全椎间盘置换术治疗腰椎间盘源性退行性疾病

目的 评价腰椎全椎间盘置换治疗腰椎间盘源性退行性疾病的效果.方法 应用两种人工腰椎间盘移植物治疗90例108节段具有明确腰椎间盘源性退行性疾病且6个月保守治疗无效的患者,男28例,女62例;年龄25~54岁,平均39.2岁;单节段植入85例,双节段10例,三节段1例;L3-4节段6例,L4-5节段39例,L5S1A节段63例.使用Prodisc L人工腰椎间盘48节段,Maverick人工腰椎间盘60节段.手术均取腹膜后人路.术后采用改良Odom评估、Oswestry评分、VAS评分及影像学检查四种方法对症状及疼痛改善程度进行评价.结果 手术时间75~160min,平均115.5min.术中血管损伤1例.术后并发深静脉血栓1例.术后90例患者均随访12个月.随访时间分别为:术后4、6、26、52周.术后Odom评估显示:优76例,良10例,可4例,优良率95.55%.住院时间2.5~6d.平均3.4d.术后翻修2例.影像学检查:假体下沉2例,两种假体移植物均无明显向前或后迁移.结论 应用腰椎全椎间盘置换可恢复退变节段的间盘高度和神经根管的高度及前、后径,保留腰椎后柱结构的完整性和稳定性.

Total lumbar disc replacement in treating degenerative disc disease

Objective To evaluate the effect of total lumbar disc replacement (TLDR) for treatment of lumbar degenerative disc disease (DDD). Methods The symptomatic 90 patients with DDD underwent single or multiple-level implantation of TLDR with Prodisc L prosthesis (48 levels) and Maverick prosthesis (60 levels). The conservative treatment failed to improve the symptoms in all patients after six months. The average age of the patients was 39.2 years (range 25-54 years). There were 62 females and 28 males. A total of 108 prostheses were implanted encompassing one and three levels. 85 patients were operated at one level, 10 patients at two levels, and 1 patient at three levels. Anterior retroperitoneal approach was performed at all cases. Subjective evaluation was performed according to Odom's criteria, Oswestry disability scale and visual analog scale (VAS) as well as radiographic assessment. Results The operating time varied between 75 and 160 minutes, mean 115.5 minutes. A venous laceration was found in 1 patient during exposure, but the laceration was repaired and the procedure was completed. The follow-up period ranged from 12 months for 90 patients. The visiting of the follow up was fixed at 4, 6, 26, 52 weeks postoperatively. In 76 of the patients excellent results were observed, and good results were recorded in 10 patients. Fair results were seen in 4 patients. The mean hospital stay was 3.4 days. Clinical outcome was reflected by a decrease from 8.3 to 3.1 pre- and postoperatively in the VAS. In one patient with double-level prosthesis developed deep vein thrombosis (DVT), 2 patients developed mild subsidence of Prodisc L prosthesis at L5S1A (1 level) and L4-5, L5S1A (2 levels), revision surgeries were performed by additional procedure of vertebralplasty in the 2 patients at 7th months during follow-up period. Conclusion The favorable preliminary results suggest that TIDR might be function as a physiologic replacement for degenerated lumbar intervertebral disc. The goals of TLDR include relieving discogenic pain, restoring disc height, foraminal height, and spinal alignment. An ideal TLDR would eliminate the risk of pseudarthrosis and possibly reduce adjacent-level degeneration. Additional benefits include shorter hospital stays and earlier return to work.