Anand Neel, Hamilton John F, Perri Brian, Miraliakbar Hamid, Goldstein Theodore
Institute for Spinal Disorders, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
Spine (Phila Pa 1976). 2006 Sep 15;31(20):E748-53. doi: 10.1097/01.brs.0000240211.23617.ae.
STUDY DESIGN/SETTING: Prospective cohort study in a tertiary care spine center.
The effectiveness of the cantilever transforaminal lumbar interbody fusion (C-TLIF) technique in creating and maintaining lordosis, avoiding nerve problems, and obtaining fusion was studied.
C-TLIF is a microscope-assisted transforaminal lumbar interbody fusion technique, emphasizing no dural retraction with placement of structural allograft and RhBMP2 anteriorly under the cortical apophyseal ring, followed by middle column cancellous autograft placed under compression with posterior pedicle spinal instrumentation.
A total of 100 consecutive patients studied with an average of 30 months of follow-up. A total of 48 had prior surgery at the index level; 16 had the procedure done at an adjacent level to a previous fusion; 32 at L5-S1 with 42 at L4-L5 and 26 at L3-L4. There were 76 single-level and 24 two-level fusions. One patient was a smoker with one other patient a compensation case. Outcome was prospectively documented with self-administered Visual Analog Pain Scale, Oswestry Disability Questionnaire, Treatment Intensity Questionnaire, and SF-36 Health Survey. Patients rated the surgery as excellent, good, fair, or poor and whether they would recommend the surgery. Student t test was used for statistical analysis with significance set at P = 0.05.
Blood loss and hospital stay averaged 300 mL and 2.2 days, respectively. There was significant reduction (P < 0.05) in pain scores from 9 to 3, Oswestry Disability Index scores from 35 to 12, and Treatment Intensity Score from 21/25 to 2/25 at final follow-up. The SF-36 PCS and MCS scores showed an increasing trend to improvement. A total of 69 rated the surgery as excellent, 23 good, 7 fair, and 1 poor. A total of 97% were satisfied and would recommend the surgery. All had improvement in radicular pain with no dural tears, neural injury, or neuropathic pain. There was significant improvement (P < 0.05) in segmental sagittal lordosis from 2 degrees to 9 degrees, anterior disc height from 6 to 14 mm, and posterior disc height from 4 to 8 mm. There was no subsidence, misplaced screws, or instrumentation failure. Solid fusion was obtained in 99 of 100 patients.
The C-TLIF allows for creation and maintenance of sagittal lordosis while avoiding subsidence and neurologic problems with a 99% fusion rate and 97% patient satisfaction.
研究设计/地点：在一家三级医疗脊柱中心进行的前瞻性队列研究。
研究悬臂式经椎间孔腰椎椎间融合术（C-TLIF）在形成和维持脊柱前凸、避免神经问题以及实现融合方面的有效性。
C-TLIF是一种显微镜辅助的经椎间孔腰椎椎间融合技术，强调在皮质骨突环前方放置结构性同种异体骨和重组人骨形态发生蛋白2（RhBMP2）时不牵拉硬脊膜，随后在压缩状态下放置中柱松质骨自体骨，并进行后路椎弓根脊柱内固定。
共对100例连续患者进行研究，平均随访30个月。其中48例在索引节段曾接受过手术；16例在先前融合节段的相邻节段进行了该手术；32例在L5-S1节段，42例在L4-L5节段，26例在L3-L4节段。有76例单节段融合和24例双节段融合。1例患者为吸烟者，另1例为工伤赔偿病例。通过患者自行填写的视觉模拟疼痛量表、Oswestry功能障碍问卷、治疗强度问卷和SF-36健康调查对结果进行前瞻性记录。患者将手术评为优秀、良好、一般或差，并表明是否会推荐该手术。采用学生t检验进行统计分析，显著性水平设定为P = 0.05。
平均失血量和住院时间分别为300 mL和2.2天。在末次随访时，疼痛评分从9分显著降低至3分（P < 0.05），Oswestry功能障碍指数评分从35分降至12分，治疗强度评分从21/25降至2/25。SF-36生理健康综合评分（PCS）和心理健康综合评分（MCS）呈改善趋势。共有69例将手术评为优秀，23例评为良好，7例评为一般，1例评为差。共有97%的患者满意并会推荐该手术。所有患者的神经根性疼痛均有改善，未发生硬脊膜撕裂、神经损伤或神经性疼痛。节段矢状面脊柱前凸从2度显著改善至9度（P < 0.05），椎间盘前缘高度从6 mm增加至14 mm，椎间盘后缘高度从4 mm增加至8 mm。未发生下沉、螺钉位置不当或内固定失败。100例患者中有99例实现了牢固融合。
C-TLIF能够形成并维持矢状面脊柱前凸，同时避免下沉和神经问题，融合率达99%，患者满意度达97%。
