腰椎后路椎间融合术后融合器后移的影响因素及再手术策略

目的 分析腰椎后路椎间融合术后融合器(cage)后移的主要影响因素及再手术策略。方法 回顾性分析自2017-01—2021-12行腰椎后路减压椎弓根钉棒内固定椎间植骨融合术治疗的1 214例退行性腰椎疾病患者,术后第1次侧位X线片和术后随访比较时cage后缘金属标记物向后移位≥2 mm的患者标记为cage移位组,再根据随机原则抽取100例无cage后移的患者标记为非移位组,比较两组患者基本资料、手术前后平均椎间隙高度及腰椎前凸角、融合前后椎间盘高度差、螺钉松动情况、cage置入深度、融合节段数量。结果 所有患者均获得随访,随访时间6～18个月,平均11.3个月。21例出现术后cage后移,其中4例需行再手术,再手术节段分别为：L_3、41例,L_4、52例,L₅S₁1例,其中1例是第1次翻修术后再次cage后移,被迫行二次翻修手术。cage后移组(n=21)手术前后平均椎间隙高度均较非移位组(n=100)高,差异有统计学意义(P<0.05),说明选择相对较小的cage是后移的影响因素。此外,骨质疏...     

腰椎后路椎间植骨融合器后移的危险因素

目的探讨腰椎后路椎间植骨融合器后移的危险因素,以有助于完善预防措施。方法回顾性分析2011年1月—2013年5月在本院接受单节段或多节段腰椎后路减压椎弓根钉棒内固定椎间植骨融合术(简称腰椎后路椎间植骨融合术)治疗的238例患者的完整病历及影像学资料,共280个节段,278枚椎间融合器(Cage)。患者年龄42~76岁,平均56.9岁;平均手术节段1.4个(1~4个);随访时间12~24个月,平均20.3个月。根据术后是否出现突然的腰痛和下肢症状决定非手术治疗或行翻修手术。结果本研究组中Cage后移7例,Cage7枚,均发生在L4/L5节段。Cage后移发生在术后1~3个月,平均1.6个月,7例患者均未因Cage后移出现腰痛或下肢症状,所有患者未行翻修手术。结论 Cage后移的危险因素有使用Cage型号过小、Cage无角度、直线型终板、术前椎间隙前后缘高度过大及合并退行性侧凸等。     

腰椎椎间融合术后笼架后移危险因素分析

[目的]探讨腰椎椎间融合术后笼架后移危险因素。[方法]回顾分析692例腰椎后路椎间融合手术患者临床资料。将患者性别、年龄、合并症、住院天数、支具佩戴时间、椎间隙高度恢复情况、笼架置入深度、椎弓根钉棒稳定情况、椎间隙前凸角恢复情况纳入分析,采用单项因素与二元多因素逻辑回归分析笼架后移的相关因素。[结果] 629例患者中,发生笼架移位的23例,占3.32%。单项因素分析表明:与未后移组相比,后移组年龄大、术后佩戴支具时间短、椎间盘突出症比率低、骨质疏松比率高、激素使用比率高、超重比率高、双节段融合比率高、术后椎间隙高度恢复不良比率高、术后前凸角恢复不良比率高、术后笼架置入深度不良比率高、术后椎弓根钉棒系统稳定不良比率高,差异均有统计学意义(P0.05)。逻辑回归表明:术后佩戴支具时间是笼架后移的保护因素(OR=0.374,P0.001)。而术后椎间隙高度恢复不良(OR=263.109,P0.001),笼架置入深度不良(OR=27.931,P0.001),骨质疏松症(OR=13.609,P=0.007)和超重(OR=8.133,P=0.038)是笼架后移的危险因素。[结论]腰椎椎间融合术后笼架后移由多因素导致。骨质疏松、超重、术后椎间隙高度恢复不良、笼架置入深度不良和术后佩戴支具时间为笼架后移独立影响因素。     

