单侧后路腰椎间植骨融合术治疗腰椎退行性疾病的近期随访

目的分析单侧后路腰椎间植骨融合术（PLIF）治疗腰椎退行性疾病的可行性、适应证以及近期临床疗效。方法9例表现为单侧下肢神经根症状的腰椎退行性病变患者于2008年11月-2009年6月期间在我科接受单侧PLIF手术治疗，男1例，女8例，年龄42-81岁，平均55岁，病程6个月～10年。采用单侧PLIF，选择下肢神经根症状侧入路，不剥离、显露对侧，患侧减压后行单侧椎弓根钉固定，椎间斜行置入单枚Cage。7例为单节段单侧固定，2例为双节段单侧固定；6例常规开放入路，3例单节段病变经扩张管微创入路。结果手术时间80～180min，平均137min。术中出血100-800ml，平均450ml。9例均获得随访，随访时间2～9个月，平均4．5个月。术前、术后1周、术后2个月平均JOA评分依次为16．7、25．7、27．8；术前、术后1周、术后2个月平均VAS评分依次为8．5、2．4、1。随访期间均未发现Cage移位、下沉或椎弓根螺钉松动断裂。末次随访CT显示完全骨性融合2例、部分融合5例、无融合征象2例，动力位x线片未发现手术节段不稳。结论对表现为单侧神经根症状的腰椎退行性病变合并轻度不稳或预计术后出现医源性不稳的患者，采用单侧椎弓根钉加单枚Cage固定行单侧PLIF是一种有效的治疗方法。

Preliminary finding of unilateral PLIF for degenerative lumbar diseases

Objective To analyze the feasibility of, indications for, and short-term clinical results of unilateral posterior lumbar interbody fusion（PLIF） for degenerative lumbar diseases. Methods From November 2008 to June 2009, 9 cases of degenerative lumbar diseases with unilateral lower extremity radieulopathy were treated by unilateral PLIF in our department. Subjects included 1 male and 8 female. The mean age was 52 years （from 42 to 81）. Duration of disease ranged from 6 months to 10 years. The unilateral PLIF were performed for all patients by ipsilateral approach without contralateral exposure and dissection, unilateral pediele screws and one cage oblique insection were performed after ipsilateral spinal canal decompression. Unilateral pedicle instrumentation included single-segment in 7 and double-segment in 2. Six of the nine subjects were treated via conventional open approaches, and other single-segment diseases were treated via minimal invasive approaches. Results The mean operation time was 137 rain （from 80 to 180 min） and the mean estimated blood loss volume was 450 ml （from 100 to 800 ml）. All patients were followed up for an average of 4.5 months （2 months to 9 months）. The mean JOA scores at preoperative, postoperative and 2 months follow-up were 16.7, 25.7 and 27.8 respectively. The mean VAS scores at preoperative, postoperative and 2 months follow-up were 8.5, 2.4 and 1 respectively. No cage translation or subsidence and no pedicle screw breakage occurred during follow-up. According to sagittal and coronal CT images taken at the latest follow-up, complete bony fusion was shown in 2 patients, incomplete bony fusion was shown in 5 patients and no sign of bony fusion was shown in 2. There was no instability sign on dynamic radiographic images. Conclusion It is effective to perform unilateral PLIF by using unilateral pedicle screw instrumentation with single cage for degenerative lumbar diseases, which accompanied with mild instability preoperatively or predicted iatrogenic instability.