经椎间孔入路与经后方入路椎间融合术治疗退变性腰椎失稳症的疗效比较

目的回顾性研究经后方入路椎体间融合术（posterior lumbar interbody fusion,PLIF）和切除上、下关节突的经椎间孔入路椎体间融合术（transforaminal lumbar interbody fusion,TLIF）治疗腰椎失稳症的疗效及并发症情况。方法采用PLIF和TLIF治疗2004年1月至2008年1月本院收治的退变性腰椎失稳症患者78例,其中PLIF31例,TLIF47例。比较两组手术时间、术中出血量、平均卧床时间、Nakai评分优良率、融合时间（按Suk标准）及术后并发症发生率。对两组术前及末次随访时的椎间隙高度及椎间孔高度进行对比研究。结果 78例患者均获随访,随访时间1.5～4.5年,平均3.5年。所有患者均获椎间骨性融合。对两组卧床时间、Nakai评分优良率、融合时间、同时间点椎间隙高度和椎间孔高度进行比较,差异无统计学意义（P〉0.05）;而在手术时间、出血量以及术后并发症发生率方面,两组之间的差异有统计学意义（P〈0.05）。两组末次随访时的椎间隙高度和椎间孔高度均较术前有明显改善（P〈0.05）。结论 TLIF和PLIF治疗退变性腰椎失稳症效果良好;与PLIF相比,TLIF操作简单,出血量小,并发症少。     

Long-term outcomes of transforaminal lumbar interbody fusion in patients with spinal stenosis and degenerative scoliosis

Background Context

Patients with spinal deformity may present with complaints related to either the deformity itself or the manifestations of the coexisting spinal stenosis. There are reports of successful management of lumbar pathology in the absence of global sagittal or coronal imbalance, with limited decompression and fusion, addressing only the symptomatic segment.

后正中入路腰椎间融合与脊柱骨盆平衡相关性研究

目的：探讨采用经后正中入路腰椎间融合（posterior lumber interbody fusion, PLIF）治疗腰椎退变性疾病时对脊柱骨盆矢状面平衡的影响。方法回顾性分析2011年2月至2012年6月我院通过PLIF治疗腰椎间盘突出症、腰椎滑脱、腰椎管狭窄症的患者40例,以常用的脊柱骨盆平衡参数中的骨盆入射角（pelvic incidence, PI）、骨盆倾斜角（pelvic tilt, PT）、骶骨倾斜角（sacral slope, SS）及腰椎前凸角（lumbar lordosis, LL）为观察指标,分别测量患者术前、术后7 d、术后1年、术后2年的脊柱骨盆平衡参数。予以比较这些参数的变化,从而评估PLIF手术对脊柱骨盆平衡的影响。并采用日本骨科协会（Jap?anese Orthopaedic Association, JOA）腰腿痛评分标准对患者手术前后腰腿痛进行评分,评估患者症状及体征改善情况。结果患者术前、术后的LL、SS、PT比较,LL从术前的38.6°±5.2°增加到术后的46.8°±7.3°（t=2.904,P=0.01),SS由术前的28.2°±6.7°增加到术后的33.4°±5.3°（t=3.608,P=0.038）,PT由术前的21.6°±7.8°减小到术后的18.2°±9.4°（t=3.062,P=0.041）;而术后不同时间段的比较,差异均无统计学意义（均P＞0.05）。35例患者的JOA评分较术前增加,由术前的（12.5±1.8）分升至末次随访的（21.6±3.2）分,差异有统计学意义（P＜0.05）。结论 PLIF术式能缓解患者的临床症状,改善患者的生活质量;并且可以有效地改善腰椎前凸的病理状态,恢复腰椎正常的生理前凸,从而对维持脊柱骨盆矢状面平衡具有重要意义。     

Effect of PLIF and TLIF on sagittal spinopelvic balance of patients with degenerative spondylolisthesis

Objective

The aim of this study was to evaluate the effects of PLIF and TLIF on sagittal spinopelvic balance and to compare radiological results of two surgical procedures with regard to spinopelvic parameters.

