Anand Neel, Baron Eli M, Thaiyananthan Gowriharan, Khalsa Kunwar, Goldstein Theodore B
Department of Surgery, Institute for Spinal Disorders, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
J Spinal Disord Tech. 2008 Oct;21(7):459-67. doi: 10.1097/BSD.0b013e318167b06b.
Prospective evaluation of 12 patients undergoing surgery for lumbar degenerative scoliosis.
To assess the feasibility of minimally invasive spine surgery (MIS) techniques in the correction of lumbar degenerative deformity.
Patient age, comorbidities, and blood loss may be limiting factors when considering surgical correction of lumbar degenerative scoliosis. MIS may allow for significantly less blood loss and tissue disruption than open surgery.
Twelve patients underwent circumferential fusion. The age range of these patients was 50 to 85 years (mean of 72.8 y). Of the 12 patients, 7 were men and 5 were women. All patients underwent direct lateral transpsoas approach for discectomy and fusion with polyetheretherketone cage and rh-BMP2. All fusions to the sacrum included L5-S1 fusion with the Trans1 Axial Lumbar Interbody Fusion technique. Posteriorly, multilevel percutaneous screws were inserted using the CD Horizon Longitude system. Radiographs, visual analog scores (VAS), and treatment intensity scores (TIS) were assessed preoperatively and at last postoperative visit. Operative times and estimated blood loss were recorded.
Mean number of segments operated on was 3.64 (range: 2 to 8 segments). Mean blood loss for anterior procedures (transpsoas discectomy/fusion and in some cases L5-S1 interbody fusion) was 163.89 mL (SD 105.41) and for posterior percutaneous pedicle screw fixation (and in some cases L5-S1 interbody fusion) was 93.33 mL (SD 101.43). Mean surgical time for anterior procedures was 4.01 hours (SD 1.88) and for posterior procedures was 3.99 hours (SD 1.19). Mean Cobb angle preoperatively was 18.93 degrees (SD 10.48) and postoperatively was 6.19 degrees (SD 7.20). Mean preoperative VAS score was 7.1; mean preoperative TIS score was 56.0. At mean follow-up of 75.5 days, mean VAS was 4.8; TIS was 28.0.
A combination of 3 MIS techniques allows for correction of lumbar degenerative scoliosis. Multisegment correction can be performed with less blood loss and morbidity than for open correction.
对12例行腰椎退变性脊柱侧凸手术的患者进行前瞻性评估。
评估微创脊柱手术（MIS）技术矫正腰椎退变性畸形的可行性。
在考虑手术矫正腰椎退变性脊柱侧凸时，患者年龄、合并症和失血可能是限制因素。与开放手术相比，MIS可能导致明显更少的失血和组织破坏。
12例患者接受了环形融合术。这些患者的年龄范围为50至85岁（平均72.8岁）。12例患者中，7例为男性，5例为女性。所有患者均采用直接外侧经腰大肌入路进行椎间盘切除术，并使用聚醚醚酮椎间融合器和重组人骨形态发生蛋白-2进行融合。所有与骶骨的融合均采用Trans1轴向腰椎椎间融合技术进行L5-S1融合。在后方，使用CD Horizon Longitude系统插入多节段经皮螺钉。术前和术后最后一次随访时评估X线片、视觉模拟评分（VAS）和治疗强度评分（TIS）。记录手术时间和估计失血量。
平均手术节段数为3.64（范围：2至8个节段）。前路手术（经腰大肌椎间盘切除术/融合术，在某些情况下为L-5-S1椎间融合术）的平均失血量为163.89 mL（标准差105.41），后路经皮椎弓根螺钉固定术（在某些情况下为L5-S1椎间融合术）的平均失血量为93.33 mL（标准差101.43）。前路手术的平均手术时间为4.01小时（标准差1.88），后路手术的平均手术时间为3.99小时（标准差为1.19）。术前平均Cobb角为18.93度（标准差10.48），术后为6.19度（标准差7.20）。术前平均VAS评分为7.1；术前平均TIS评分为56.0。平均随访75.5天时，平均VAS为4.8；TIS为28.0。
三种MIS技术联合应用可矫正腰椎退变性脊柱侧凸。与开放矫正相比，多节段矫正可减少失血和并发症。
