Comparison of Clinical and Radiologic Results between Expandable Cages and Titanium Mesh Cages for Thoracolumbar Burst Fracture

Objective

A thoracolumbar burst fracture is usually unstable and can cause neurological deficits and angular deformity. Patients with unstable thoracolumbar burst fracture usually need surgery for decompression of the spinal canal, correction of the angular deformity, and stabilization of the spinal column. We compared two struts, titanium mesh cages (TMCs) and expandable cages.

Methods

33 patients, who underwent anterior thoracolumbar reconstruction using either TMCs (n=16) or expandable cages (n=17) between June 2000 and September 2011 were included in this study. Clinical outcome was measured by visual analogue scale (VAS), American Spinal Injury Association (ASIA) scale and Low Back Outcome Score (LBOS) for functional neurological evaluation. The Cobb angle, body height of the fractured vertebra, the operation time and amount of intra-operative bleeding were measured in both groups.

Results

In the expandable cage group, operation time and amount of intraoperative blood loss were lower than that in the TMC group. The mean VAS scores and LBOS in both groups were improved, but no significant difference. Cobb angle was corrected higher than that in expandable cage group from postoperative to the last follow-up. The change in Cobb angles between preoperative, postoperative, and the last follow-up did not show any significant difference. There was no difference in the subsidence of anterior body height between both groups.

Conclusion

There was no significant difference in the change in Cobb angles with an inter-group comparison, the expandable cage group showed better results in loss of kyphosis correction, operation time, and amount of intraoperative blood loss.     

Anterior expandable cylindrical cage reconstruction after cervical spinal metastasis resection

Surgical therapy of cervical spine metastases had evolved a in the last years from posterior decompressive approaches to a direct anterior reconstructive approaches. Indication for surgery included intractable neck pain, spinal cord compression and stabilization of impending pathological fractures. We report our experience with expandable cylindrical cages in order to reconstruct and to stabilize cervical spine with metastasis. Between June 2004 and January 2006, a consecutive series of six patients underwent to resection of metastatic tumor in the cervical spine followed by expandable cylindrical cage reconstruction of the anterior vertebral column. All patients achieved immediate stability with neurological preservation. There were no significant complications related to the expandable cages in a mean follow up period of 10.5 months.Expandable cylindrical cages are effective resources for functional reconstruction after tumor resection in patients with cervical metastasis with advantages in the quality of life.     

Outcomes of contemporary use of rectangular titanium stand-alone cages in anterior cervical discectomy and fusion: Cage subsidence and cervical alignment

Cervical intervertebral disc replacement using a rectangular titanium stand-alone cage has become a standard procedure for anterior cervical discectomy and fusion (ACDF). We examined outcomes resulting from the contemporary use of rectangular titanium stand-alone cages for ACDF, particularly focusing on cage subsidence and subsequent kyphotic malalignment. Patient data were collected prospectively, and a total of 47 consecutive patients who underwent periodic follow-up of at least 1 year’s duration after ACDF were studied retrospectively. Sixty-three rectangular titanium cages were implanted during 31 1-level and 16 2-level procedures. None of the patients developed surgery-related complications (including cage displacement or extrusion). Mean Neurosurgical Cervical Spine Scale scores were significantly improved at 1 year after surgery. Twelve of the 63 inserted cages (19.0%) were found to have cage subsidence, occurring in 11 of 47 patients (23.4%). There was no significant difference in functional recovery between patients with and without cage subsidence. Logistic regression analysis indicated that fusion level, cage size and cage position were significantly related to cage subsidence. The distraction ratio among patients with cage subsidence was significantly higher than that among patients without cage subsidence. Cage subsidence resulted in early deterioration of local angle and total alignment of the cervical spine. Although a longer follow-up is warranted, a good surgical outcome with negligible complications appears to justify the use of rectangular titanium stand-alone cages in 1- and 2-level ACDF. Excessive distraction at the fusion level should be avoided, and cage position should be adjusted to the anterior vertical line.     

Rib-head osteotomies for posterior placement of expandable cages in the treatment of metastatic thoracic spine tumors

Metastatic spine tumors commonly affect the thoracic spine, and effective tumor control often requires corpectomy with reconstruction. In some instances, anterior approaches for corpectomy may be difficult or less than ideal because of medical co-morbidities, pulmonary disease or difficult access behind the mediastinum. Thus, posterior approaches are commonly used for corpectomies with anterior column reconstruction in the thoracic spine. Expandable cages have the advantage of restoring height, correcting kyphosis, and providing secure wedging between the vertebral bodies. However, the spinal cord and thorax may prevent direct, easy access for placement of expandable cages. Reconstruction has been performed with different materials; however, expandable cages have hitherto been less frequently used because of their size and difficulty expanding the cages posteriorly. We describe a technical note that may facilitate the placement of an expandable cage in the thoracic spine after posterior transpedicular corpectomies.     

