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11.
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 总被引:1,自引:0,他引:1
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。 相似文献
12.
Seth Ahlquist Howard Y. Park Jonathan Gatto Ayra N. Shamie Don Y. Park 《The spine journal》2018,18(11):1999-2008
Background Context
Lumbar fusion is a popular and effective surgical option to provide stability and restore anatomy. Particular attention has recently been focused on sagittal alignment and radiographic spinopelvic parameters that apply to lumbar fusion as well as spinal deformity cases. Current literature has demonstrated the effectiveness of various techniques of lumbar fusion; however, comparative data of these techniques are limited.Purpose
This study aimed to directly compare the impact of various lumbar fusion techniques (anterior lumbar interbody fusion [ALIF], lateral lumbar interbody fusion [LLIF], transforaminal lumbar interbody fusion [TLIF], and posterolateral fusion [PLF]) based on radiographic parameters.Study Design/Setting
A single-center retrospective study examining preoperative and postoperative radiographs was carried out.Patient Sample
A consecutive list of lumbar fusion surgeries performed by multiple spine surgeons at a single institution from 2013 to 2016 was identified.Outcome Measures
Radiographic measurements used included segmental lordosis (SL), lumbar lordosis (LL), pelvic incidence (PI), pelvic incidence-lumbar lordosis (PI-LL) mismatch, anterior and posterior disc height (DH-A, DH-P, respectively), and foraminal height (FH).Methods
Radiographic measurements were performed on preoperative and postoperative lateral lumbar radiographs on all single-level lumbar fusion cases. Demographic data were collected including age, gender, approach, diagnosis, surgical level, and implant lordosis. Paired sample t test, one-way analysis of variance (ANOVA), McNemar test, and independent sample t test were used to establish significant differences in the outcome measures. Multiple linear regression was performed to determine a predictive model for lordosis from implant lordosis, fusion technique, and surgical level.Results
There were 164 patients (78 men, 86 women) with a mean age of 60.1 years and average radiographic follow-up time of 9.3 months. These included 34 ALIF, 23 LLIF, 63 TLIF, and 44 PLF surgeries. ALIF and LLIF significantly improved SL (7.9° and 4.4°), LL (5.5° and 7.7°), DH-A (8.8?mm and 5.8?mm), DH-P (3.4?mm and 2.3?mm), and FH (2.8?mm and 2.5?mm), respectively (p≤.003). TLIF significantly improved these parameters, albeit to a lesser extent: SL (1.7°), LL (2.7°), DH-A (1.1?mm), DH-P (0.8?mm), and FH (1.1?mm) (p≤.02). PLF did not significantly alter any of these parameters while significantly reducing FH (?1.3?mm, p=.01). One-way ANOVA showed no significant differences between ALIF and LLIF other than ALIF with greater ΔDH-A (3.0?mm, p=.02). Both ALIF and LLIF significantly outperformed PLF in preoperative to postoperative changes in all parameters p≤.001. Additionally, ALIF significantly outperformed TLIF in the change in SL (6.2°, p<.001), and LLIF significantly outperformed TLIF in the change in LL (5.0°, p=.02). Both outperformed TLIF in ΔDH-A (7.7?mm and 4.7?mm) and ΔDH-P (2.6?mm and 1.5?mm), respectively (p≤.02). ALIF was the only fusion technique that significantly improved the proportion of patients with a PI-LL<10° (0.410.66, p=.02). Lordotic cages had superior improvement of all parameters compared with non-lordotic cages (p<.001). Implant lordosis (m=1.1), fusion technique (m=6.8), and surgical level (m=6.9) significantly predicted postoperative SL (p<.001, R2=0.56).Conclusions
This study demonstrated that these four lumbar fusion techniques yield divergent radiographic results. ALIF and LLIF produced greater improvements in radiographic measurements postoperatively compared with TLIF and PLF. ALIF was the most successful in improving PI-LL mismatch, an important parameter relating to sagittal alignment. Lordotic implants provided better sagittal correction and surgeons should be cognizant of the impact that these differing implants and techniques produce after surgery. Surgical technique is an important determinant of postoperative alignment and has ramifications upon sagittal alignment in lumbar fusion surgery. 相似文献13.
