Jun B Y
Department of Neurosurgery, College of Medicine, Inha University, Inchun, Korea.
Spine (Phila Pa 1976). 2000 Apr 15;25(8):917-22. doi: 10.1097/00007632-200004150-00004.
To report the techniques and surgical results of posterior lumbar interbody fusion with restoration of the lamina and facet fusion.
To present a technique to reconstruct the posterior construct in posterior lumbar interbody fusion.
Successful arthrodesis in posterior lumbar interbody fusion requires both a large amount of graft and maximal graft filling, it also requires an excessive distraction of neural structures and excessive removal of the facet-lamina structure, which plays a significant mechanical role, especially in rotatory stability.
This study consisted of 36 surgery patients comprising 27 cases of chronic herniated lumbar disc, 4 caused by failed back surgery syndrome, 3 by recurrent lumbar disc herniation, and 2 by apophysis fracture with disc avulsion. The facetolaminotomy was performed by osteotomizing bilateral pars interarticularis with a Gigli saw. Posterior lumbar interbody fusion was performed through the more widely exposed intervertebral space by inserting a pair of carbon fiber cages and medial iliac bone blocks between the cages. The facetolaminotomy flap was returned to the previous site and fixed by translaminar and transisthmic screw fixation. Bilateral facet arthrodesis was also performed.
There were no neural complications related to facetolaminotomy by using the Gigli saw, nor were there any complications related to the screw fixation for the restoration of the posterior construct. Of the 22 patients available for more than a 6-month postoperative follow-up period, radiologic union at the interbody fusion site and at both pars interarticularis was noted in 18. An incomplete union at unilateral pars interarticularis was noted in the other 4 patients.
The technique of posterior lumbar interbody fusion with restoration of the lamina and facet fusion not only provides a wide interspace for safe and effective posterior lumbar interbody fusion but also restores the posterior constructs, thereby preserving its important mechanical roles and often even achieving natural circumferential arthrodesis.
报告后路腰椎椎间融合术结合椎板及小关节融合重建的技术及手术结果。
介绍一种在后路腰椎椎间融合术中重建后方结构的技术。
后路腰椎椎间融合术中成功的关节融合需要大量的植骨及最大程度的植骨填充，同时还需要对神经结构进行过度牵拉以及过度切除起重要力学作用的小关节-椎板结构，尤其是在旋转稳定性方面。
本研究纳入36例手术患者，其中27例为慢性腰椎间盘突出症，4例因腰椎手术失败综合征导致，3例为复发性腰椎间盘突出症，2例为椎体附件骨折伴椎间盘撕脱。采用线锯切断双侧关节突关节间部进行小关节突椎板切除术。通过插入一对碳纤维椎间融合器及在融合器间植入髂骨块，经更广泛暴露的椎间隙进行后路腰椎椎间融合术。将小关节突椎板切除皮瓣复位至原位置，通过椎板及峡部螺钉固定。同时进行双侧小关节融合术。
使用线锯进行小关节突椎板切除术未出现与神经相关的并发症，重建后方结构的螺钉固定也未出现任何并发症。在22例术后随访超过6个月的患者中，18例椎间融合部位及双侧关节突关节间部出现影像学融合。另外4例患者单侧关节突关节间部出现不完全融合。
后路腰椎椎间融合术结合椎板及小关节融合重建技术不仅为安全有效的后路腰椎椎间融合术提供了宽大的间隙，还重建了后方结构，从而保留其重要的力学作用，甚至常能实现自然的环形融合。