An anterior expandable titanium cage in Mycobacterium avium vertebral osteomyelitis

Mycobacterial infection is most commonly caused by Mycobacterium tuberculosis. M. avium and M. intracellulare are two other organisms within the Mycobacteria group often classified together as the mycobacterium avium-intracellulare complex (MAC). MAC is of low virulence and usually causes disease in immunocompromised patients such as those with the human immunodeficiency virus. Isolated vertebral osteomyelitis secondary to MAC infection is rare with only 18 previous reports, only one of which required surgical intervention. There is increasing evidence that vertebral body osteomyelitis with other pathogens can be treated with decompression, debridement and reconstruction with titanium vertebral body cages in the setting of active infection. We present a 70-year-old Caucasian male with a pathological fracture of T6 vertebral body and a kyphosis of 60° and MRI findings consistent with granulomatous osteomyelitis. Vertebrectomies of T5 and T6 were performed and an expandable titanium cage was inserted with supplementary lateral fixation using plate and screws. This is the first report of a single-stage decompression and fusion with a titanium vertebral body cage for active MAC vertebral osteomyelitis.     

钛网及同种异体骨植骨结合内固定治疗脊柱结核：23例随访验证

背景：植骨内固定治疗脊柱结核容易出现植骨块滑移、骨折、吸收或突入椎管引起神经症状,从而导致脊柱不稳。钛网为强度非常高的圆桶状,其边缘以锯齿状与椎体接触,具有显著防滑移作用。 目的：探讨钛网植入内固定结合同种异体骨植骨治疗胸腰椎脊柱结核的临床效果。 方法：选择胸腰椎结核患者23例,男12例,女11例,年龄13~55岁。采用一期病灶清除,前和/或后路椎弓根系统置入内固定,钛网及同种异体骨联合应用植入治疗,术后观察伤口愈合、结核中毒症状及神经功能恢复,固定融合及复发情况。 结果与结论：23例患者获得1~3年随访,伤口均一期愈合,结核中毒症状明显改善或消失,神经功能完全恢复,内固定无松动、断裂,植骨无移动、折断、吸收,无后突畸形发生,固定融合情况良好,无结核复发迹象,6~12周带支具下床活动,6个月恢复正常生活及工作。证实脊柱结核病灶一期清除后,应用钛网及同种异体骨植骨结合内固定置入治疗能使脊柱获得即刻及远期的稳定,纠正后凸畸形,促进椎体间植骨融合,是目前治疗脊柱结核的一种安全有效的治疗方法。     

Transpedicular corpectomy with posterior expandable cage placement for L1 burst fracture

The surgical management of lumbar burst usually involves either a posterior or an anterior approach. Posterior-only procedures usually rely on ligamentotaxis or manual tamping of bone fragments for decompression of the spinal canal. Transpedicular corpectomies allow for circumferential surgery through a single posterior approach; however, they are rarely done for lumbar burst fractures. The presence of intervening nerve roots is one impediment to the placement of expandable cages to reconstruct the anterior column through the transpedicular approach. Using an adaptation of a technique previously described for the treatment of spinal tumors, we were able to successfully treat a traumatic lumbar burst fracture with an expandable cage from a purely posterior approach. This treatment included decompression of the neural elements, correction of the kyphosis, restoration of vertebral body height and reconstruction of the anterior column using an expandable cage with nerve root preservation. We describe our surgical procedure in this technical note.     

The Safety and Efficacy of Cadaveric Allografts and Titanium Cage as a Fusion Substitutes in Pyogenic Osteomyelitis

Objective

The safety and efficacy of various fusion substitutes in pyogenic osteomyelitis has not been investigated. We evaluated and compared the cadaveric allograft and titanium cages used to reconstruct, maintain alignment and achieve fusion in the management of pyogenic spinal infection.