TLIF术式治疗双节段腰椎滑脱症的临床研究

【摘要】 目的 探讨经椎间孔椎间融合术(TLIF术)式治疗双节段腰椎滑脱症的手术疗效。方法 采用TLIF后路减压、复位、椎弓根螺钉内固定、椎间植骨融合术治疗双节段腰椎滑脱11例,按Lenke标准评价脊柱融合情况,按Henderson标准评价临床疗效。结果 所有病例均获得较大程度的复位,术后随访1~2年,根据Lenke标准评价脊柱植骨融合:A级10例,B级1例;根据Henderson标准评价临床疗效:优9例,良1例,可1例。结论〓TLIF术式治疗双节段腰椎滑脱症,其脊柱融合满意,疗效显著可靠。     

Effect of one- or two-level posterior lumbar interbody fusion on global sagittal balance

Background Context

Sagittal imbalance is associated with poor clinical outcomes in patients with degenerative lumbar disease. However, there is no consensus on the impact of posterior lumbar interbody fusion (PLIF) on local and global sagittal balance.

Clinical outcomes of minimally invasive versus open approach for one-level transforaminal lumbar interbody fusion at the 3- to 4-year follow-up

Purpose

Supporters of minimally invasive approaches for transforaminal lumbar interbody fusion (TLIF) have reported short-term advantages associated with a reduced soft tissue trauma. Nevertheless, mid- and long-term outcomes and specifically those involving physical activities have not been adequately studied. The aim of this study was to compare the clinical outcomes of mini-open versus classic open surgery for one-level TLIF, with an individualized evaluation of the variables used for the clinical assessment.

Methods

A prospective cohort study was conducted of 41 individuals with degenerative disc disease who underwent a one-level TLIF from January 2007 to June 2008. Patients were randomized into two groups depending on the type of surgery performed: classic open (CL-TLIF) group and mini-open approach (MO-TLIF) group. The visual analog scale (VAS), North American Spine Society (NASS) Low Back Pain Outcome instrument, Oswestry Disability Index (ODI) and the Short Form 36 Health Survey (SF-36) were used for clinical assessment in a minimum 3-year follow-up (36–54 months).

Results

Patients of the MO-TLIF group presented lower rates of lumbar (p = 0.194) and sciatic pain (p = 0.427) and performed better in daily life activities, especially in those requiring mild efforts: lifting slight weights (p = 0.081), standing (p = 0.097), carrying groceries (p = 0.033), walking (p = 0.069) and dressing (p = 0.074). Nevertheless, the global scores of the clinical questionnaires showed no statistical differences between the CL-TLIF and the MO-TLIF groups.

Conclusions

Despite an improved functional status of MO-TLIF patients in the short term, the clinical outcomes of mini-open TLIF at the 3- to 4-year follow-up showed no clinically relevant differences to those obtained with open TLIF.     

Minimally invasive transforaminal lumbar interbody fusion: Results of 23 consecutive cases

Background:

The use of minimally invasive surgical (MIS) techniques represents the most recent modification of methods used to achieve lumbar interbody fusion. The advantages of minimally invasive spinal instrumentation techniques are less soft tissue injury, reduced blood loss, less postoperative pain and shorter hospital stay while achieving clinical outcomes comparable with equivalent open procedure. The aim was to study the clinicoradiological outcome of minimally invasive transforaminal lumbar interbody fusion.

Materials and Methods:

This prospective study was conducted on 23 patients, 17 females and 6 males, who underwent MIS-transforaminal lumbar interbody fusion (TLIF) followed up for a mean 15 months. The subjects were evaluated for clinical and radiological outcome who were manifested by back pain alone (n = 4) or back pain with leg pain (n = 19) associated with a primary diagnosis of degenerative spondylolisthesis, massive disc herniation, lumbar stenosis, recurrent disc herniation or degenerative disc disease. Paraspinal approach was used in all patients. The clinical outcome was assessed using the revised Oswestry disability index and Macnab criteria.

Results:

The mean age of subjects was 55.45 years. L4-L5 level was operated in 14 subjects, L5-S1 in 7 subjects; L3-L4 and double level was fixed in 1 patient each. L4-L5 degenerative listhesis was the most common indication (n = 12). Average operative time was 3 h. Fourteen patients had excellent results, a good result in 5 subjects, 2 subjects had fair results and 2 had poor results. Three patients had persistent back pain, 4 patients had residual numbness or radiculopathy. All patients had a radiological union except for 1 patient.

