脊柱非融合U型棘突间钛合金材料植入治疗早期腰椎间盘突出伴

背景：脊柱非融合技术是目前对于早期脊柱疾病进行干预的新技术,可以在保护脊柱运动功能的同时达到治疗患者病情的效果。U型棘突间钛合金材料植入物属于后路棘突间非融合新技术范畴,此方面的研究将是非融合技术的一个热点。 目的：观察腰椎后路动态腰椎管狭窄运动保留的非融合U型棘突间钛合金材料植入物的临床力学性能。 设计、时间及地点：对比观察,病例来自2006-06/2007-12上海长海医院骨科。 对象：选择退变性椎间盘突出伴有动态椎管狭窄的患者28例,男23例,女5例,年龄41~58岁。 方法：根据患者自愿的方式随机分为2组,单纯椎间盘摘除减压组(n=20)：单纯椎间盘摘除减压术摘除责任节段椎间盘;材料植入物组(n=8)：先摘除责任节段椎间盘后去除棘突间韧带,将2个翼状突起夹在头尾端棘突上,然后在棘突间植入U型棘突间钛合金材料植入物。 主要观察指标：术后及随访测量责任节段的椎间隙高度保护度、椎管面积以及患者的腰椎JOA评分。 结果：28例退变性椎间盘突出伴有动态椎管狭窄患者均进入结果分析。材料植入物组植入U型钛合金材料后椎间隙高度保护度和平均椎管面积较单纯椎间盘摘除减压组明显增加(P < 0.05)。患者腰椎手术前后的JOA评分均有明显改善,但是采用非融合技术材料植入物组的改善程度明显优于常规单纯椎间盘摘除减压组(P < 0.05)。 结论：脊柱非融合U型棘突间钛合金材料植入物对于早期椎间盘突出伴有动态腰椎管狭窄患者的腰椎力学性能有很好的保护作用。     

Coflex棘突间动力重建系统治疗腰椎退变性疾病18例

背景：近年来脊柱非融合技术一直是脊柱外科研究与争论的热点。Coflex棘突间动力重建系统作为腰椎后路非融合器材,国外虽已应用较长时间,但国内尚处于试用阶段。 目的：探讨Coflex棘突间动力重建系统治疗腰椎退变性疾病的适应证,并对其早期临床疗效进行评价。 方法：2008-10/2010-06使用Coflex棘突间动力重建系统治疗腰椎退变性疾病31例,对其中随访超过1年的18例患者临床资料进行分析总结。治疗方式均为后路髓核摘除,椎管减压、Coflex棘突间动力重建系统置入;1例患者术中置入2枚Coflex。治疗前及各次随访时均对患者进行日本骨科学会下腰痛功能量表、中文版Oswestry功能障碍指数量表及目测类比评分法评估,并测量治疗前后、各次随访时腰椎前屈后伸位置入节段及其上下节段活动范围、Colfex上下极板夹角及置入节段椎间隙高度。 结果与结论：患者均获随访,随访时间12~20个月。末次随访时患者日本骨科学会下腰痛功能量表评分、中文版Oswestry功能障碍指数量表评分及目测类比评分均获显著改善;治疗前后置入节段椎间高度及其上下节段椎间活动度差异均无显著性意义(P > 0.05),末次随访时Coflex上下极板夹角在过伸位较中立位显著增大(P < 0.05)。提示Coflex棘突间动力重建系统对腰椎间盘突出症、椎管狭窄及腰椎不稳等腰椎退变性疾病安全有效,在腰椎后伸时能够有效分担载荷,同时对腰椎生理活动影响较小,有利于维护腰椎功能,早期临床疗效肯定。     