后路椎体间植骨融合术治疗下腰椎不稳

目的探讨后路椎体间植骨融合术治疗下腰椎不稳的手术技术并评价其应用价值.方法对明确诊断为下腰椎不稳的32例患者进行后正中入路下的椎管狭窄减压手术,椎弓根螺钉植入并行椎间隙撑开,双侧切除椎间盘保留侧方以及前方的纤维环,刮除终板的软骨层,植入足量的松质骨以及椎板切除物,最后植入双条三面皮质骨的髂骨块,椎弓根螺钉系统加压固定.结果平均手术时间,平均失血量较常规手术无显著差别.28例获得手术后的3个月随访,原有的神经压迫症状大部恢复,行走距离增加最为明显.椎间高度术前2.8～6.7mm,平均高度4.2mm,术后椎间高度11.8～14.3mm,平均12.6mm.在3个月随访时平均高度为10.8～13.2mm,平均11.6mm.椎间孔3个月后较术前增加6mm.27例显示椎间隙的活动度小于2°,椎体与植骨块交界处无透亮区.1例植骨块吸收,但症状改善.最常见的并发症为脑脊液漏和神经根牵拉刺激,最终缓解.结论后路椎体间植骨融合术结合椎弓螺钉系统固定治疗下腰椎不稳满足充分减压,即刻的腰椎稳定性的重建以及长期可靠骨性融合治疗的基本要素.     

腰椎后路椎间植骨融合术后Cage后移的相关因素分析

目的探讨腰椎退行性疾病行后路椎间植骨+Cage融合术后,发生Cage后移的相关因素。方法自2009-09-2014-03,共收治241例腰椎退行性疾病患者,其中腰椎间盘突出症56例,腰椎管狭窄症129例,腰椎滑脱症56例;合并退行性腰椎侧凸48例。241例共282个节段行椎间植骨融合手术,手术节段分布情况:L_(1-2)节段2例,L_(2-3)3例,L_(3-4)6例,L_(4-5)130例,L_5-S_131例,L_(3-4)合并L_(4-5)33例,L_(4-5)合并L_5-S_19例,其他26例。所有患者术后均随访24个月以上,分别于术后3天、1、3、6个月和术后2年进行疗效观察,主要观察指标包括:(1)VAS评分,Oswestry功能障碍指数;(2)Cobb角,手术节段前缘和后缘椎间隙高度,手术前后的椎体前后缘椎间隙高度变化情况。同时统计Cage置入情况、融合情况等。结果 241例术后,共8例发生Cage后移,包括肾形3枚,子弹头形5枚,但并未出现压迫硬膜或神经根等情况,且术后3个月均顺利融合,故未予翻修手术。8例患者的术前椎间隙前、后缘高度均明显高于对照组,且Cage高度与椎间隙高度比值明显低于对照组(P0.05);单因素分析中,Cage置入深度不足、形状无角度的Cage、合并腰椎退行性侧凸的患者以及直线型终板者,其Cage后移的发生率明显更高(P0.05),提示上述因素可能会增加Cage后移的危险。结论在行腰椎后路椎间植骨融合术中,应充分结合术前椎间隙前、后缘高度情况选取合适型号的Cage,置入深度应在3 mm以上,同时应避免内固定不牢固所引起的Cage滑移问题。     

单侧微创经椎间孔腰椎体间融合术采用椎弓根螺钉结合经椎板关节突螺钉混合内固定可行性研究

目的 探讨单侧切口微创经椎间孔腰椎体间融合术(MIS-TLIF)采用椎弓根螺钉结合对侧经椎板关节突螺钉混合内固定的可行性和安全性.方法 2010年1月至6月18例单节段腰椎退变性疾病患者,采用单侧切口METRxTM X-tube进行MIS-TLIF手术,同侧置入椎弓根螺钉后进行加压固定,同一切口向对侧置入经椎板关节突螺钉,进行围手术期指标观察、影像学和术后疗效评价.结果 所有患者均顺利完成手术,未出现并发症.平均手术时间(107±19)min,术中出血量(62±21)ml,术后平均下床活动时间(21±5)h.经椎板关节突螺钉平均长度(52± 2) mm.术后X线和CT显示螺钉均穿过关节突关节,术后和随访期间腰痛和腿痛视觉模拟评分与Oswestry功能障碍指数评分与术前相比均明显改善(F =42.221 ～259.833,P＜0.01).结论 单侧切口MIS-TLIF可完成椎弓根螺钉结合经椎板关节突螺钉的双侧混合内固定,具有创伤小、恢复快、缩短手术时间、节省内固定费用等优点.     

