Lee Dong Yeob, Jung Tag-Geun, Lee Sang-Ho
Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea.
J Neurosurg Spine. 2008 Aug;9(2):137-44. doi: 10.3171/SPI/2008/9/8/137.
The purpose of this study was to analyze the surgical outcomes in cases involving elderly patients who underwent single-level instrumented mini-open transforaminal lumbar interbody fusion (TLIF).
The authors performed a retrospective review of 27 consecutive cases involving elderly patients (> or = 65 years of age) who underwent single-level instrumented mini-open TLIF and were followed up for at least 3 years. Degenerative spondylolisthesis was diagnosed in 16 patients, stenosis with instability in 8, and lytic spondylolisthesis in 3. All cases were Grade I or II based on the American Society of Anesthesiologists' classification system. Clinical outcomes were assessed using a visual analog scale, the Oswestry Disability Index, and patients' subjective satisfaction. Sagittal balance, bone union, and adjacent segment degeneration (ASD) were assessed using plain radiography and 3D CT.
The mean age of patients at the time of surgery was 69.3 years (range 65-80 years). Minor complications occurred in 2 patients (7.4%) in the perioperative period. At a mean follow-up duration of 38.6 months (range 36-42 months), clinical success was achieved in 88.9% of cases. The mean segmental lordosis and sacral tilt significantly increased after surgery (from 11.9 and 33.5 degrees to 13.9 and 37.2 degrees , p = 0.024 and p = 0.001, respectively). Solid fusion was achieved in 77.8% of the patients. Adjacent segment deterioration was found in 44.4% of the patients. No patients underwent revision surgery due to nonunion or ASD. The development of ASD was significantly related to postoperative sacral tilt (p = 0.006).
Single-level instrumented mini-open TLIF yielded good clinical and radiological outcomes with a low complication rate in elderly patients.
本研究旨在分析接受单节段器械辅助微创经椎间孔腰椎椎体间融合术（TLIF）的老年患者的手术效果。
作者对27例连续接受单节段器械辅助微创TLIF且年龄≥65岁的老年患者进行了回顾性研究，并对其进行了至少3年的随访。其中16例诊断为退变性椎体滑脱，8例为伴有不稳的椎管狭窄，3例为峡部裂性椎体滑脱。根据美国麻醉医师协会分类系统，所有病例均为I级或II级。使用视觉模拟量表、Oswestry功能障碍指数和患者主观满意度评估临床疗效。通过X线平片和三维CT评估矢状面平衡、骨融合及相邻节段退变（ASD）情况。
患者手术时的平均年龄为69.3岁（范围65 - 80岁）。围手术期有2例患者（7.4%）出现轻微并发症。平均随访38.6个月（范围36 - 42个月），88.9%的病例临床治疗成功。术后节段性前凸和骶骨倾斜度平均显著增加（分别从11.9°和33.5°增加至13.9°和37.2°，p分别为0.024和0.001）。77.8%的患者实现了牢固融合。44.4%的患者发现有相邻节段退变。没有患者因骨不连或ASD接受翻修手术。ASD的发生与术后骶骨倾斜度显著相关（p = 0.006）。
单节段器械辅助微创TLIF在老年患者中临床和影像学效果良好，并发症发生率低。