椎间融合器植入并双侧下关节突切除治疗退变性腰椎管狭窄症

背景：对退变性腰椎管狭窄治疗可行全椎板减压内固定置入、单侧或双侧开窗减压、后路全椎板减压等方法。但采取何种方式治疗中是否需行椎间融合器植入内固定目前还没有定论。 目的：评价以cage椎间植骨融合椎弓根内植入固定并腰后路全椎板及双侧下关节突切除减压、自体小关节骨质移植治疗退变性腰椎管狭窄症的效果。 方法：选择经3个月保守治疗无效的退变性腰椎管狭窄症患者41例,男23例,女18例,平均年龄60.3岁,行腰后路全椎板及双侧下关节突切除减压、自体小关节骨质及cage椎间植骨融合植入椎弓根内固定治疗,随访24个月,术前及术后随访时JOA评分评价患者疗效,放射学检查患者植骨融合情况及手术节段椎体稳定性。 结果与结论：随访时JOA评分较术前有明显提高(P < 0.01),临床优良率为90%;40例获得骨性融合,融合率98%,1例患者有腰椎不稳征象。术后均无内固定物松动、断裂等并发症发生,但有2例发生硬脊膜撕裂,1例发生椎弓根位置偏斜,1例假关节形成。结果提示腰后路全椎板及双侧下关节突切除减压、自体小关节骨质及cage椎间植骨融合植入椎弓根内固定治疗退变性腰椎管狭窄症具有良好的临床效果。     

置入棘突间稳定系统Wallis治疗腰椎退变性疾病：与单纯腰椎管减压的比较☆

背景：在早期,腰椎间盘退变性疾病的治疗临床常用髓核摘除或髓核摘除加刚性内固定融合技术,但是随着非刚性固定技术的发展,棘突间稳定系统固定和全椎间盘置换在脊柱非融合治疗中逐渐受到人们的重视,其优点日益突出。 目的：与单纯腰椎管减压相比,评价腰椎管减压并棘突间稳定系统Wallis置入固定治疗腰椎退变性疾病的效果。 方法：选择2007-12/2008-12华中科技大学附属同济医院骨科收治的腰椎退变性疾病患者40例,随机选取20例行单纯髓核摘除(对照组),20例行突出髓核摘除加棘突间稳定系统Wallis固定(实验组)。分别于置入后1周,1年对两组患者分别进行JOA评分、目测类比评分。 结果与结论：两组患者置入后1周JOA评分及目测类比评分差异均无显著性意义(P > 0.05);术后1年JOA评分及目测类比评分差异均有显著性意义(P < 0.05)。提示两术式即刻效果无差异,均取得良好的效果,此效果主要依赖于手术有效的减压。实验组中期效果明显优于乙组,主要是棘突间稳定系统Wallis发挥良好的生物学作用,有效缓解了患者残余的慢性下腰痛。 关键词：腰椎退变性疾病;椎管减压;棘突间稳定系统;硬组织植入物     

腰椎棘突间置入动态内固定Coflex系统治疗中年腰椎旋转不稳：近期腰椎稳定性评价

背景：腰椎棘突间动态内固定Coflex系统主要用于治疗轻度腰椎管狭窄病例,其适应范围是否可有进一步的扩大？ 目的：观察腰椎棘突间动态内固定Coflex系统治疗中年腰椎旋转不稳的近期疗效。 方法：对腰椎旋转不稳的11例中年患者行Coflex内固定术,均为L4~5节段性不稳定。所有患者术前及术后均行日本骨科学会(JOA)评分;观测影像指标包括手术前术后椎间隙中立角,过伸角,过屈角和 L4~5活动度。观察手术时间,术中出血量。 结果与结论：全部患者随访6个月。Coflex置入时间平均72.6 min,平均出血85.7 mL。术后6个月随访时,JOA评分由术前14.45±2.42提高到21.00±2.24,差异有显著性意义(P < 0.05)。L4~5活动度由术前(13.18±2.04)°减少到(8.09±0.94)°,差异有显著性意义(P < 0.05)。提示腰椎棘突间动态内固定Coflex系统治疗中年腰椎旋转不稳的近期疗效良好,腰椎稳定性有明显提高,中远期疗效尚待观察。     