腰椎融合器后移的原因分析及处理对策

 目的 探讨腰椎融合术后融合器后移的原因及临床处理对策。方法 回顾性分析2005年12月至2011年10月腰椎融合术后融合器后移至椎管的11例患者的完整资料,男7例,女4例;初次手术时年龄36～78岁,平均52.3岁。6例患者在初次手术后0.5～3个月,平均2.1个月椎间融合器发生后移(早期移位),5例患者在初次手术后14～36个月,平均24.8个月发生后移(晚期移位)。分析11例患者融合器后移发生原因,根据患者是否伴腰痛及下肢症状而行保守或手术治疗。结果 早期移位发生原因与椎间隙处理不当、髓核残留过多、软骨终板刮除不足、融合器型号选择过小、融合器植入位置不当、固定强度不足等相关。晚期移位发生原因与手术方案选择不当、多节段融合固定、术前椎间节段存在不稳定、高龄、骨质疏松及合并糖尿病等有关。11例患者均获得随访,随访时间6～72个月,平均34个月;3例经保守治疗、8例接受翻修手术治疗均获得临床愈合。随访期间该组病例临床症状无明显加重,影像学随访未发现融合器再次移位、植骨不融合、椎弓根螺钉松动等并发症。结论 腰椎融合术后融合器后移的发生原因复杂,移位发生时间的不同对移位原因的判断具有一定的临床价值;针对不同的移位原因、临床表现及影像学检查结果选择个性化方案进行治疗。     

360°植骨融合钉棒固定治疗腰椎滑脱症

目的探讨360°植骨融合加单枚Cage及四钉两棒固定手术治疗腰椎滑脱症的临床疗效。方法采用后路椎弓根提拉螺钉复位滑脱椎体,单节段椎板减压,摘除椎间盘、刮除椎体终板,撑开恢复椎间高度,将碎骨粒加压夯实置入椎间隙内并放置单枚插入型Cage,双侧横突间植骨方法治疗39例腰椎滑脱症患者。结果术后3～24个月随访,平均15个月。手术完全复位33例,不完全复位3例,4例原位融合,椎间高度未丢失,Cage无松动、钉棒无断钉,平均出血量410mL。结论 360°植骨融合加单枚Cage及钉棒固定手术治疗腰椎滑脱症,复位效果满意,出血量少,经济,并发症少。     

不同植骨融合术治疗腰椎滑脱症的疗效分析

目的比较腰椎后外侧融合术(PLF)、腰椎后路椎间植骨融合术(PLIF)及腰椎经椎间孔椎间植骨融合术(TLIF)治疗腰椎滑脱症的临床效果。方法 118例腰椎滑脱患者,均予以椎弓根螺钉复位固定后行植骨融合术,其中行腰椎后外侧融合术36例(A组),腰椎后路椎间植骨融合术42例(B组),腰椎经椎间孔椎间植骨融合术40例(C组)。回顾性分析3组患者临床资料,比较3种植骨融合术的融合率及临床症状的改善情况。结果 C组的手术时间、术中出血量均明显低于A组和B组(P<0.05),但C组的植骨融合率明显高于A组和B组(P<0.05);A、B、C组的优良率分别为77.8%、83.3%和95.0%,3组间比较无统计学差异(P>0.05)。结论联合椎弓根螺钉系统复位固定,有利于提高植骨融合率,减少并发症;腰椎经椎间孔椎间植骨融合术具有手术时间短、出血量少、椎间融合面积大、融合率高等优点,值得临床推广应用。     

加压植骨联合单枚Cage的椎体间融合与后外侧融合治疗双节段腰椎椎管狭窄症临床效果的回顾性研究

目的探讨双节段腰椎椎管狭窄症后路减压手术后行椎间加压植骨联合单枚Cage置入的椎体间融合术（posterior lumbar interbody fusion,PLIF）与后外侧融合术（posterolateral fusion,PLF）的临床效果。方法回顾性随访分析53例双节段腰椎椎管狭窄症行后路椎管减压、融合手术的患者,分为2组,PLF组31例,PLIF组22例。对2组患者手术情况进行比较,手术前、后及末次随访进行日本骨科协会（Japanese Orthopaedic Association,JOA）评分及下腰痛的视觉模拟量表（visual analog scale,VAS）评分。结果 2组手术时间差异有统计学意义（P〈0.05）;出血量、输血量差异无统计学意义（P〉0.05）;JOA评分,手术前2组差异无统计学意义（P〉0.05）,术后2组差异有统计学意义（P〈0.05）;术后2组下腰背疼痛的VAS评分差异有统计学意义（P〈0.01）。结论椎弓根螺钉内固定椎间加压植骨联合单枚Cage置入椎体间融合术较后外侧融合效果肯定,手术方式安全,手术后恢复快,出现下腰疼痛病例少,融合率高。     