Conclusion:

The study demonstrates a good clinicoradiological outcome of minimally invasive TLIF. It is also superior in terms of postoperative back pain, blood loss, hospital stay, recovery time as well as medication use.     

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.     

经皮内窥镜下经椎间孔入路腰椎椎间融合术治疗腰椎椎管狭窄症

目的 对比分析经皮内窥镜下经椎间孔入路腰椎椎间融合术（TLIF）与单纯椎板切除术治疗腰椎椎管狭窄症（LSS）的临床疗效。方法 2018年5月-2020年5月收治LSS患者180例,采用随机数字表法分为2组,其中90例采用经皮内窥镜下TLIF治疗（内窥镜组）,其余90例采用椎板切除术治疗（对照组）。记录2组切口长度、手术时间、住院时间及切口感染、脑脊液漏、硬膜囊损伤等并发症发生情况,采用疼痛视觉模拟量表（VAS）评分评估腰腿痛程度,采用生活质量评价量表（SF-36）评分评估患者生活质量,采用改良MacNab标准评定疗效并计算疗效优良率。结果 所有手术顺利完成,所有患者随访（11.26±1.35）个月。与对照组相比,内窥镜组切口更小,手术时间、住院时间更短,差异均有统计学意义（P<0.05）。2组术后12个月腰腿痛VAS评分均较术前明显改善,差异有统计学意义（P<0.05）,组间差异无统计学意义（P>0.05）。2组术后12个月SF-36各维度评分较术前均显著提升,差异有统计学意义（P<0.05）,组间差异无统计学意义（P>0.05）。2组临床疗效优良率差异无统计学意义（P>0.05）。2组并发症发生率差异无统计学意义（P>0.05）。结论 经皮内窥镜下TLIF和椎板切除术治疗LSS均可获得良好疗效,可有效减轻患者腰腿痛程度,改善患者生活质量,但经皮内窥镜下TLIF具有创伤更小、术后恢复更快等优点,临床中可依据患者情况和意愿灵活选择。     

经皮内窥镜下经椎间孔入路腰椎椎间融合术治疗退行性腰椎椎管狭窄症

目的 探讨经皮内窥镜下经椎间孔入路腰椎椎间融合术(TLIF)治疗退行性腰椎椎管狭窄症(DLSS)的疗效.方法 2018年10月—2019年10月,南阳市中心医院收治DLSS患者40例,采用随机数字表法分为A组(20例,采用经皮内窥镜下TLIF治疗)、B组(20例,采用传统开放TLIF治疗).记录2组切口长度、手术时间、...     

实时三维导航辅助微创经椎间孔腰椎椎间融合术后腰骶部矢状位平衡参数变化分析

目的:探讨实时三维导航辅助微创经椎间孔腰椎椎体间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)与传统开放TLIF术治疗腰椎退行性疾病后腰骶部矢状位参数的动态变化.方法:回顾性分析2017年9月至2019年9月行单节段手术治疗...     

Instrumented posterior interbody fusion in degenerative and multioperated lumbar spine

Abstract Lumbar interbody fusion is a valid technique for the treatment of disc diseases. We report a series of 37 patients who underwent posterior lumbar interbody fusion with titanium cylindric screwing-expansion cages. Clinical outcomes and radiological results were evaluated 3 years after surgery. After surgery, the majority of patients returned to their normal activities. Follow-up plain roentgenograms showed no loss of disc height and no signs of implant looseness. Computed tomography (CT) showed the presence of mineralized autologous bone grafts inside the interbody cages. Expandable interbody cages allow the restoration of disc space height, giving support to the anterior column, opening the neuroforaminal area and providing increased stability. The interpretation of fusion on the basis of roentgenograms is difficult; CT offers more information than radiography about the fusion process, but a bony arthrodesis cannot be demonstrated with certainty.     

