Wang Ren-Yan, Hua Yong-Jun, Guo Zhi-Hui
The Orthopaedics and Traumatology Hospital of TCM of Fuyang City, Fuyang 311400, Zhejiang, China.
Zhongguo Gu Shang. 2010 Apr;23(4):248-50.
To evaluate the value of transforaminal approach single interbody fusion cage combining with fixation with pedicle screws in treating lumbar instability.
From 2006 to 2009, 36 patients (39 interspaces) with lumbar instability were retrospectively analyzed, included 14 males and 22 females; aged from 45 to 68 years with an average of 54 years; course of disease was from 6 months to 12 years with an average of 4 years. Of them, instability in lumbar disc herniation had 8 cases, lumbar spinal stenosis 5 cases, postoperative instability in lumbar disc herniation 3 cases, lumbar spondylolysis 20 cases; unstable segment in L3,4 had 2 cases, L4,5 18 cases, L5S1 13 cases, and double segment 3 cases (both L4,5 and L5S1). All patients underwent decompression, reduction, interbody fusion with single cage from transforaminal approach with pedicle screws and posterolateral fusion. The clinical effects were evaluated according to imaging results and JOA scoring system.
All the patients were followed up from 8 to 32 months with an average of 18 months. The results of 38 intervertebral fusion, suspicious fusion of a vertebral space, fusion rate was 97.4% (38/39). Segmental lordosis angle after operation was increased (4.09 +/- 0.13) degrees than before operation (P < 0.01), and final follow-up was reduced (3.83 +/- 0.17) degrees than after operation (P > 0.05). JOA scoring before operation and final follow-up were respectively 8.14 +/- 1.09 and 13.54 +/- 1.19, there was statistically significant between the two periods (P < 0.01); the JOA score improvement rate (RIS): 28 cases got excellent result, 6 good and 2 fair, the rate of excellent and good was 94.4%.
The path through the transforaminal approach single-fusion cage, implantation of pedicle screw fixation fusion surgery can simplify operations, reduce complications, and can obtain satisfactory clinical efficacy, which is an effective method for the treatment of lumbar instability.
评估经椎间孔入路单枚椎间融合器联合椎弓根螺钉固定治疗腰椎不稳的价值。
回顾性分析2006年至2009年收治的36例（39个间隙）腰椎不稳患者，其中男14例，女22例；年龄45～68岁，平均54岁；病程6个月至12年，平均4年。其中，腰椎间盘突出症合并不稳8例，腰椎管狭窄症5例，腰椎间盘突出症术后不稳3例，腰椎峡部裂20例；L3、4节段不稳2例，L4、5节段18例，L5S1节段13例，双节段3例（L4、5和L5S1）。所有患者均行减压、复位，经椎间孔入路单枚椎间融合器椎间融合并椎弓根螺钉固定及后外侧融合。根据影像学结果及JOA评分系统评估临床疗效。
所有患者随访8～32个月，平均18个月。39个椎间隙中38个获得椎间融合，1个椎间隙可疑融合，融合率为97.4%（38/39）。术后节段前凸角较术前增加（4.09±0.13）°（P＜0.01），末次随访时较术后减小（3.83±0.17）°（P＞0.05）。术前及末次随访时JOA评分分别为8.14±1.09和13.54±1.19，差异有统计学意义（P＜0.01）；JOA评分改善率（RIS）：优28例，良6例，可2例，优良率为94.4%。
经椎间孔入路单枚融合器植入并椎弓根螺钉固定融合手术可简化操作，减少并发症，获得满意的临床疗效，是治疗腰椎不稳的有效方法。