Risk Factors and Scoring System of Cage Retropulsion after Posterior Lumbar Interbody Fusion: A Retrospective Observational Study

ObjectiveTo investigate risk factors of cage retropulsion after posterior lumbar interbody fusion (PLIF) in China and to establish a scoring system of cage retropulsion.MethodsThe retrospective analysis was based on two hospital databases. The medical data records of posterior lumbar interbody fusion with cage retropulsion were selected from August 2009 to August 2019. Inclusion and exclusion criteria were set in advance. Risk factors including patients'' baseline demographics (age, gender, operation diagnosis time difference), preoperative neurological symptoms, whether the fusion involves single or double segments, screw type, intraoperative compression, preoperative bone mineral density, whether there are neurological symptoms before surgery, whether there is urine dysfunction before surgery, disease type, complete removal of the endplate, and patient''s education level. The research endpoint was the retropulsion of fusion cages. The Kaplan–Meier (K‐M) method was used to analyze potential risk factors, and multivariate Cox regression was used to identify independent risk factors (P < 0.05). The Statistical Package for the Social Sciences (version 22.0; SPSS, IBM, Chicago, IL, USA) software was used for statistical analysis, and univariate analysis was used to screen out the factors related to cage retropulsion. All independent risk factors were included to predict the survival time of the retropulsion of cage.ResultsThis study included a total of 32 patients with PLIF between 2009 to 2019. All patients were residents of China. Univariate analysis showed that there were 13 patients over 60 years old and 19 patients under 60 years old. There were 20 male patients and 12 female patients. The surgical diagnosis time was seven patients within 1 month, 17 patients within 1 to 3 months, and eight patients over 3 months. The disease type was 18 cases of lumbar disc herniation, 10 cases of lumbar spinal stenosis, four cases of lumbar spondylolisthesis. The fusion segment was 18 cases of single segment, 14 cases of double segment. The intraoperative compression was seven cases of compression, 25 cases of no compression. The preoperative bone mineral density was 10 cases of low density, 18 cases of normal, four cases of osteoporosis. The screw type was 27 cases of universal screw, five cases of one‐way screw. Preoperative neurological symptoms were found in 25 cases and not in seven cases. Preoperative urination dysfunction occurred in 8 cases, whereas 24 cases did not have this dysfunction. The endplate was completely removed in 10 cases and not in 22 cases. Education level was nine cases of primary school education, 10 cases of secondary school, 13 cases of university level. Cox regression analysis showed that intraoperative pressure (hazard ratio [HR] = 4.604, P = 0.015) and complete removal of the endplate (HR = 0.205, P = 0.027) are associated with the time of cage retropulsion. According to the HR of each factor, the scoring rules were formulated, and the patients were divided into the low‐risk group, moderate‐risk group, and high‐risk group according to the final score. The three median survival times of the three groups were 66 days in the low‐risk group, 55 days in the moderate‐risk group, and 45 days in the high‐risk group, with statistical significance (P < 0.05).ConclusionIntraoperative pressure and complete removal of the intraoperative endplate can be helpful to evaluating the expected time of cage retropulsion in patients with PLIF, and this clinical model guided the selection of postoperative prevention and follow‐up treatment.     

椎弓根固定结合经椎间孔椎间融合治疗复发性腰椎间盘突出症伴腰椎不稳

目的：探讨经肌间隙入路椎弓根固定结合经椎间孔椎间融合（transforaminal lumbar interbody fusion,TLIF）治疗复发性腰椎间盘突出症伴腰椎不稳的临床疗效。方法：2008年3月至2010年5月收治35例复发性腰椎间盘突出症,其中15例行经肌间隙入路单边椎弓根固定结合TLIF术式（单边固定组）,20例行后正中入路双边椎弓根固定结合后路椎间植骨融合（posterior lumbar interbody fusion,PLIF）术式（双边固定组）.观察手术时间、术中出血量,并比较手术前后两组患者JOA评分、腰痛及腿痛VAS评分及融合情况。结果：所有患者获得随访,时间6～30个月,平均16.8个月。两组患者腰腿痛等临床症状较术前明显缓解,X线片显示植骨融合良好（双边固定组中1例未融合）,无融合器移位、下沉及内固定器械松动或断裂。两组患者手术时间、术中出血量比较差异有统计学意义（P<0.05）.术后JOA评分均较术前降低（P<0.05）.术后1周,两组患者腰痛VAS评分比较差异有统计学意义（P<0.05）,腿痛VAS评分比较差异无统计学意义（P>0.05）;末次随访,腰痛及腿痛VAS评分两组比较差异无统计学意义（P>0.05）.结论：两种术式在治疗复发性腰椎间盘突出症伴腰椎不稳均可达到满意的疗效,经肌间隙入路单边椎弓根固定结合TLIF术式切口较小,手术时间较短,术中出血量较少,术后腰痛缓解较快。     

