With the improvement of medical technology, the indications of spinal endoscopy technology are becoming more and more widespread. Percutaneous endoscopic posterior tranforaminal lumbar interbody fusion (Endo-P/TLIF) has been rapidly and widely used in lumbar spondylolisthesis combined with lumbar spinal stenosis, achieving certain efficacy in clinical observation. Compared with traditional fusion cages, height adjustable titanium fusion cage have better distraction effect and can effectively restore intervertebral space height, with obvious efficacy in Endo-P/TLIF surgery.

To investigate the application and clinical efficacy of Endo-P/TLIF combined with height adjustable titanium fusion cage in the treatment of lumbar spondylolisthesis with lumbar spinal stenosis.

The clinical data of 171 patients with lumbar spondylolisthesis with lumbar spinal stenosis treated at the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine from January 2019 to June 2021 were retrospectively analyzed. The included patients were divided into 35 cases in the Endo-P/TLIF+adjustable fusion cage group, 57 cases in the Endo-P/TLIF+ordinary fusion cage group, 47 cases in the Endo-TLIF+ordinary fusion cage group and 32 cases in the unilateral approach biportal endoscopic (UBE) +ordinary fusion cage group according to the operation mode. The gender, age, intraoperative bleeding, hospital stay, preoperative, immediate postoperative, 6-month postoperative and 12-month postoperative Oswestry disability index (ODI) score, visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, degree of lumbar spondylolisthesis, lumbar lordosis angle, and dural cross-sectional area were compared among the four groups.

There was no statistically significant difference in gender, age, operative time, intraoperative bleeding, and hospital stay among the four groups of patients (P>0.05). There was no interaction effect of group and time on ODI score, VAS score, JOA score, lumbar lordosis angle, and dural cross-sectional area (P>0.05) ; there was an interaction effect of group and time on the degree of lumbar spondylolisthesis (P<0.05). There was a significant main effect of group on ODI score, JOA score, lumbar lordosis angle, and dural cross-sectional area (P<0.05) ; there was a significant main effect of time on ODI score, VAS score, JOA score, lumbar spondylolisthesis degree, lumbar lordosis angle, and dural cross-sectional area (P<0.05). At the immediate postoperative period, the dural cross-sectional area in the Endo-P/TLIF+adjustable fusion cage group and Endo-P/TLIF+ordinary fusion cage group was higher than that in the Endo-TLIF+ordinary fusion cage group and UBE+ordinary fusion cage group, respectively (P<0.05). At 6 months after surgery, the ODI score in the Endo-P/TLIF+adjustable fusion cage group and Endo-P/TLIF+ordinary fusion cage group was lower than that in the Endo-TLIF+ordinary fusion cage group and UBE+ordinary fusion cage group, respectively (P<0.05). At 12 months after surgery, the ODI score and VAS score of the Endo-P/TLIF+adjustable fusion cage group were lower than those in the other three groups, while the JOA score, lumbar spondylolisthesis degree, and dural cross-sectional area were higher in the Endo-P/TLIF+adjustable fusion cage group than those in the Endo-TLIF+ordinary fusion cage group and UBE+ordinary fusion cage group (P<0.05) .

As a modified spinal endoscopic interbody fusion, Endo-P/TLIF has the advantages of less trauma, less intraoperative bleeding, shorter hospitalization stay, and complete decompression. The combination of height adjustable titanium fusion cage can restore the height of intervertebral space well with good short-term effect, which is worthy of extensive clinical promotion and application.

随着医学技术的提升，脊柱内镜技术的适应证越来越广泛，经皮内镜后路经椎间孔腰椎椎间融合术（Endo-P/TLIF）快速而广泛地运用于腰椎滑脱合并腰椎管狭窄症的治疗中，并取得了一定的疗效。高度可调钛质融合器较传统融合器而言，其撑开效果更好，能够较好地恢复椎间隙高度，用于Endo-P/TLIF术式中疗效明显。

探讨Endo-P/TLIF联合高度可调钛质融合器在腰椎滑脱合并腰椎管狭窄症治疗中的应用及临床疗效。

回顾性分析2019年1月—2021年6月在广西中医药大学第一附属医院治疗的171例腰椎滑脱合并腰椎管狭窄症患者的临床资料，按照手术方式分为Endo-P/TLIF+可调节融合器组35例、Endo-P/TLIF+普通融合器组57例、经皮内镜经椎间孔腰椎椎间融合术（Endo-TLIF）+普通融合器组47例、单侧入路双通道内镜（UBE）+普通融合器组32例，比较四组患者的性别，年龄，手术时间，术中出血，住院时间，术前、术后即刻、术后6个月、术后12个月的腰椎Oswestry功能障碍指数（ODI）评分、视觉模拟评分法（VAS）评分、日本骨科协会评估治疗分数（JOA）评分、腰椎滑脱程度、腰椎前凸角、硬膜横断面积。

四组患者性别、年龄、手术时间、术中出血、住院时间比较，差异无统计学意义（P>0.05）。组别和时间对ODI评分、VAS评分、JOA评分、腰椎前凸角、硬膜横断面积不存在交互作用（P>0.05）；组别和时间对腰椎滑脱程度存在交互作用（P<0.05）。组别在ODI评分、JOA评分、腰椎前凸角、硬膜横断面积上主效应显著（P<0.05）；时间在ODI评分、VAS评分、JOA评分、腰椎滑脱程度、腰椎前凸角、硬膜横断面积上主效应显著（P<0.05）。术后即刻，Endo-P/TLIF+可调节融合器组与Endo-P/TLIF+普通融合器组硬膜横断面积分别高于Endo-TLIF+普通融合器组和UBE+普通融合器组（P<0.05）；术后6个月，Endo-P/TLIF+可调节融合器组与Endo-P/TLIF+普通融合器组ODI评分分别低于Endo-TLIF+普通融合器组和UBE+普通融合器组，硬膜横断面积分别高于Endo-TLIF+普通融合器组和UBE+普通融合器组（P<0.05）；术后12个月，Endo-P/TLIF+可调节融合器组ODI评分、VAS评分低于其他三组，而JOA评分、腰椎滑脱程度、硬膜横断面积高于Endo-TLIF+普通融合器组和UBE+普通融合器组（P<0.05）。

Endo-P/TLIF是改良的脊柱内镜椎间融合术，具有创伤小、术中出血少、住院时间短、减压彻底等优势，联合高度可调钛质融合器能够较好地恢复椎间隙高度，具有良好的近期疗效，值得临床广泛推广应用。