AN OBSERVATIONAL STUDY OF 79 CASES OF INEFFECTIVE LUMBAR MINIMALLY INVASIVE TREATMENT: CAUSE ANALYSIS AND TREATMENT STRATEGIES

Lei Cai^{1, #}, Xuwu Li^{2, #}, Qingbo Li^{1, #}, Wei Wang¹, Zhengkun Wang¹, Weijun Liu^{1, *}

¹Department of Orthopaedics, Wuhan Fourth Hospital, Pu Ai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China - ²Department of Orthopaedics, Caidian district traditional Chinese medicine hospital, Wuhan, People’s Republic of China

Objective: Although there are many minimally invasive treatments for lumbar degenerative diseases, some cases were ineffective. Herein, we summarized the clinical symptoms and treatment methods of such cases.

Methods: A retrospective analysis of 79 ineffective cases after minimally invasive surgery between January 2016 and June 2019. All cass underwent X-ray, MRI and CT examinations. Among them, 61 cases showed residual lumbar disc herniation or lumbar spinal stenosis, and were included in Group 1. They underwent transforaminal lumbar interbody fusion (TLIF) surgery of the corresponding segment. 18 patients showed no obvious lumbar disc herniation or lumbar spinal stenosis. These 18 patients underwent corresponding segmental nerve root block, of which 15 patients showed significant remission and were included in Group 2. Thereafter, corresponding segmental TLIF surgeries were performed. Three cases had no obvious remission after treatment of nerve root block, and were conservatively treated. A total of 76 patients were enrolled. The average follow-up time was 12 months. The effects of revision surgery were evaluated with Visual Analogue Scale (VAS) for low back and leg pain and Oswestry Disability Index (ODI).

Results: A total of 79 patients in both groups underwent TLIF at the corresponding levels. Most cases in Group 1 showed nerve root adhesion and edema. All cases in Group 2 showed nerve root adhesion and edema. VAS and ODI scores were significantly improved 1 day before revision and 2 weeks, 3 months, 6 months and 12 months after revision (p<0.05).

Conclusion: Some cases were ineffective after minimally invasive surgery. Most of which were found imaging abnormalities, while a few of which were found no obvious imaging abnormalities. When conservative treatment failed, nerve root block could help to diagnose. The TLIF surgery could fully release the adhered nerve roots, which were effective.