双通道椎间孔镜技术治疗腰椎管狭窄症的初步临床研究

目的初步探讨采用双通道椎间孔镜技术治疗退变性腰椎管狭窄症的临床疗效。方法回顾性分析5例采用双通道椎间孔镜技术治疗退变性腰椎管狭窄症病人的临床资料,统计病人的手术时长、出血量、住院时间等临床资料,术后通过Oswestry功能障碍指数(ODI)、腰椎日本骨科协会(JOA)评分及视觉模拟评分法(VAS)对治疗效果进行评价。结果 5例病人均顺利完成手术,手术时长(110.6±18.9) min,术中出血量(15.2±9.7) ml,住院时间(4.5±1.2) d。病人术后间歇性跛行及神经根性症状均明显缓解;无术中及术后并发症。术后ODI、JOA、VAS评分改善率分别为48.7%、69.1%和62.0%。结论双通道椎间孔镜技术能安全、有效地治疗退变性腰椎管狭窄症,其手术创伤小,病人术后恢复快。该技术具有术野开阔、操作灵活的特点,是手术疗效、手术效率与微创的合理平衡。     

腰椎棘突间内固定器的基础研究及临床应用★

腰椎棘突间内固定器是脊柱外科后路非融合置入物的一类，根据其特性及作用特点可分为静态系统和动态系统两类。随着内固定器制作工艺的飞速发展，腰椎棘突间内固定器的材料构成范围也很广泛，包括同种异体骨移植物、钛、聚醚醚酮和人造橡胶复合物等。大量的基础及临床研究表明，腰椎棘突间内固定器在退变性椎管狭窄、椎间盘原性下腰痛、关节突综合征、椎间盘突出症和腰椎不稳等疾病的治疗中有着广阔的应用前景，但其中也有许多问题，诸如腰椎棘突间内固定器对腰椎后柱结构的影响及其对腰椎间盘的作用机制和对脊柱稳定性的影响等将有待于进一步解决，其临床适应证也有待于长期随访最终确证。     

椎间关节植骨加内固定治疗退变性腰椎管狭窄症

目的 介绍椎间关节植骨加内固定治疗退变性腰椎管狭窄症的疗效.方法 采用椎间关节植骨加内固定治疗退变性腰椎管狭窄症268例.结果 268例,平均随访36个月,优良率为89.6%,并发症2.3%.结论 椎间关节植骨加内固定治疗退变性腰椎管狭窄症疗效确切,融合率高.     

植入Cage及自体棘突、椎板颗粒骨填充行后路腰椎椎间融合治疗退变性腰椎疾病63例：远期随访

背景：临床多见应用后路腰椎椎间融合+Cage行椎间融合时采用自体髂骨颗粒填充Cage治疗退变性腰椎疾病椎间融合率的报道,很少有整个融合过程中不同时间段的融合情况以及自体椎板颗粒骨椎间植骨融合率的远期随访报道。 目的：随访观察自体椎板、棘突作为骨源联合Cage植入行后路腰椎椎间融合的影像学随访结果及临床效果。 方法：选择退变性腰椎疾病患者63例,均为单一椎间隙病变,男24例,女39例;年龄46(35~72)岁,将全椎板减压后的自体椎板、棘突碎骨粒庆大霉素浸泡后充填于Cage内,应用髓核钳沿备好的Cage 通道将部分绞碎自体骨植入Cage 前间隙内,然后再沿备好的Cage通道植入Cage。随访53(37~62)个月;术后1周,3,6,12个月及远期行腰椎正侧位X射线片检查,观察患者不同时期椎间植骨融合情况。 结果与结论：63例患者中,51例患者成功融合(81%),融合部位均位于Cage内及其前方,融合时间为术后6~12个月。所有患者腰腿痛症状消失或明显减轻,椎间融合好,椎间隙高度无明显减少。结果说明自体椎板、棘突作为骨源联合椎间Cage植入在后路腰椎椎间融合后可获得满意的融合结果。应用减压后的椎板骨颗粒填塞Cage及椎间植骨,可缩短手术时间,并减少取骨区的术后并发症。     