Methods

There were 33 patients with pyogenic osteomyelitis underwent fusion in this study. Fifteen of the 33 patients were operated on by fusion with allografts (cadaveric patella bones) and 18 of those were operated with titanium mesh cages filled with autologous cancellous iliac bone. After the affected disc and vertebral body resection with pus drainage, cadaveric allograft or titanium cages were inserted into the resected space. Posterior transpedicular screw fixation and rod compression in resected space, where cadaveric allograft or titanium cages were inserted, was performed to prevent the malposition in all patients except in 1 case. Recurrent infection was identified by serial erythrocyte sedimentation rate and cross reactive protein follow-up. Osseous union and recurred infection available at a minimum of 2 years following operation was identified. The amount of kyphosis correction and the subsidence were measured radiographically.

Results

Spinal fusion was achieved in 29 of 33 patients. In the cadaveric allograft group, 93.3% of patient (14 of 15) showed the osseous union while 83.3% of patient (15 of 18) in the titanium cage group showed union. Subsidence was noted in 12 of the patients. Twelve patients (36.3%) showed unsettling amounts of subsidence postoperatively whereas 46.6% of patients in the cadaveric allograft group and 37.7% of patients in the titanium cage group showed similar subsidence, respectively. There were statistical difference in the fusion rate (p=0.397) and subsidence rate (p=0.276) between the two groups. There was significant statistical difference in the postoperative improvement of segmental kyphosis between the two groups (p=0.022), that is the improvement in sagittal alignment was greater in the titanium cage group than in the cadaveric allograft group. There was no case of recurred infection.

Conclusion

The cadaveric allograft and titanium cages are effective and safe in restoring and maintaining sagittal plane alignment without increased incidence in infection recurrence in pyogenic osteomyelitis. The postoperative improvement of segmental kyphosis was better in the cage group.     

Multi-level corpectomies and reconstruction via a single posterolateral approach

The surgical treatment of ventral spinal canal compression has traditionally required either an anterior or combined anterior–posterior decompression and stabilization. These types of approaches carry a significant morbidity and may not be appropriate for all patients. We report our experience with multi-level corpectomies and reconstruction performed via a single, posterolateral approach. A retrospective review was performed of six consecutive patients at a single institution who were treated for ventral multi-level spinal cord compression via a single posterolateral approach. All six patients underwent reconstruction and stabilization with an expandable cage and posterior fixation. Five patients had metastatic cancer with spinal cord compression and one patient had osteomyelitis with a ventral epidural abscess and vertebral body collapse. All patients underwent 2-level corpectomies. Pre-operative and post-operative neurologic function and stabilization construct integrity were analyzed. All patients had successful decompression and stabilization and there were no hardware complications. Three peri-operative complications were encountered: post-operative pleural effusion needing thoracostomy drainage, transient leg paresis that resolved at 2 months and a post-operative wound infection needing operative debridement. At last follow-up all patients had improvement or stabilization of their neurological function. Long-term follow-up was limited by the progression of metastatic disease and death in all the patients with cancer. This study demonstrates that symptomatic improvement can be achieved in select patients requiring multi-level corpectomies when using a single posterolateral approach with expandable cage reconstruction and posterior stabilization.     

前路钛网植骨钛板置入内固定治疗下颈椎椎体转移癌

背景：下颈椎椎体转移癌会破坏颈椎的稳定性并导致颈髓的压迫,这类患者常需手术治疗。 目的：观察前方入路病灶清除、钛网植骨重建及钛板置入内固定治疗下颈椎椎体转移癌的效果。 方法：选择2005-06/2007-06广西医科大学第一附属医院脊柱骨病科收治的下颈椎椎体转移癌患者30例,均采用前方入路行病灶清除、钛网植骨重建及钛板置入内固定治疗。记录手术时间、下床活动时间、并发症、以Frankel评分衡量脊髓损伤情况,椎X射线片检查内固定物位置情况,部分患者行MRI检查局部复发及脊髓减压情况。 结果与结论：手术时间90~150 min,出血量100~600 mL。手术过程中无并发症发生。所有患者均得到随访,随访时间12~24个月,平均14个月。随访中有3例患者因多处转移,全身衰竭死亡。末次随访中,9例患者由Frankel D级恢复到E级。随访中无断钉及内固定失效发生。提示经前方入路病灶清除、钛网植骨重建及钛板置入内固定是治疗下颈椎椎体转移癌的有效方法,具有病灶清除彻底、脊柱稳定性恢复好、患者术后可早期下地活动等优点。     

Subsidence of Cylindrical Cage (AMSLU? Cage) : Postoperative 1 Year Follow-up of the Cervical Anterior Interbody Fusion

Objective

There are numerous reports on the primary stabilizing effects of the different cervical cages for cervical radiculopathy. But, little is known about the subsidence which may be clinical problem postoperatively. The goal of this study is to evaluate subsidence of cage and investigate the correlation between radiologic subsidence and clinical outcome.