微创经椎间孔入路腰椎椎间融合术中横突定位法置钉治疗腰椎退行性疾病

目的 探讨微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)中横突定位法置钉治疗腰椎退行性疾病的可行性.方法 回顾性分析2017年1月—2019年5月在新华医疗集团新华医院接受MIS-TLIF治疗的70例腰椎退行性疾病患者的临床资料,其中采用横突定位法置钉33例(观察组),采用传统人字嵴定位法置钉37例(对照组).记录并比较2组术中出血量、透视次数、置钉时间、一次置钉成功率、置钉优良率、关节突关节破坏率,在术前、术后3个月和末次随访时采用Oswestry功能障碍指数(ODI)、疼痛视觉模拟量表(VAS)评分评价患者腰椎功能及疼痛程度.结果 所有手术顺利完成,患者随访16～36(23.18±3.91)个月.观察组置钉时间、透视次数、关节突关节破坏率显著低于对照组,一次置钉成功率、置钉优良率显著高于对照组,差异均有统计学意义(P<0.05);术中出血量组间差异无统计学意义(P>0.05).2组术后3个月、末次随访时VAS评分和ODI均较术前显著改善,差异均有统计学意义(P<0.05),组间比较差异无统计学意义(P>0.05).结论 MIS-TLIF术中采用横突定位法置钉治疗腰椎退行性疾病近期疗效良好,可减少置钉时间,提高置钉成功率与准确率.     

三维导航技术在微创经椎间孔入路腰椎椎间融合术中的应用

目的 探讨术中三维导航技术在微创经椎间孔入路腰椎椎间融合术(MIS-TLIF)中的应用价值.方法 2016年1月—2017年12月采用MIS-TLIF治疗腰椎退行性疾病患者64例,其中32例术中应用三维导航(A组),另32例术中采用传统C形臂X线机透视(B组).记录并比较2组手术时间、术中出血量、术中辐射量、置钉准确率及每枚螺钉置入时间,采用疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)及日本骨科学会(JOA)评分评价临床疗效,记录并发症发生情况.结果 所有手术顺利完成.所有患者随访24～48个月,平均29.5个月.A组手术时间、术中出血量、置钉准确率及每枚螺钉置入时间优于B组,而术中辐射量则高于B组,差异均有统计学意义(P<0.05).2组术后VAS评分、ODI及JOA评分均较术前显著改善,差异有统计学意义(P<0.05);组间差异无统计学意义(P>0.05).所有患者术中、术后均无明显并发症发生.结论 MIS-TLIF术中应用三维导航技术可提高置钉准确率,缩短手术时间,提高手术的便利性和安全性.     

单侧微创与开放经椎间孔腰椎椎体间融合内固定治疗腰椎椎间盘突出症的临床疗效比较

目的：比较微创经椎间孔融合内固定与传统开放经椎间孔融合内固定术治疗腰椎椎间盘突出症的临床疗效。方法2009年10月～2012年10月,对54例腰椎椎间盘突出症手术患者进行回顾性分析,其中男32例,女22例,年龄34～60岁,平均42．7岁;病变节段为L4/L534例,L5/S120例。依据手术方式将其分成微创经椎间孔腰椎椎体间融合（minimally invasive transforaminal lumbar interbody fusion , MiTLIF）组和开放经椎间孔腰椎椎体间融合（open transforaminal lumbar interbody fusion , OTLIF）组,分别为24例和30例。分析手术时间、手术出血量、住院时间、术中术后并发症,影像学观察术后1年椎间融合情况,采用日本骨科学会（ Japanese Orthopaedic Association ,JOA）评分评估临床效果。结果所有患者均获随访,随访时间12～36个月,平均21．4个月,MiTLIF组出血量（40．2±15．6） mL,住院时间（6．2±2．4） d,术后2周JOA评分18．7±1．9,OTLIF组出血量（203．6±52．8） mL,住院时间（10．8±4．2） d,术后2周JOA评分15．1±1．4,2组差异具有统计学意义（P＜0．05）。2组手术时间,术中术后并发症发生率,术后1个月、3个月和1年JOA评分,术后1年椎间融合率差异无统计学意义（P＞0．05）。结论在行单侧椎弓根固定治疗腰椎椎间盘突出症时,MiTLIF组出血量更少短期临床疗效更好。     