Radiological and functional outcome after anterior lumbar interbody spinal fusion

Outcome after anterior spinal fusion has mainly been studied radiologically and reported fusion rates vary greatly. The aim of this study was to investigate radiological and long-term clinical outcome. The study comprised 120 consecutive patients, operated on during the period 1979–1987, with single-or two-level anterior interbody spinal fusion due to disc degeneration or isthmic spondylolisthesis with lumbar instability. In 64 patients a suplemental facet joint fusion was performed. Clinical outcome was evaluated 5–13 years after surgery using the patient-administered Dallas Pain Questionnaire (DPQ). Radiological outcome was determined on the basis of radiographs taken at a 2-year follow-up assessed by independent observers. The radiological follow-up rate was 98%. Complete fusion was found in 52%, questionable fusion in 24%, and definitive pseudoarthrosis in 24% of patients. Radiological results were poor in patients who had undergone previous spinal surgery (P<0.05) and in those with two-level fusion (P<0.05). The DPQ reply rate was 80%. Sixty-six patients claimed improvement in all functional groups. Patients with complete or questionable union had significantly better results than did those with non-union (P<0.01). Poorer functional outcome was found in patients who had undergone previous spinal surgery (P<0.01) or fusion at the L4/L5 level (P<0.05), in those who had responded poorly to the preoperative test brace (P<0.05), and in those above 45 years old at the time of surgery (P<0.05). Radiological and functional outcome did not vary according to whether patients were treated postoperatively with a plaster jacket or with facet screw fixation. The study demonstrated a functional success rate of approximately 66% following anterior lumbar spinal fusion after a mean follow-up of 8 years. There was a clear tendency for poorer prognosis for patients who had undergone previous spinal surgery, those aged above 45 years, those operated at the L4/L5 level and those who had responded poorly to the preoperative test brace. DPQ scores correlated well with radiological outcome.     

The use of RhBMP-2 in single-level transforaminal lumbar interbody fusion: a clinical and radiographic analysis

The “off label” use of rhBMP-2 in the transforaminal lumbar interbody fusion (TLIF) procedure has become increasingly popular. Although several studies have demonstrated the successful use of rhBMP-2 for this indication, uncertainties remain regarding its safety and efficacy. The purpose of this study is to evaluate the clinical and radiographic outcomes of the single-level TLIF procedure using rhBMP-2. Patients who underwent a single-level TLIF between January 2004 and May 2006 with rhBMP-2 were identified. A retrospective evaluation of these patients included operative report(s), pre- and postoperative medical records, and dynamic and static lumbar radiographs. Patient-reported clinical outcome measures were obtained from a telephone questionnaire and included a modification of the Odom’s criteria, a patient satisfaction score, and back and leg pain numeric rating scale scores. Forty-eight patients met the study criteria and were available for follow-up (avg. radiographic and clinical follow-up of 19.4 and 27.4 months, respectively). Radiographic fusion was achieved in 95.8% of patients. Good to excellent results were achieved in 71% of patients. On most recent clinical follow-up, 83% of patients reported improvement in their symptoms and 84% reported satisfaction with their surgery. Twenty-nine patients (60.4%) reported that they still had some back pain, with an average back pain numeric rating score of 2.8. Twenty patients (41.7%) reported that they still had some leg pain, with an average leg pain numeric rating score was 2.4. Thirteen patients (27.1%) had one or more complications, including transient postoperative radiculitis (8/48), vertebral osteolysis (3/48), nonunion (2/48), and symptomatic ectopic bone formation (1/48). The use of rhBMP-2 in the TLIF procedure produces a high rate of fusion, symptomatic improvement and patient satisfaction. Although its use eliminates the risk of harvesting autograft, rhBMP-2 is associated with other complications that raise concern, including a high rate of postoperative radiculitis.     