Methods

To assess possible subsidence, the authors investigated clinical and radiological results of the one-hundred patients who underwent anterior cervical fusion by using AMSLU™ cage during the period between January 2003 and June 2005. Preoperative and postoperative lateral radiographs were measured for height of intervertebral disc space where cages were placed. Intervertebral disc space was measured by dividing the sum of anterior, posterior, and midpoint interbody distance by 3. Follow-up time was 6 to 12 months. Subsidence was defined as any change in at least one of our parameters of at least 3 mm.

Results

Subsidence was found in 22 patients (22%). The mean value of subsidence was 2.21 mm, and mean subsidence rate was 22%. There were no cases of the clinical status deterioration during the follow-up period. No posterior or anterior migration was observed.

Conclusion

The phenomenon of subsidence is seen in substantial number of patients. Nevertheless, clinical and radiological results of the surgery were favorable. An excessive subsidence may result in hardware failure. Endplate preservation may enables us to control subsidence and reduce the number of complications.     

Use of an empty, Plasmapore-covered titanium cage for interbody fusion after anterior cervical microdiscectomy.

The use of cages of different material and shapes for cervical discectomy with fusion (ACDF) has increased during the last few years. The use of additional osteogenic material is controversial. We prospectively evaluated an empty, Plasmapore-covered titanium cage (PCTC) in 45 patients undergoing 58 ACDFs. Patients were evaluated using standard clinical and radiological criteria. Good to excellent outcome was achieved in 93%, 78% and 75% after 3, 12 and 48 months, respectively. Sixty-five percent of patients could resume their prior work after 48 months. Disc space height and lordosis could be preserved in all cases. Two percent of the treated levels showed subsidence and 2% increased segmental motion. There were no procedure-related complications. Implantation of an empty PCTC after microsurgical anterior cervical discectomy is a safe procedure with good results and low incidence of complications. Disc height and lordosis can be preserved with low incidence of subsidence and good fusion rates.     

Clinical experience using polyetheretherketone (PEEK) intervertebral structural cage for anterior cervical corpectomy and fusion

Anterior cervical corpectomy and fusion (ACCF) is commonly performed for various pathologies involving the cervical spine. Although polyetheretherketone (PEEK) cages have been widely used following anterior cervical discectomy and fusion (ACDF), clinical literature demonstrating its efficacy following ACCF is sparse. A retrospective review of patients enrolled in a prospective database who underwent single/multi-level ACCF was performed. Fifty-nine patients were identified who underwent corpectomy reconstruction with PEEK cages for symptomatic degenerative, neoplastic, infectious, or traumatic pathologies of the cervical spine. Thirty-five patients having at least 6 months follow-up (FU) were included in the final analysis. The mean age of patients was 51 years (range, 18–81 years) with FU ranging from 6 to 33 months (mean, 6.6 months). None of the patients had dysphagia at last FU. There was no implant failure with fusion occurring in all patients. While 57% of patients (20/35) remained stable with no progression of myelopathy, 43% (15/35) improved one (11 patients) or two (four patients) Nurick grades after surgery. The use of PEEK cages packed with autograft or allograft is safe and effective following anterior cervical corpectomy, demonstrating high fusion rates and good clinical results. This synthetic material obviates the morbidity associated with autograft harvest and possible infectious risks of allograft. The wide array of cage dimensions facilitates ease of use in patients of all sizes and appears safe for use in the typical pathologic conditions encountered in the cervical spine.     