皮质骨通道螺钉结合改良腰椎后路椎间融合术治疗腰椎退变性疾病的临床疗效

目的探讨皮质骨通道(cortical bone trajectory,CBT)螺钉结合改良腰椎后路椎间融合术(posterior lumbar interbody fusion,PLIF)治疗腰椎退变性疾病的临床疗效。方法回顾分析我院2016年1月至2018年1月的72例腰椎退变性疾病病人的临床资料,按手术方式分为椎弓根螺钉PLIF组(29例)、CBT螺钉PLIF组(24例)和改良CBT螺钉PLIF组(19例)。分析三组的手术时间、术中出血量、术后引流量、术后卧床及住院时间、术后血清肌酸激酶(creatine kinase,CK)浓度及围手术期并发症;比较各组术后12个月的疼痛视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)及融合率。结果改良CBT螺钉PLIF组的手术时间、术中出血量、术后引流量、术后住院时间、术后12个月的ODI均显著少于其他两组,差异均有统计学意义(P均<0.05);椎弓根螺钉PLIF组的CK值和术后卧床时间均显著高于其他两组,差异均有统计学意义(P均<0.05)。三组的并发症发生率、术后12个月的VAS评分和融合率比较,差异均无统计学意义(P均>0.05)。结论CBT螺钉固定结合改良PLIF术式治疗腰椎退变性疾病手术时间短、术中出血量少、创伤小、术后恢复快,临床疗效满意。     

Comparison of open and minimally invasive techniques for posterior lumbar instrumentation and fusion after open anterior lumbar interbody fusion

Background contextMinimally invasive techniques for spinal fusion have theoretical advantages for the reduction of iatrogenic injury. Although this topic has been investigated previously for posterior-only interbody surgery, such as transforaminal lumbar interbody fusion, similar studies have not evaluated these techniques after anteroposterior spinal fusion, a study design that can more accurately determine the effect of pedicle screw placement and decompression via a minimally invasive technique without the confounding effect of simultaneous interbody cage placement.PurposeTo compare process measures that provide insight into the morbidity of surgery, such as surgical time and the length of postoperative hospital stay between open and minimally invasive anteroposterior lumbar fusion; and to compare the complications during the intraoperative and early postoperative period between open and minimally invasive anteroposterior lumbar fusion.Study designRetrospective case-control study.Patient sampleOne hundred sixty-two patients.Outcome measuresEstimated blood loss, length of surgery, intraoperative fluoroscopy time, length of postoperative hospital stay, malpositioned instrumentation on postoperative imaging, and postoperative complications, including pulmonary embolus and surgical site infection.MethodsPatients who underwent open anterior lumbar interbody fusion followed by either traditional open posterior fusion (Open group) or minimally invasive posterior fusion (minimally invasive surgery [MIS] group) were matched by the number of surgical levels. A chart review was performed to document the intraoperative and postoperative process measures and associated complications in the two groups. Secondary analyses were performed to compare the subgroups of patients, who did and did not undergo a posterior decompression at the time of posterior instrumentation to determine the effect of decompression.ResultsBaseline characteristics were similar between the Open and MIS groups. Estimated blood loss and postoperative transfusion rate were significantly higher in the Open group, differences that the subanalyses suggested were largely because of those patients who underwent concomitant decompression. Length of stay was not significantly different between the groups but was significantly shorter for MIS patients treated without decompression than for Open patients treated without decompression. Intraoperative fluoroscopy time was significantly longer in the MIS group. There was no difference in the infection or complication rates between the groups.ConclusionsOur case-control study comparing patients who underwent anterior lumbar interbody fusion followed by open posterior instrumentation with those who underwent anterior lumbar interbody fusion followed by minimally invasive posterior instrumentation demonstrated that patients undergoing MIS fusion without decompression had less blood loss, less need for transfusion in the perioperative period, and a shorter hospital stay. In contrast, most outcome measures were similar between MIS and Open groups for patients who underwent decompression.     