Taleef R. Khan Kalin R. Pearce Steven J. McAnany Colleen M. Peters Munish C. Gupta Lukas P. Zebala 《The spine journal》2018,18(3):439-446
Background Context
Recombinant human bone morphogenetic protein 2 (rhBMP-2) plays a pivotal role in complex spine surgery. Despite its limited approval, the off-label use of rhBMP-2 is prevalent, particularly in transforaminal lumbar interbody fusions (TLIFs).Purpose
To determine the effectiveness and safety of rhBMP-2 use in TLIF procedures versus autograft.Study Design
Retrospective cohort study.Patient Sample
Patients older than 18 years undergoing spine surgery for lumbar degenerative spine disease at a single academic institution.Outcome Measures
Clinical outcome was determined according to patient records. Radiographic outcome was determined according to plain X-rays and computed tomography (CT).Methods
A retrospective study from 1997 to 2014 was conducted on 191 adults undergoing anterior-posterior instrumented spinal fusion with TLIF at a single academic institution. Patient data were gathered from operative notes, follow-up clinic notes, and imaging studies to determine complications and fusion rates. One hundred eighty-seven patients fit the criteria, which included patients with a minimum of one TLIF, and had a minimum 2-year radiographic and clinical follow-up. Patients were further classified into a BMP group (n=83) or non-BMP group (n=104). Three logistic regression models were run using rhBMP-2 exposure as the independent variable. The respective outcome variables were TLIF-related complications (radiculitis, seroma, osteolysis, and ectopic bone), surgical complications, and all complications.Results
Bone morphogenetic protein (n=83) and non-BMP (n=104) groups had similar baseline demographics (sex, diabetes, pre-existing cancer). On average, the BMP and non-BMP groups were similarly aged (51.9 vs. 47.9 years, p>.05), but the BMP group had a shorter follow-up time (3.03 vs. 4.06 years; p<.001) and fewer smokers (8 vs. 21 patients; p<.048). The fusion rate for the BMP and non-BMP groups was 92.7% and 92.3%, respectively. The pseudoarthrosis rate was 7.5% (14 of 187 patients). Radiculitis was observed in seven patients in the BMP group (8.4%) and two patients in the non-BMP group (1.9%). Seroma was observed in two patients in the BMP group (2.4%) and none in the non-BMP group. No deep infections were observed in the BMP group, and in one patient in the non-BMP group (0.96%). Although patients exposed to BMP were at a significantlygreater risk of developing radiculitis and seroma (odds ratio [OR]=4.53, confidence interval [CI]=1.42–14.5), BMP exposure was not a significant predictor of surgical complications (OR=0.32, CI=0.10–1.00) or overall complications (OR=1.11, CI=0.53–2.34). The outcome of TLIF-related complications was too rare and the confidence interval too wide for practical significance of the first model.Conclusion
Evidence supports the hypothesis that off-label use of rhBMP-2 in TLIF procedures is relatively effective for achieving bone fusion at rates similar to patients receiving autograft. Patients exhibited similar complication rates between the two groups, with the BMP group exhibiting slightly higher rates of radiculitis and seroma. 相似文献14.
Jeffrey A. Rihn Junaid Makda Joseph Hong Ravi Patel Alan S. Hilibrand David G. Anderson Alexander R. Vaccaro Todd J. Albert 《European spine journal》2009,18(11):1629-1636
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. 相似文献
15.
目的 探讨微创经椎间孔腰椎椎体间融合术(TLIF)治疗腰椎间盘突出症的疗效.方法 15例腰椎间盘突出症采用微创TLIF手术治疗,所有病例均为单节段椎间盘突出,其中伴有节段不稳定6例,超外侧间盘突出9例;腰3/4节段2例,腰4/5节段10例,腰5骶1节段3例.观察手术时间、出血量、创面大小、术后下地活动时间、术中的X线透视时间及并发症等.采用VAS评分评估手术前后疼痛缓解情况.结果 15例微创TLIF的手术时间平均3.4h,出血量100ml,切口长3cm,无伤口引流管,术后1d下地活动,术中X线透视时间27-38s.随访6-30个月,患者术后症状缓解,VAS评分从术前8.3分恢复到术后第3天4.7分、1周时3.8分、1个月时2.6分,与术前相比有显著性差异(P<0.05).1例患者出现椎弓根钉进入椎管内,出现下肢无力,再次手术重置椎弓根钉同定,术后1个月症状完全消失.结论 微创TLIF手术治疗腰椎间盘突出症手术创伤小,脊柱结构破坏少,可早期下床活动,术后效果良好. 相似文献
16.
目的比较经单侧腰椎间孔椎体间融合(transforaminal lumbar interbody fusion,TLIF)中不同轴向植入角度椎弓根螺钉和不同放置位置融合器的生物力学特性。方法建立正常L3~5有限元模型,在验证其有效性基础上,在L4~5节段模拟后路双侧TLIF和4种不同组合类型椎弓根螺钉植入和融合器放置的单侧TLIF有限元重构模型,即:小角度植入椎弓根螺钉+对侧放置融合器(模型A)、小角度植入椎弓根螺钉+同侧放置融合器(模型B)、大角度植入椎弓根螺钉+同侧放置融合器(模型C)、大角度植入椎弓根螺钉+对侧放置融合器(模型D),分别比较4种重构模型在各种生理应力下的活动范围(range of the motion,ROM)以及螺钉、融合器与L4下终板界面的最大Von Mises应力差异。结果 4种单侧TLIF重构模型在融合节段(L4~5)ROM均较正常模型显著下降,但仍高于双侧TLIF重构模型。4种单侧TLIF重构模型稳定性比较,模型C下降最多,其在屈伸、侧屈和扭转应力下ROM分别减少约为正常模型的50.7%、89.9%和90.3%。螺钉和融合器与L4下终板界面最大Von Mises应力比较,相对于其他3组模型,模型C除了在同侧侧屈和扭转外的大部分应力下承受较小的应力。结论在单侧TLIF重构模型中选择大角度植入椎弓根螺钉和同侧放置融合器能够获得最佳的生物力学稳定性,通过缩小与双侧TLIF模型稳定性差异以减少断钉或融合器下沉的风险,值得临床推广运用。 相似文献
17.
