Kong Doo-Sik, Kim Eun-Sang, Eoh Whan
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul, Korea.
J Korean Med Sci. 2007 Apr;22(2):330-5. doi: 10.3346/jkms.2007.22.2.330.
The authors hypothesized that the placement of the interspinous implant would show a similar clinical outcome to the posterior lumbar interbody fusion (PLIF) in patients having spinal stenosis with mild segmental instability and that this method would be superior to PLIF without significantly affecting degeneration at the adjacent segments. Forty two adult patients having degenerative spinal stenosis with mild segmental instability who underwent implantation of Coflex (Spine motion, Germany) or PLIF at L4-5 between January 2000 and December 2003 were consecutively selected and studied for one-year clinical outcome. At 12 months after surgery, both groups showed a significant improvement in the visual analogue scale score and Oswestry disability index score for both lower extremity pain and low back pain. However, the range of motion at the upper adjacent segments (L3-4) increased significantly after surgery in the PLIF group, which was not manifested in the Coflex group during the follow-up. The authors assumed that interspinous implantation can be an alternative treatment for the spinal stenosis with segmental instability in selected conditions posing less stress on the superior adjacent level than PLIF.
作者们推测，对于患有轻度节段性不稳定的腰椎管狭窄症患者，棘突间植入物的置入将显示出与后路腰椎椎间融合术（PLIF）相似的临床效果，并且该方法在不显著影响相邻节段退变的情况下优于PLIF。连续选取了42例在2000年1月至2003年12月期间于L4 - 5节段接受Coflex（德国脊柱运动公司）植入或PLIF手术的患有退行性腰椎管狭窄症且伴有轻度节段性不稳定的成年患者，并对其进行了为期一年的临床效果研究。术后12个月时，两组患者的视觉模拟量表评分以及下肢疼痛和腰痛的Oswestry功能障碍指数评分均有显著改善。然而，PLIF组术后上相邻节段（L3 - 4）的活动度显著增加，而在随访期间Coflex组未出现这种情况。作者认为，在特定条件下，棘突间植入术可作为节段性不稳定腰椎管狭窄症的一种替代治疗方法，与PLIF相比，其对上位相邻节段施加的应力更小。
