Shenzhen Nanshan Hospital, Nanshan, Shenzhen, China.
Eur Spine J. 2010 Feb;19(2):325-30. doi: 10.1007/s00586-009-1167-6. Epub 2009 Sep 26.
Degenerative disc disease (DDD) causes gradual intervertebral space collapse, concurrent discogenic or facet-induced pain, and possible compression radiculopathy. A new minimal invasion procedure of percutaneous posterior-lateral lumbar interbody fusion (PPLIF) using a B-Twin stand-alone expandable spinal spacer (ESS) was designed to treat this disease and evaluated by follow-up more than 1 year. 12 cases with chronic low back pain and compressive radiculopathy due to DDD refractory were selected to conservative treatment. Under fluoroscopy in the posterior-lateral position, a K-wire was advanced into the intervertebral space and a dilator and working cannula were introduced into the disc space step by step. Discectomy and endplate scratching were performed through the cannula using pituitary forceps and endplate curettage. An ESS was inserted into the intervertebral space by a B-Twin expandable spinal delivery system after some bone graft chips implanted into the disc space. The ongoing study includes intraoperative difficulties, complications, radiologic evidence of fusion and clinical outcome as scored by pre- and postoperative questionnaires pertaining to pain intensity and degree of disability. The 12 procedures of lumbar interbody fusion using stand-alone expandable spinal system through percutaneous approach were successful. Radiologic study demonstrated fusion in a total of 11 cases and only 1 exception after more than 1 year visiting. The values of Visual Analog Scale (VAS) on movement and Oswestry Disability Index (ODI) dropped by more than 80 and 67.4%, respectively. Disk space heights averaging 9.0 mm before procedure were increased to 11.5 mm 1 month (a significant difference compared with preprocedure, P < 0.01) after surgery and stabilized at 10.8 mm upon final follow-up (a significant difference compared with preprocedure, P < 0.01). The results demonstrated that the percutaneous approach for posterior-lateral lumbar interbody fusion using expandable spinal system is a valuable micro-invasion method for the DDD patients and can achieve the same outcome as with other methods.
退变性椎间盘疾病（DDD）导致椎间间隙逐渐塌陷，并发椎间盘源性或小关节源性疼痛，并可能导致压迫性神经根病。一种新的微创经皮后路腰椎体间融合术（PPLIF）使用 B-Twin 独立可扩张脊柱间隔器（ESS）的方法被设计用来治疗这种疾病，并通过超过 1 年的随访进行了评估。选择了 12 例因 DDD 导致慢性下腰痛和压迫性神经根病的难治性患者进行保守治疗。在透视下，将 K 线穿过外侧位进入椎间隙，逐步引入扩张器和工作套管。通过套管使用垂体钳和终板刮匙进行椎间盘切除术和终板刮除术。将一些骨移植物植入椎间盘间隙后，通过 B-Twin 可扩张脊柱输送系统将 ESS 插入椎间隙。正在进行的研究包括术中困难、并发症、融合的影像学证据以及术前和术后与疼痛强度和残疾程度相关的问卷调查评分的临床结果。12 例经皮前路使用独立可扩张脊柱系统的腰椎体间融合术均成功完成。影像学研究显示，在 11 例中均有融合，只有 1 例在随访 1 年以上时出现异常。视觉模拟量表（VAS）在运动和 Oswestry 残疾指数（ODI）上的评分分别下降了 80%以上和 67.4%。术前椎间盘间隙高度平均为 9.0mm，术后 1 个月增加至 11.5mm（与术前相比差异有统计学意义，P<0.01），最终随访时稳定在 10.8mm（与术前相比差异有统计学意义，P<0.01）。结果表明，使用可扩张脊柱系统的经皮后路腰椎体间融合术是治疗 DDD 患者的一种有价值的微创方法，可获得与其他方法相同的效果。
