Wu Chin-Hsien, Wong Chak-Bor, Chen Lih-Huei, Niu Chi-Chien, Tsai Tung-Ting, Chen Wen-Jer
Department of Orthopaedics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kweishan, Taoyuan, Taiwan.
J Spinal Disord Tech. 2008 Jul;21(5):310-5. doi: 10.1097/BSD.0b013e318148b256.
Surgery for degenerative lumbar scoliosis remains challenging for spine surgeons even with the application of pedicle screw instrumentation. This retrospective study assesses the outcomes of instrumented posterior lumbar interbody fusion (PLIF) for degenerative lumbar scoliosis.
From April 2000 to April 2004, 26 patients with degenerative lumbar scoliosis were treated with instrumented PLIF. Mean age of the 15 females and 11 males was 64.2 years (range, 51 to 77 y). Clinical and radiographic outcomes were retrospectively reviewed for each case at a minimum follow-up of 2 years (median follow-up, 3 y; range, 2 to 6 y). At final follow-up, patients were classified as "satisfied" or "dissatisfied" according to self-reported outcomes.
At most recent follow-up, the average Oswestry Disability Index score was significantly lower than the preoperative score (25.8 vs. 58.0; P<0.001). Twenty (76.9%) patients reported that they were satisfied with their surgical outcomes. The average lumbar scoliosis angles were significantly less than preoperative angles (7.4 vs. 16.5 degrees; P<0.001), resulting in a reduction in mean scoliosis angles of 55.2%. The average angles of lumbar lordosis were significantly higher than preoperative angles (30.1 vs. 22.2 degrees; P=0.001), an increase in mean lumbar lordosis angles of 35.6%. No perioperative deaths or major medical complications occurred. Five patients had adjacent segment degeneration and 4 (80%) of 5 reported dissatisfactory outcomes. Further study is required to identify the etiologies of adjacent segment degeneration and methods for avoiding such degeneration.
Analytical results demonstrate that instrumented PLIF after laminectomy in patients with degenerative lumbar scoliosis is an effective and safe procedure.
即便应用椎弓根螺钉内固定技术，退行性腰椎侧弯的手术对脊柱外科医生而言仍具挑战性。本回顾性研究评估了用于退行性腰椎侧弯的后路腰椎椎间融合术（PLIF）并使用内固定的疗效。
2000年4月至2004年4月期间，26例退行性腰椎侧弯患者接受了PLIF并使用内固定治疗。15例女性和11例男性的平均年龄为64.2岁（范围51至77岁）。对每例患者进行了至少2年的回顾性临床和影像学随访（中位随访时间3年；范围2至6年）。在末次随访时，根据患者自我报告的结果将其分为“满意”或“不满意”。
在最近一次随访时，平均Oswestry功能障碍指数评分显著低于术前评分（25.8对58.0；P<0.001）。20例（76.9%）患者报告对手术结果满意。平均腰椎侧弯角度显著小于术前角度（7.4对16.5度；P<0.001），导致平均侧弯角度减少55.2%。平均腰椎前凸角度显著高于术前角度（30.1对22.2度；P = 0.001），平均腰椎前凸角度增加35.6%。未发生围手术期死亡或重大医疗并发症。5例患者出现相邻节段退变，其中5例中有4例（80%）报告结果不满意。需要进一步研究以确定相邻节段退变的病因及避免此类退变的方法。
分析结果表明，退行性腰椎侧弯患者行椎板切除术后的PLIF并使用内固定是一种有效且安全的手术。
