized prospective study with participation of 94 patients aged from 20 to 70 years with monosegmental lumbar spine lesions are presented. Minimum invasive surgical interventions were performed in 55 patients from the main group. Control group consisted of 39 patients in whom decompressive-stabilizing operations via conventional posteromedian approach with skeletization of posterior segments of vertebral column were performed. Average size of operative wound in open interventions more than 10 times exceeded that size in minimum invasive interventions and made up 484 ± 56 and 36 ± 12 sq.cm, respectively. Mean blood loss was 326.6 ± 278.0 ml in the main group and 855.1 ± 512.0 ml in the comparative one. In the main group no one patient required substitution hemotransfusion, while in 13 patients from the comparative group donor erythrocytic mass and/or fresh-frozen plasma were used to eliminate the deficit of blood components. Intensity of pain syndrome in the zone of surgical intervention by visual analog scale in the main group was lower than in comparative group. In the main and comparative groups the duration of hospitalization made up 6.1 ± 2.7 and 9.7 ± 3.7 bed days, respectively. In no one patient from the main group complications in the zone of operative wound were noted. Three patients from the comparative group required secondary debridement and in 1 patient early deep operative wound suppuration was observed. Application of low invasive surgical techniques for the treatment of patients with degenerative lumbar spine lesions enabled to perform radical surgical treatment with minimal iatrogenic injury. The method possessed indubitable advantages over the conventional open operations especially intraoperatively and in early postoperative period.

MIS-TLIF versus O-TLIF for single-level degenerative stenosis: study protocol for randomised controlled trial

“…Under non-inferiority design, the sample size was calculated for ODI difference between the values before intervention and 3 months after. Assuming mean of ODI difference is 39 and SD of ODI difference is 19.3 in both groups (based on our own published data (18.8 at 1-year follow-up, 27 19.3 at 3-month follow-up 28 ), the noninferiority margin δ=12, for a one-sided Mann-Whitney U test with a critical significance p=0.05 and test power is 80%, it is enough to allocate 38 patients. Considering the 20% loss, the total sample size will be 96 patients, 48 in each group.…”