目的 探讨经神经根孔入路腰椎融合术(transforaminal lumbar interbody fusion,TLIF)治疗腰椎间盘突出症伴腰椎不稳的手术方法及疗效。方法 对26例腰椎间盘突出伴腰椎不稳患者行TLIF。采用经神经根孔后壁的扩大椎板间开窗、髓核摘除和彻底减压,椎间隙前1/3植入碎骨,后2/3植入单个融合器,同时使用经椎弓根螺钉系统固定脊柱。效果 平均手术时间2(1.5~4)h;术中平均出血量250(100~450)ml。随访1.5(1~2)年,所有患者脊柱节段均获融合(100%),平均融合时间为8(6~11)个月。术后症状均有不同程度改善,优良率为96.2%(25/26)。结论 TLIF治疗伴有腰椎不稳的椎间盘突出具有手术简单、创伤小、融合率高和效果好等优点。 相似文献
18.
苏小桃 《航空航天医学杂志》2014,(5):593-594
目的:探讨TLIF手术经多裂肌间隙入路与传统后正中入路治疗腰椎退变性疾病的临床疗效。方法将149例患者依据TLIF术入路方式不同分成两组。观察组:75例患者,采用经多裂肌间隙入路;对照组:74例患者,实施传统后正中入路。对比两组围术期各项指征与术后VASJ、OA 评分情况。结果观察组手术时间、术中出血量、切口大小、引流量均少于对照组(均为P<0.05);两组术前VAS评分与JOA评分无显著性差异( P>0.05);术后组间评分差异明显( P<0.05)。结论经多裂肌间隙入路行TLIF术医治腰椎退变性疾病,对多裂肌与神经功能损伤明显较传统入路方式小,且微创、安全,值得临床推广。 相似文献
19.
As the population ages, more elderly patients will develop painful degenerative lumbar pathology requiring lumbar fusion for treatment. Unfortunately, traditional techniques for lumbar fusion have been associated with increased morbidity and mortality in elderly patients. Minimally invasive transforaminal lumbar interbody fusion (TLIF) has been associated with fewer complications; however, little specific to the elderly population has been published. Thus, we performed a retrospective analysis on 84 consecutive patients (<65 years, young - 45 patients; ?65 years, elderly - 39 patients) who underwent single-level, minimally invasive TLIF between October 2007 and December 2010. Hospital records, including operative notes, progress notes, and discharge summaries, were reviewed for patient demographics, procedures, disposition, and perioperative and postoperative complications. There was no significant difference between the young and elderly patients with respect to the total number of major, minor, or major and minor complications. Likewise, there was no significant difference between the two groups with respect to the number of patients experiencing one or more major, minor, or major and minor complications. The overall rate of experiencing at least one perioperative or postoperative complication was 16.33% for young patients and 20.00% in the elderly cohort (p = 0.7748). Thus, elderly patients with single-level degenerative lumbar pathology requiring fusion are not at increased risk of perioperative and postoperative complications compared to younger patients when undergoing single-level, minimally invasive TLIF. 相似文献
20.
目的探究采用多孔融合器在不同入路腰椎融合术的生物力学性能。方法建立完整腰椎三维有限模型,通过实验方法获得多孔材料的力学参数。针对多孔融合器在前路腰椎椎间融合术(anterior lumbar interbody fusion, ALIF)、后路腰椎椎间融合术(posterior lumbar interbody fusion, PLIF)、经椎间孔腰椎椎间融合术(transforaminal lumbar interbody fusion, TLIF)和直接外侧椎体间融合术(direct lateral interbody fusion, DLIF)中的生物力学性能进行对比研究。结果在施行椎间融合术后,DLIF、ALIF模型预测的活动度(range of motion, ROM)和融合器应力明显低于PLIF、TLIF模型,DLIF、ALIF和TLIF模型预测的终板应力明显低于PILF模型。结论采用多孔融合器的DLIF模型显示出较优的生物力学性能,而且在临床过程中操作简单适于微创术式。DLIF手术具有更优的综合性能。 相似文献