椎板开窗潜挖式椎管扩大术治疗椎管狭窄症临床分析

目的探讨椎板开窗潜挖式椎管扩大治疗椎管狭窄症的临床效果。方法回顾2009-01-2011-02采用椎板间开窗潜行扩大减压术治疗腰椎管狭窄症患者69例进行分析。结果 69例患者均顺利完成手术,术中未出现脊髓、神经及血管损伤,无间隙感染、脊柱不稳及症状复发。依据Naka l评分标准进行疗效评价,优40例,良11例,可14例,差4例,总优良率94.20%。结论采取椎板开窗潜挖式椎管扩大治疗椎管狭窄症具有创伤小、减压充分、保留腰椎后部结构,维持了腰椎稳定性和活动程度。     

Evaluation of Coflex interspinous stabilization following decompression compared with decompression and posterior lumbar interbody fusion for the treatment of lumbar degenerative disease: A minimum 5-year follow-up study

Few studies have compared the clinical and radiological outcomes between Coflex interspinous stabilization and posterior lumbar interbody fusion (PLIF) for degenerative lumbar disease. We compared the at least 5-year clinical and radiological outcomes of Coflex stabilization and PLIF for lumbar degenerative disease. Eighty-seven consecutive patients with lumbar degenerative disease were retrospectively reviewed. Forty-two patients underwent decompression and Coflex interspinous stabilization (Coflex group), 45 patients underwent decompression and PLIF (PLIF group). Clinical and radiological outcomes were evaluated. Coflex subjects experienced less blood loss, shorter hospital stays and shorter operative time than PLIF (all p < 0.001). Both groups demonstrated significant improvement in Oswestry Disability Index and visual analogue scale back and leg pain at each follow-up time point. The Coflex group had significantly better clinical outcomes during early follow-up. At final follow-up, the superior and inferior adjacent segments motion had no significant change in the Coflex group, while the superior adjacent segment motion increased significantly in the PLIF group. At final follow-up, the operative level motion was significantly decreased in both groups, but was greater in the Coflex group. The reoperation rate for adjacent segment disease was higher in the PLIF group, but this did not achieve statistical significance (11.1% vs. 4.8%, p = 0.277). Both groups provided sustainable improved clinical outcomes for lumbar degenerative disease through at least 5-year follow-up. The Coflex group had significantly better early efficacy than the PLIF group. Coflex interspinous implantation after decompression is safe and effective for lumbar degenerative disease.     

The effect of laminectomy on instability in the management of degenerative lumbar stenosis surgery: a retrospective radiographic assessment

A retrospective study was conducted to assess the surgical outcomes of degenerative lumbar spinal stenosis. Thirty-four patients treated with decompressive surgery in Departments of III. Neurosurgery, Bakirkoy Hospital for Psychiatric and Neurological Diseases between 2000-2004 were reviewed. There were 13 males and 21 females. The average age was 57.5 (range 51 to 73 years old) and the average follow-up time was 23 (12- 60) mounts. The types of surgery consisted of standard single laminectomy. The surgical outcomes were assessed with dynamic radiographic investigation and more than 15 degrees were assessed as segmental instability. Average preoperative sagittal rotation angles were measured 3.5 degrees and average postoperative angles were measured 6.5 degrees. Only one patient (%3) with two level laminectomy and 17 degrees postoperative sagittal rotation angle showed a significantly poorer clinical outcome and accepted instable. This study showed that, treatment of degenerative lumbar stenosis can be safely and effectively performed with standard laminectomy alone, resulting no significant sagittal plane instability. We concluded that single decompressive surgery offers satisfactory results in degenerative lumbar stenosis.     