退变性脊柱侧凸患者后路矫形术后腰椎前凸指数对矢状面平衡的预测作用

目的:探讨术后腰椎前凸指数(lumbar lordosis index,LLI)对退变性脊柱侧凸患者后路矫形术后矢状面平衡的预测作用。方法:回顾性分析2005年1月~2011年12月在我院行单一后路矫形术的57例退变性脊柱侧凸患者,其中男9例,女48例,年龄56.3±10.8岁(48~70岁)。纳入标准为年龄45岁以上、内固定节段≥5个节段且随访≥2年的患者。在术前、术后即刻和末次随访的站立位全脊柱X线片上测量矢状面垂直轴(SVA)、胸椎后凸角(TK)、腰椎前凸角(LL)、骨盆入射角(PI)、骨盆倾斜角(PT)和骶骨倾斜角(SS),计算腰椎前凸指数(LLI=LL/PI)。根据末次随访时患者矢状面平衡情况分为正常组(A组,末次随访时SVA≤5cm且PT≤25°)和失代偿组(B组,末次随访时SVA5cm或PT25°)。应用相关性分析研究57例患者术前、术后即刻和末次随访时LLI与其他脊柱骨盆矢状面参数的相关性,使用独立样本t检验分别比较A组和B组患者术前、术后即刻和末次随访的矢状面参数,P0.05为差异有统计学意义。结果:A组患者41例,B组16例。术后随访时间4.4±1.9年(2~8年),其中A组随访4.3±1.8年,B组随访4.6±1.9年,两组随访时间无统计学差异(P=0.725)。57例患者LLI与相应时间点的PI、LL、PT、SVA和LL丢失值均有显著相关性(P0.05),但与TK和SS无相关性。两组间术前LLI的差异无统计学意义(0.45±0.18 vs.0.47±0.21,P=0.638);A组术后即刻LLI为0.89±0.13,显著大于B组术后即刻的LLI(0.61±0.14)(P=0.005)。A组末次随访时SVA为2.73±2.62cm、PT为20.34°±4.28°,而B组患者末次随访时SVA为7.81±3.26cm、PT为29.81±5.13°,两组间SVA和PT的差异均有统计学意义(P0.01)。结论:术后即刻LLI重建不良的退变性脊柱侧凸患者在随访中可能出现矢状面失代偿的风险,而良好的术后LLI重建可以降低随访中脊柱矢状面失平衡的风险。     

工作区域内移的改良经椎间孔腰椎椎体间融合术

 目的 总结 Mast Quadrant辅助下工作区域内移改良经椎间孔腰椎椎体间融合术(transforaminal lumbar interbody fusion, TLIF)的手术操作技巧及其短期随访结果。方法 2006年 9月至 2008年 10月, Mast Quadrant拉钩辅助下改良 TLIF治疗 54例腰椎单节段退变性疾病患者。术中经”C冶型臂 X线机透视定位病变节段, ±次置入 Mast Quadrant拉钩并适度纵向扩张, 充分显露关节突关节和椎板, 直视下咬除患侧上位椎体的下关节突及椎板下 1/2~2/3、黄韧带及下位椎体上关节突增生内聚部分, 减压神经根管及中央管, 处理椎间隙行椎体间植骨融合, 进一步行椎弓根螺钉固定。统计该组患者的手术操作时间、术中失血量、术后引流量、术后住: 时间、手术相关并发症;术后 3、6、12、24个月随访, 记录患者疼痛视觉模拟评分法(visual analogue scale, VAS)、Oswestry功能障碍指数(Oswestry disability index, ODI), 以及末次随访影像学融合率。结果 54例患者均顺利完成手术, 51例患者获得随访。平均手术时间(178.7±63.2) min, 平均术中失血量为(224.2±136.5) ml, 术后引流量平均(117.2±91.4) ml, 平均术后住: 时间(5.8±3.6) d。患者术后各随访时间点 ODI、VAS与术前相比差异均有统计学意义。末次随访时 51例患者均达到影像学融合标准, 未发现断钉、断棒等内固定相关并发症。结论 Mast Quadrant辅助下改良 TLIF为直视下操作, 较为安全, 易于掌握;对单节段腰椎退变性疾病患者具有良好的临床治疗效果。     

Comparison of the early results of transforaminal lumbar interbody fusion and posterior lumbar interbody fusion in symptomatic lumbar instability

Background:

Transforaminal lumbar interbody fusion (TLIF) has been preferred to posterior lumbar interbody fusion (PLIF) for different spinal disorders but there had been no study comparing their outcome in lumbar instability. A comparative retrospective analysis of the early results of TLIF and PLIF in symptomatic lumbar instability was conducted between 2005 and 2011.

Materials and Methods:

Review of the records of 102 operated cases of lumbar instability with minimum 1 year followup was done. A total of 52 cases (11 men and 41 women, mean age 46 years SD 05.88, range 40-59 years) underwent PLIF and 50 cases (14 men and 36 women, mean age 49 years SD 06.88, range 40-59 years) underwent TLIF. The surgical time, duration of hospital stay, intraoperative blood loss were compared. Self-evaluated low back pain and leg pain status (using Visual Analog Score), disability outcome (using Oswestry disability questionnaire) was analyzed. Radiological structural restoration (e.g., disc height, foraminal height, lordotic angle, and slip reduction), stability (using Posner criteria), fusion (using Hackenberg criteria), and overall functional outcome (using MacNab''s criteria) were compared.

