单枚cage单侧椎弓根螺钉置入内固定治疗退行性腰椎不稳51例

背景：既往多采用双侧显露，双侧椎弓根钉置入固定治疗退行性腰椎不稳，手术风险较大，出血较多，手术时间长，费用高。 目的：探讨后路单枚cage单侧椎弓根钉置入内固定治疗退行性腰椎不稳的临床效果。 方法：采用后路椎弓根钉及椎间融合器治疗需行内固定融合的退行性腰椎不稳患者51例，男32例，女19例，年龄41~72岁；单节段47例，双节段4例。手术方法均采用单侧显露症状侧椎板及关节突，单侧置入椎弓根钉，经椎间孔入路手术切除椎间盘及软骨终板，植骨后放入单枚cage。根据日本JOA评分法评估术后疗效。 结果与结论：术中出血90~430 mL；手术时间单节段为100(85~120) min， 双节段为150(120~170) min；术后第二三天即可离床活动。术后有2例患者腰腿痛无好转，复查CT 和MRI 均未见异常，其中1 例经3 个月对症处理后腰腿痛减轻，另1 例无变化。按日本JOA 评分法评定标准，术前JOA 评分11(7~13 )分，术后1 年JOA 评分25(18~27 )分。94%患者的JOA改善率>50%。51 例患者中融合44 例，可能融合7例，融合时间为5.4(4.3~7.1) 个月。本组未发现椎弓根螺钉松动、拔出、断钉及cage 移位。说明单侧椎弓根钉及cage内固定手术方法简单，出血少，手术时间短，对脊柱结构破坏少，是治疗退行性腰椎不稳可供选择的较好方法。

Single cage plus unilateral pedicle screw placement for treating lumbar degenerative instability in 51 cases

BACKGROUND: Most of the patients suffered from degenerative lumbar instability are treated by exposure both sides and bilateral pedicle screw fixation, which bring highly operative risk, large blood loss and great medical expenditure to patients. OBJECTIVE: To explore the clinical efficacy of single cage plus unilateral pedicle screw placement for treating lumbar degenerative instability. METHODS: Totally 51 cases with lumbar degenerative instability underwent single cage plus unilateral pedicle screw placement were selected, including 32 males and 19 females, aged ranging from 41 to 72 years. 47 cases had single segment involved and 4 cases had two segments involved. All cases experienced unilateral laminectomy and transforamenal lumbar interbody fusion. The therapeutic effect was assessed by Japanese Orthopaedic Association (JOA) score system. RESULTS AND CONCLUSION: The blood loss was 90-430 mL. The surgical time was 100 minutes (85-120 minutes) for single segment and 150 minutes (120-170 minutes) for double segments. The patients were allowed to early ambulation at 2-3 days after operation. Two cases did not get improvement on back-leg pain, but there was no abnormality from CT and MRI recheck, one case felt pain relieved after anti-symptom treatment for 3 months while the other did not relieve. The average JOA scores at pre-operation and 1 year follow-up was 11 (7-13 scores) and 25 (18-27 scores), respectively. The total improvement rate of JOA was larger than 50%. 44 cases were evaluated as fusion and 7 cases as possible fusion. The average fusion time was 5.4 months (4.3-7.1 months). Postoperative X-ray showed no evidence of pedicle screw loosening, broken, or cage displacement. Single cage plus unilateral pedicle screw placement is characterized by simple operation, small blood loss, short operation and few interference to spine, which is a better method for treating lumbar degenerative instability.