Posterior-only approach in patients with poor general condition and spinal metastatic vertebral fracture

PurposeThe surgical treatment of spinal metastases is mostly palliative in nature and focuses on improving the quality of life of patients. The posterior transpedicular surgical approach provides circumferential 360° decompression, allows reconstruction and stabilisation to be achieved in a single session and can be performed using an open, mini-open or minimally invasive approach. We present and discuss the surgical techniques and outcomes for patients with single-level metastatic spinal disease and in poor general condition who underwent surgery via the posterior-only transpedicular corpectomy approach and reconstruction with expandable corpectomy cages.MethodsPatients with a single level thoracolumbar metastatic disease (T3-L5) and a Karnofsky score of ≤70, who underwent a complete posterior transpedicular corpectomy with expandable cage reconstruction of the anterior spinal column were retrospectively reviewed. Patients’ demographics, SINS, modified Tokuhashi scores as well as preoperative and postoperative ASIA scale, Karnofsky scores, VAS scores and vertebral height/Cobb angle values were analysed.ResultsA total of 44 patients (24 M/20 F) (mean age 53.25 ± 21.26 years) met the inclusion criteria. The modified Tokuhashi scores were as follows: score 0–8, 5 (11.4%) patients; score 9–11, 14 (31.8%) patients; and score 12–15, 25 (56.8%) patients. There were significant improvements in the postoperative VAS scores (mean 7.7–2.9), Karnofsky scores (mean 63.3–79.6) as well as the Cobb angles (18.6–12.8°) and vertebral height. Thirtyfive patients showed improved neurological function by at least one ASIA grade, whereas 9 showed no improvement during the postoperative period.ConclusionsThis technique, which has a low complication rate and a short recovery time, can help achieve satisfactory results even in patients with poor metabolic profiles and Karnofsky scores in the preoperative period. Further clinical studies with large patient groups are warranted to confirm the results of this study.     

Minimally invasive central corpectomy for ossified posterior longitudinal ligament in the cervical spine

Minimally invasive central corpectomy (MICC) for cervical segmental ossified posterior longitudinal ligament (OPLL) is described. The procedure of MICC includes upper- or lower-half central corpectomy of the involved cervical spine, transdiscal decompression of the adjacent disc level, dissection and partial removal of the OPLL, removal of the OPLL behind the vertebral body via these windows, and fusion with cylindrical titanium cages. Anterior plate fixation is not necessary. From January 2008 to December 2009 we surgically treated three patients with cervical OPLL by MICC. All three patients showed remarkable improvement of their symptoms within a few days after the operation. No neurological or radiological complication was observed during that period. MICC is beneficial in avoiding complete corpectomy and long fusion, usage of an anterior plate, and usage of a large external orthosis. MICC also reduces the risk of postoperative esophageal perforation due to a screw backing out of the plate.     

Long-Term Follow-Up Radiologic and Clinical Evaluation of Cylindrical Cage for Anterior Interbody Fusion in Degenerative Cervical Disc Disease

Objective

Various procedures have been introduced for anterior interbody fusion in degenerative cervical disc disease including plate systems with autologous iliac bone, carbon cages, and cylindrical cages. However, except for plate systems, the long-term results of other methods have not been established. In the present study, we evaluated radiologic findings for cylindrical cervical cages over long-term follow up periods.

Methods

During 4 year period, radiologic findings of 138 patients who underwent anterior cervical fusion with cylindrical cage were evaluated at 6, 12, 24, and 36 postoperative months using plain radiographs. We investigated subsidence, osteophyte formation (anterior and posterior margin), cage direction change, kyphotic angle, and bone fusion on each radiograph.

Results

Among the 138 patients, a minimum of 36 month follow-up was achieved in 99 patients (mean follow-up : 38.61 months) with 115 levels. Mean disc height was 7.32 mm for preoperative evaluations, 9.00 for immediate postoperative evaluations, and 4.87 more than 36 months after surgery. Osteophytes were observed in 107 levels (93%) of the anterior portion and 48 levels (41%) of the posterior margin. The mean kyphotic angle was 9.87° in 35 levels showing cage directional change. There were several significant findings : 1) related subsidence [T-score (p=0.039) and anterior osteophyte (p=0.009)], 2) accompanying posterior osteophyte and outcome (p=0.05).

Conclusion

Cage subsidence and osteophyte formation were radiologically observed in most cases. Low T-scores may have led to subsidence and kyphosis during bone fusion although severe neurologic aggravation was not found, and therefore cylindrical cages should be used in selected cases.     