Results:

Pain, disability, neurology, and overall functional status were significantly improved in both groups but PLIF required more operative time and caused more blood loss. Postoperative hospital stay, structural restoration, stability, and fusion had no significant difference but neural complications were relatively more with PLIF.

Conclusions:

Both methods were effective in relieving symptoms, achieving structural restoration, stability, and fusion, but TLIF had been associated with shorter operative time, less blood loss, and lesser complication rates for which it can be preferred for symptomatic lumbar instability.     

Clinical outcomes,radiologic kinematics,and effects on sagittal balance of the 6 df LP-ESP lumbar disc prosthesis

Background contextSurgical treatment of degenerative disc disease remains a controversial subject. Lumbar fusion has been associated with a potential risk of segmental junctional disease and sagittal balance misalignment. Motion preservation devices have been developed as an alternative to fusion. The LP-ESP disc is a one-piece deformable device achieving 6 df, including shock absorption and elastic return. This is the first clinical report on its use.PurposeTo assess clinical outcomes and radiologic kinematics in the first 2 years after implantation.Study designProspective cohort of patients with LP-ESP total disc replacement (TDR) at the lumbar spine.Patient sampleForty-six consecutive patients.Outcome measuresClinical outcomes were the visual analog scale (VAS) for pain, the Oswestry disability index (ODI), and the GHQ28 (General Health Questionnaire) psychological score. Radiologic data were the range of motion (ROM), sagittal balance parameters, and mean center of rotation (MCR).MethodsPatients had single-level TDR at L4–L5 or L5–S1. Outcomes were prospectively recorded for 2 years (before and at 3, 6, 12, and 24 months after surgery). The SpineView software was used for computed analysis of the radiographic data. Paired t tests were used for statistical comparisons.ResultsNo intraoperative complication occurred. All clinical scores improved significantly at 24 months: the back pain VAS scores by a mean of 4.1 points and the ODI by 33 points. The average ROM of the instrumented level was 5.4°±4.8° at 2 years and more than 2° for 76% of prostheses. The MCR was in a physiological area in 73% of cases. The sagittal balance (pelvic tilt, sacral slope, and segmental lordosis) did not change significantly at any point of the follow-up.ConclusionsResults from the 2-year follow-up indicate that LP-ESP prosthesis recreates lumbar spine function similar to that of the healthy disc in terms of ROM, quality of movement, effect on sagittal balance, and absence of modification in the kinematics of the upper adjacent level.     

PLIF与TLIF治疗腰椎不稳症的疗效比较

目的对比研究后路腰椎椎体间植骨融合术(posteriorlumbarinterbodyfusion,PLIF)与经腰椎间孔入路腰椎椎间植骨融合术(transforaminallumbarinterbodyfusion,TLIF)治疗腰椎不稳症的疗效。方法1999年2月~2006年3月,217例重度退变性腰椎不稳症患者接受腰椎后路椎间植骨融合,辅以相应节段椎弓根钉内固定术,其中76例经腰椎间孔椎体间植骨融合(TLIF组),另外141例经腰椎管内(硬脊膜外)椎体间植骨融合(PLIF组),比较两组手术方式的临床疗效、植骨融合率及手术并发症。结果217例患者手术切口均一期愈合,无椎间隙感染、下肢深静脉栓塞等并发症。PLIF组128例患者经6~82个月随访,平均64个月,发生硬脊膜撕裂4例,脑脊液漏1例,马尾神经及神经根一过性牵拉损伤3例。TLIF组67例经4~56个月随访,平均36个月,未发生神经损伤等并发症。两组平均手术时间、术中平均出血量、平均住院时间均无明显差异。TLIF组与PLIF组的临床优良率分别为89.86%和86.72%,两者无显著性差异(P>0.05),植骨融合率分别为92.75%和93.75%,两者无显著性差异(P>0.05)。结论经腰椎间孔入路椎间植骨融合术治疗腰椎不稳症,不但技术操作可行,而且能明显降低因侵入椎管而带来的各种并发症,是治疗重度退变性腰椎不稳症的有效手术方式。