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±0.0354),(7.4266±0.0369),(7.4533±0.0369),(7.5166±0.0369),(7.4308±0.0369)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。

Unilateral pedicle screw fixation with lumbar interbody infusion for adjacent segment degeneration

BACKGROUND:There are no reports addressing effects of unilateral pedicle screw plus cage internal fixation on adjacent segment degeneration in the treatment of lumbar degenerative disease.OBJECTIVE:To review the effects of unilateral pedicle screw plus cage internal fixation on adjacent segment degeneration in the treatment of lumbar degenerative disease.METHODS:From 2006 to 2009,22 patients with partial lumbar spinal stenosis,lumbar instability,and lumbar intervertebral disc herniation received unilateral pedicle screw plus cage internal fixation.X-ray and magnetic resonance imaging (MRI) examinations were performed at 3,6,12,20 months after treatment as well as at 3 and 6 months after fixated screws were removed.Based on X-ray films,height of intervertebral space was measured using angle bisectrix method.MRI examination was performed for observation of disc nucleus pulposus degeneration.RESULTS AND CONCLUSION:During the follow-up,all symptoms related to spinal stenosis and nerve root disappeared,and no new clinical symptoms occurred.The height of intervertebral space (mm) was 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,respectively,before infusion,at 3,6,12 and 20 months after infusion (P>0.05).Fixation fusion adjacent disc nucleus pulposus in upper T2-weighted images had no apparent degeneration.It is indicated that the unilateral pedicle screw plus interbody infusion could effectively prevent adjacent segment degeneration in the treatment of partial lumbar intervertebral degenerative disease.