Safety of anterior cervical discectomy and fusion using titanium-coated polyetheretherketone stand-alone cages: Multicenter prospective study of incidence of cage subsidence

This multicenter prospective study investigated cage subsidence in anterior cervical discectomy and fusion (ACDF) using titanium-coated polyetheretherketone (PEEK) stand-alone cages. This study recruited patients who underwent 1- or 2-level ACDF using titanium-coated PEEK stand-alone cages for cervical disc disease. Patients with acute trauma or past cervical spine operations were excluded. Sixty-two cages in 42 patients were eligible for analysis. Minimum follow-up was 6 months after ACDF. Significant cage subsidence was recognized in 11 of 62 cages (17.7%). Cage subsidence was predominantly moderate (14.5%), with severe subsidence found in only 2 cages (3.2%). The slowest occurrence of cage subsidence was 6 months after surgery, in 4 of 11 cages. Frequency of cage subsidence did not differ significantly between patients <65 and ≥65 years old. Patients with and without cage subsidence both demonstrated significant improvement of neurological function. Cage subsidence resulted in aggravation of local angle, but finally did not affect C2-7 angle or cervical tilt angle. Severe cage subsidence was found in only 3.2% of patients within 6 months after ACDF. Cage subsidence aggravated local angle, but finally did not affect C2-7 angle or cervical tilt angle. One- or 2-level ACDF using titanium-coated PEEK stand-alone cages appears safe and justified, even in elderly patients.     

体外生物力学评价上胸椎前路钛板内固定装置的三维运动稳定性

背景：国内外少见颈前路带锁钢板重建上胸椎的体外生物力学报道。 目的：从生物力学角度评价自行研制的上胸椎前路钛板内固定装置。 方法：15具成人尸体上胸椎标本分成3组，即上胸椎前路钛板内固定组(B)，颈前路钛板预弯内固定组(C)，颈前路钛板未预弯内固定组(D)。对完整标本进行三维活动度测量，分别安装好各组内固定再次进行标本在前屈、后伸和侧弯及旋转状态下的三维运动稳定性测量，并与完整状态(A)进行对比。 结果与结论：在完整状态下B、C、D 3组标本的三维运动稳定性差异无显著性意义(P > 0.05)。前屈稳定性排列：B>D>C>完整，B、A之间差异有显著性意义(P=0.012)；后伸稳定性排列：B>C>A>D，B与A，C，D之间差异有显著性意义(P=0.001，0.021，0.01)；旋转状态下的稳定性排列：B>C>A>D，各组差异无显著性意义；侧弯稳定性排列：A>B>C>D，A和C，D之间差异有显著性(P=0.005，0.002)。提示上胸椎前路钛板装置具有较好的三维稳定性，如果采用颈前路钛板内固定建议塑型。     

Combination Ti/PEEK ALIF cage for anterior lumbar interbody fusion: Early clinical and radiological results

Anterior lumbar interbody fusion (ALIF) is a common procedure for patients with degenerative pathologies of the lumbar spine. In this study, the clinical and radiological outcomes of a combination titanium/polyetheretherketone (Ti/PEEK) ALIF cages in one, two and three-level surgery were evaluated. Over an 18-month time period, a prospective single surgeon series of 20 implants (15 patients) were included in the study, with minimum 10-months follow-up. From these 15 patients, two were supplemented with posterior percutaneous pedicle screw fixation for additional stability. Radiological follow-up with fine cut CT scan at 9–12 months was performed to evaluate early fusion rates, and integration of the Titanium/PEEK cage at the endplate junction. 20 implants were followed for a minimum of 10 months, and a mean of 15 months. A 95% (19/20 implants) fusion rate with no implant related complications was achieved at the mean 15-month postoperative mark. Patients experienced statistically significant improvement in pain and functional outcomes (SF12 and ODI) compared to their pre-operative status. A single patient with a non-union at L5/S1 (smoker) did not experience any improvement in symptoms. A Ti–PEEK cage, with allograft and BMP-2 to achieve interbody fusion is an effective implant for use in anterior lumbar surgery with high fusion rates, no lucency around the titanium endplates at follow-up, and with promising early results.     

经皮穿刺后外侧入路B-twin椎间隙融合术的临床应用(附6例分析)

目的总结经皮穿刺后外侧入路行B-twin椎间隙融合术治疗腰椎间盘退行性疾病的经验。方法选择6例腰椎间盘退行性疾病的病人,在影像学透视下经皮穿刺椎间隙,摘除椎间盘组织,椎间隙植骨后置入B-twin膨胀式融合器（cage）。结果均成功完成手术,无并发症。术后随访1～6个月,疼痛均明显缓解,视觉模拟评分（VAS）及Oswestry功能障碍指数（ODI）评分改善超过70%4例,改善约50%2例。首例术后10个月复查X-线和CT示椎间隙融合。结论经皮穿刺后外侧入路B-twin椎间隙融合术是腰椎间盘退行性疾病一种可行的微创治疗方法。