The comparison of therapeutic effects between paraspinal and midline approach in patients undergoing transforaminal lumbar interbody fusion

To compare and analyze the therapeutic effects of paraspinal approach and midline approach in patients undergoing transforaminal lumbar interbody fusion (TLIF) 80 patients with single-segment lumbar disc herniation from April 2023 to Feb 2025 were randomly selected and studied through retrospective analysis. They were randomly divided into two groups: the paraspinal approach group (Group A) and the midline approach group (Group B), with 40 patients in each group. By comparing and analyzing indicators such as patient age, average length of stay, operation time, postoperative skin abrasions, wound infection, wound drainage volume, postoperative pain score, screw insertion angle, and fusion rate between the two groups, the effectiveness of the two surgical methods was evaluated. There were no statistical differences in age and average length of stay between the two groups. The operation time in the paraspinal and midline approach group were 241.20±62.85 minutes and 230.55±38.10 minutes, suggesting a shorter duration in the midline approach group. The postoperative skin abrasions and wound drainage volume were significantly higher in the midline approach group compared to the paraspinal approach group (P<0.05). There were no significant differences in Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores between two groups at 3 days and 24 weeks postoperatively. However, at 7 days postoperatively, the VAS and ODI scores in the paraspinal approach group were significantly lower than those in the midline approach group, with statistical differences (P<0.05). Postoperative CT showed that the pedicle screw inclination angles were 61.40±13.27 in the paraspinal approach group and 40.43±8.32 in the midline approach group, with the paraspinal approach group having a greater inclination angle. During the 18 weeks follow-up, there were no significant statistical differences in fusion rates between the two groups (P>0.05). The paraspinal approach results in less surgical trauma, reduced skin abrasions and wound drainage, and has a minor impact on patients during the perioperative period. Additionally, this approach allows for greater screw placement angles, although there is no significant difference in fusion rates ultimately.