选择性经椎间孔椎间融合结合后路融合术治疗退行性腰椎侧凸

目的 探讨后路融合结合选择性节段经椎间孔腰椎体间融合术(transforaminal lumbar in-terbody fusion,TLIF)治疗退行性腰椎侧凸的有效性.方法 2002年11月至2005年11月,共46例患者,男14例,女32例;年龄41～78岁,平均66.4岁.节段行TLIF的标准:运动节段存在僵硬的后凸畸形,椎体在任一个方向存在明显移位、节段不稳定,冠状位L3或L4椎体明显倾斜;3个节段行TLIF 3例,2个节段21例,1个节段22例.随访2～5年,平均3.6年.影像学评价包括腰椎侧凸Cobb角、腰椎前凸角和节段前凸角;临床疗效评价包括腰部和下肢症状的JOA评分.结果Cobb角术前平均31.7°3±14.4°,末次随访平均10.2°±6.5°,与术前比较差异有统计学意义(t=15.26,P<0.05),术后改善率67.8%.腰椎前凸角术前平均27.5°±12.6°,末次随访平均39.3°±9.7°,与术前比较差异有统计学意义(t=12.17,P<0.05),术后改善率44.4%.TLIF节段前凸角术前平均6.5°±5.1°,末次随访平均11.6°±5.9°;TLIF节段的脊柱其他畸形和椎体移位均得到明显矫正.术前JOA评分平均(14.1±4.2)分,末次随访平均(22.2±4.8)分,与术前比较差异有统计学意义(t=11.45,P<0.05),根据JOA评分恢复率,优良率84.8%;术后JOA评分增加与术后腰椎前凸角增加呈正相关(r=0.61.P=0.02).结论 选择性TLIF的应用有利于进一步恢复腰椎前凸、矫正节段畸形和移位,从而提高脊柱后路融合术治疗退行性腰椎侧凸的临床疗效.

Treatment of degenerative lumbar scoliosis with selective segmental transforaminal lumbar interbody fusion and posterior spinal fusion

Objective To investigate the treatment outcome of degenerative lumbar scoliosis (DIS) with selective segmental transforaminal lumbar interbody fusion (TLIF) and posterior spinal fusion. Methods Forty-six patients with DIS treated by selective segmental TLIF and posterior spinal fusion were studied ret-rospectively. There were 14 males and 32 females, with a mean age of 66.4 years (range, 41-78). Posterior spinal fusion was performed 7 segments in 5 cases, 5 in 4, 4 in 4, 3 in 12, 2 in 16, and 1 in 5 cases. The in-dications for TLIF of motion segment included: rigid kyphosis in the lumbar spine, significant vertebral trans-lation in any orientation, segmental instability, and significant upper endplate obliquities of L3 or L4 All pa-tients were followed with a mean duration of 3.6 years postoperatively. The imaging evaluation included Cobb angle of scoliosis, lumbar lordosis angle and segmental lordosis angle. The low-back and lower-extremity clinical symptoms were evaluated with JOA score. Results The mean preoperative Cobb angle of 31.7°±14.4° was significantly corrected to 10.2°±6.5°at the final follow-up (t=15.26, P< 0.05), and the correction rate was 67.8%. The mean preoperative lumbar lordosis angle of 27.5°±12.6° was also significantly corrected to 39.3°±9.7°(t=12.17, P< 0.05), and the correction rate was 44.4%. The mean preoperative segmental lordo-sis angle of 6.5°±5.1° in TLIF segment was increased to 11.6°±5.9°. The segmental deformity and vertebral translation were corrected significantly. The mean preoperative JOA score of 14.1±4.2 was significantly in-creased to 22.2±4.8 (t=11.45, P< 0.01). Besides, there was a significant positive correlation between the fi-nal increment of JOA score and the increment in lumbar lordosis angle (r=0.61,P=0.02). Conclusion Se-lective segmental TLIF is helpful in correcting lumbar lordosis, segmental deformity and translation, and thus obtaining better outcome of posterior spinal fusion for the treatment of DLS.