经皮穿刺腰椎椎间固定融合术的初步临床应用

Objective To characterize the feasibility, key technology, indications and clinical outcome of percutaneous lumbar interbody fusion. Methods Clinical data from 32 cases 16 made, 16 female, age range 31-77 years, average disease duration (5.0±2.0) years ] underwent percutaneous nucleotomy and endplate curettage was retrospectively analyzed. After percutaneous nucleotomy and endplate curettage, one expandable spinal spacer B-twin was introduced into the intervertebral space and some allograft cancellous bone implanted around the B-twin. Indications for treatment included degenerative lumbar disc herniation (LDH) with intervetebral distability or Ⅰ degree spondylolythesis (21 cases), LDH with intervetebral space collapse (10 cases) and lumbar discogenic pain (1 case). The symptoms and function of all patients were evaluated before, 3 months and 12 months after the operation by clinical outcome judgment criterion of surgical treatment for low back pain formulated by JOA, and the rate of clinical improvement and treatment efficacy were calculated. The JOA scales preoperatively, postoperatively and on the final follow-up was compared using ANOVA in SPSS. The changes before and after surgery with the JOA score and the the rate of clinical improvement between 3 months and 12 months after the operation was also compared using χ2 test. Results The average operation time 1 hour and blood loss < 20 ml, Surgical site: L3-4 4 cases, L4-5 19 cases, I5-S1 6 cases, L3-4 and L4-5 3 cases, B-TWIn were implanted fusion cage 35, in three cases of intervertebral space with two implantso Average in Hospital time was (10.0±2.1) d . Complication included 1 case with displacement and 1 case with secondary instability of next intervertebral space. All the patients were evaluated after a follow-up of 3-36 months (average 13 months) 32 cases of patients with low back pain JOA score: before surgery is(4.1±1.8), 3 months after surgery is (11.9±3.9), 1 year after surgery of the 22 cases is (12.0±3.2). Score before and after surgery were statistically significant differences (F = 5.67, P < 0.01). The rate of clinical improvement After surgery there was no significant difference (F = 4.18, P > 0.05). Conclusions Percutaneous posterior lumbar interbody fusion with B-twin expandable fusion cage could lead to satisfactory outcome in the treatment of degenerative disc disease and intervertebral instability,which minimize surgical soft tissue and trauma spinal damage, does not destroy the structure of spinal stability. The technique The long-term outcome, complications and fusion rate need further observing.

Primary investigation of clinical application of percutanous posterior lumbar interbody fusion