Lumbar spinal stenosis

Lumbar spinal stenosis refers to a diversity of conditions that decrease the total area of the spinal canal, lateral recesses, or neural foramina. Lumbar stenosis is a common disorder that may be present in isolation, with or without associated disk bulge or herniation, or can be associated with degenerative spondylolisthesis or scoliosis. Symptomatic lumbar spinal stenosis is characterized by neurogenic claudication and/or lumbar or sacral radiculopathy. Sixty percent to 85% of properly selected patients have a satisfactory symptomatic improvement with surgical treatment.     

Acute pyogenic diskitis (spondylodiskitis) in adults

Most cases of back pain are the result of degenerative changes in the spine or are related to musculoskeletal elements. Pyogenic infections of the back can be subcategorized into cases involving the paraspinal epidural space, vertebral bodies, or the intervertebral disk spaces. Any region of the spine may be the site of diskitis, although the process most commonly involves the lumbar spine. Most cases of diskitis are managed with conservative therapy, including antibiotics and spinal immobilization using braces or corsets. Surgical therapy is generally reserved for patients with neurological complications, spinal instability, or progressive spinal deformity or those who fail to respond clinically to antibiotic therapy alone.     

单侧椎弓根螺钉置入并椎间融合对邻近椎间盘节段退变的影响

背景：坚强内固定和良好融合存在严重缺陷和不足。目前还未见临床应用单侧椎弓根螺钉固定结合椎间cage植骨融合治疗腰椎退变性疾病对邻近节段退变影响的相关报道。 目的：回顾分析单侧椎弓根螺钉固定结合椎间cage植骨融合治疗部分腰椎退变性疾病后对固定融合邻近上下节段退变的影响。 方法：2006-03/2009-12对收治的部分腰椎管狭窄症、腰椎失稳及腰椎间盘脱出症患者22例,进行了单侧椎弓根螺钉固定加椎间cage植骨融合,术中不显露对侧。在固定融合后3,6,12,20个月及取出内固定钉棒后3,6个月,随访X射线片及MRI。针对X射线片运用角平分线法测量固定融合邻近上位椎间隙高度变化,MRI测量椎间盘髓核退变情况。 结果与结论：所有病例获得随访,患者椎管狭窄症状及神经根性症状消失,并且在随访期间内没有新的临床症状出现。固定融合前、固定融合后3,6,12,20个月邻近节段上位椎间隙高度分别为(7.420±0.035 4),(7.426 6±0.036 9),(7.453 3±0.036 9),(7.516 6±0.036 9),(7.430 8±0.036 9) mm,结果表明,腰椎单侧固定融合后邻近节段椎间隙高度无明显变化(P > 0.05)。MRI测量结果显示,固定融合邻近上位椎间盘髓核信号在T2加权像无明显退变。提示单侧椎弓根螺钉固定结合椎间融合治疗部分腰椎退变性疾病能有效预防固定融合邻近上下节段退变。     

Symptomatic progression of degenerative scoliosis after decompression and limited fusion surgery for lumbar spinal stenosis

Significant degenerative scoliosis together with lumbar spinal stenosis increases the complexity of planning a surgical intervention for iatrogenic instability may be introduced by decompression in the midst of the curve, especially at or near the curve apex, that may lead to more rapid progression of a deformity, especially if surgery is at, or is near, the apex of the curve and a listhesis is present. Surgical options include simple laminectomy, a laminectomy with limited fusion, or an extensive fusion that addresses the overall curve, but there is no consensus as to the best approach. There is scant information in the literature about specific instances of failure of a limited surgical approach from which any instructive lessons may be learned. We report a surgical failure in a 59-year-old woman with degenerative lumbar stenosis and scoliosis from L3–5 and L3–4 disc herniation treated with a simple hemilaminectomy and discectomy, a subsequent fusion for symptomatic progression of deformity, and a third surgery to fuse the entire scoliotic curve after development of severe deformity, pain, and neurological deficits. We conclude that surgical decision-making should take into consideration any risk factors for deformity progression as well as overall sagittal and coronal balance and advise that similar patients be followed for a lengthy period following surgery to monitor for stability.