Rosenberg W S, Mummaneni P V
Neurospinal Disorders Program, Department of Neurological Surgery, University of California at San Francisco, 94143, USA.
Neurosurgery. 2001 Mar;48(3):569-74; discussion 574-5. doi: 10.1097/00006123-200103000-00022.
To demonstrate the safety, surgical efficacy, and advantages of the transforaminal approach for lumbar interbody fusion when combined with pedicle screw fixation.
We retrospectively reviewed the records of 22 patients (age range, 34-63 yr; mean, 49 yr) with Grade I or II spondylolisthesis who underwent transforaminal lumbar interbody fusion. Nineteen patients presented with low back pain and associated radiculopathy, and three presented with low back pain only. Transforaminal lumbar interbody fusion was performed at L4-L5 in 8 patients, L5-S1 in 11 patients, L3-L4 and L4-L5 in 2 patients, and L4-L5 and L5-S1 in 1 patient. Periodic follow-up took place 1 to 12 months after surgery (mean, 5.3 mo). Decompression is performed according to clinical circumstances. Pedicle screws are placed, and a discectomy is carried out. The cartilaginous endplates are removed. The interspace is gradually distracted, resulting in lost disc height being regained, and interbody fusion cages are positioned. The pedicle screw-and-rod construct is then compressed, restoring lumbar lordosis.
Low back pain completely resolved in 16 patients, moderate relief from pain was achieved in 5 patients, and the pain was unchanged in one patient. Nonneurological complications included intraoperative durotomy in one patient and postoperative wound infection in two. In one patient, postoperative mild L5 motor paresis resolved. One patient had a temporary brachial plexopathy due to intraoperative positioning, and one patient had peripheral polyneuropathy secondary to prolonged intraoperative blood pressure cuff inflation.
Transforaminal lumbar interbody fusion is a safe and effective method for achieving circumferential spinal fusion via a single-stage procedure. This procedure is particularly useful in restoring disc space height and lumbar lordosis.
证明经椎间孔入路联合椎弓根螺钉固定进行腰椎椎间融合术的安全性、手术疗效及优势。
我们回顾性分析了22例（年龄范围34 - 63岁，平均49岁）I级或II级椎体滑脱患者行腰椎椎间融合术的记录。19例患者表现为腰痛伴神经根病，3例仅表现为腰痛。8例患者在L4 - L5节段行腰椎椎间融合术，11例在L5 - S1节段，2例在L3 - L4和L4 - L5节段，1例在L4 - L5和L5 - S1节段。术后1至12个月（平均5.3个月）进行定期随访。根据临床情况进行减压。置入椎弓根螺钉，行椎间盘切除术。去除软骨终板。逐渐撑开椎间隙，恢复丢失的椎间盘高度，然后置入椎间融合器。接着对椎弓根螺钉 - 棒结构进行加压，恢复腰椎前凸。
16例患者腰痛完全缓解，5例患者疼痛中度缓解，1例患者疼痛无变化。非神经并发症包括1例术中硬脊膜切开和2例术后伤口感染。1例患者术后轻度L5运动麻痹症状缓解。1例患者因术中体位导致暂时性臂丛神经病变，1例患者因术中长时间使用血压袖带充气继发周围性多发性神经病。
经椎间孔腰椎椎间融合术是一种通过单阶段手术实现脊柱环形融合的安全有效的方法。该手术在恢复椎间盘间隙高度和腰椎前凸方面特别有用。