Risk factors for postoperative ileus after oblique lateral interbody fusion: a multivariate analysis

Background ContextOblique lateral interbody fusion (OLIF)–has become a widely used, efficient surgical tool for various degenerative lumbar conditions. Postoperative ileus (POI) is a relatively common complication after anterior lumbar interbody fusion due to the manipulation of the intestine during the surgical approach. However, to our knowledge, little is known about POI following OLIF even though it also involves bowel manipulation during a surgical procedure.PurposeTo assess the incidence of POI and identify independent risk factors for POI development after OLIF.Study Design/SettingRetrospective cohort study.Patient SampleAll consecutive patients who underwent OLIF and percutaneous pedicle screw instrumentation from August 2012 until October 2019 at a single institutionOutcome MeasuresPatient demographics (sex, age, body weight, height, and body mass index), comorbidities (diabetes mellitus, gastroesophageal reflux disease, antithrombotic medication, previous abdominal surgery, and previous lumbar surgery), and perioperative details (preoperative diagnosis, number of levels fused, inadvertent endplate fracture during cage insertion, type of interbody graft, intraoperative estimated blood loss, duration of surgery and anesthesia, the amount of intraoperative remifentanil and propofol used as anesthetic agents, the total postoperative retroperitoneal closed-suction drainage output, and the cumulative opioid dosage administered in the first 72 hours postoperatively).MethodsPOI was defined as 2 or more of the following at 72 hours postoperatively: (1) ongoing nausea or vomiting postoperatively, (2) the absence of flatus over last 24-hour period, (3) inability to tolerate an oral diet over last 24-hour period, (4) ongoing abdominal distention postoperatively, and (5) radiological confirmation. The subjects were divided into 2 groups: patients with POI and those without POI. Binary logistic regression analyses were performed on demographics, comorbidities, and perioperative factors to identify independent risk factors for POI.ResultsEighteen (3.9%) of 460 patients experienced POI after OLIF and percutaneous pedicle screw instrumentation. Patients with POI had a significantly longer postoperative length of hospital stay than those without POI (8.61 ± 2.66 vs 6.48 ± 2.64, p = .001). Multivariate logistic regression analysis identified inadvertent endplate fracture (adjusted odds ratio = 6.017, p = .001) and the amount of intraoperative remifentanil (adjusted odds ratio = 1.057, p = .024) as independent risk factors for the occurrence of POI following OLIF.ConclusionThis study identified inadvertent endplate fracture and the amount of intraoperative remifentanil as independent risk factors for the development of POI after OLIF.     

3D打印模板导航经皮椎弓根螺钉置钉在经椎间孔腰椎椎间融合术治疗腰椎椎管狭窄症中的初步应用

目的探讨3D打印模板导航经皮椎弓根螺钉置钉在经椎间孔腰椎椎间融合术(TLIF)治疗腰椎椎管狭窄症中应用的可行性、准确性和安全性。方法回顾性分析2016年1月—2017年3月本院采用TILF治疗的单节段腰椎椎管狭窄症患者的临床资料,选取10例应用3D打印模板导航置钉的患者作为试验组,选取一般情况相似的10例作为对照组。试验组下肢无临床表现侧在3D打印模板导航下置入螺钉(模板侧),下肢有临床表现侧切开后经Wiltse入路顺导针置入螺钉(穿刺侧);对照组采用传统徒手法置入椎弓根螺钉。记录患者手术时间、出血量、透视时间及次数、螺钉置入的准确性及脊髓、神经损伤并发症发生情况。结果试验组手术时间、出血量少于对照组,差异有统计学意义(P0.05)。试验组模板侧透视时间及次数少于穿刺侧及对照组,差异有统计学意义(P0.05);而穿刺侧与对照组相比差异无统计学意义(P0.05)。试验组无2级螺钉,对照组2级螺钉有4枚。0级螺钉比例,试验组两侧均优于对照组,差异有统计学意义(P0.05);试验组两侧差异无统计学意义(P0.05)。所有患者均无脊髓、神经损伤等并发症发生。结论 3D打印模板导航经皮椎弓根螺钉置钉应用于TLIF治疗腰椎椎管狭窄症是可行的。虽然应用过程中需要注意避免皮肤移动、体位变化对置钉准确性的影响,但仍是一种新的、可选择的微创置钉技术。