Li Fangcai, Chen Qixin, Chen Weishan, Xu Kan, Wu Qionghua
Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
J Spinal Disord Tech. 2011 Jul;24(5):308-12. doi: 10.1097/BSD.0b013e3181f9a7d5.
Forty-six patients with degenerative lumbar scoliosis, and treated with selective segmental transforaminal lumbar interbody fusion (TLIF), were studied retrospectively.
To investigate the surgery outcomes of the posterior-only approach with selective segmental TLIF for the treatment of degenerative lumbar scoliosis.
Degenerative lumbar scoliosis usually occurs late in the life of patients with no history of scoliosis. TLIF has been successfully used in the surgical treatment of other degenerative diseases of the lumbar spine.
Forty-six patients with degenerative lumbar scoliosis and treated with selective segmental TLIF were studied retrospectively. There were 14 male and 32 female patients, with a mean age of 66.4 years. The indications for TLIF of the motion segment included segmental kyphosis in the lumbar spine, significant vertebral translation in any orientation, segmental instability, and significant upper endplate obliquities of L3 or L4. All the patients were followed for a mean duration of 42 months postoperatively. Radiographic evaluation included Cobb angle of scoliosis, lumbar lordosis angle, and segmental lordosis angle. The clinical outcomes were assessed by means of Japanese Orthopedic Association score and patient satisfaction index.
The mean preoperative Cobb angle of 31.7 ± 14.4 degrees was corrected to 10.2 ± 6.5 degrees at the final follow-up (t = 15.262, P < 0.001), and the correction rate was 67.8%. The mean preoperative lumbar lordosis angle of -27.5 ± 12.6 degrees was corrected to -39.3 ± 9.7 degrees (t = 12.165, P < 0.001), and the correction rate was 44.4%. The mean preoperative segmental lordosis angle of -6.5 ± 5.1 degrees in the TLIF segment was increased to -11.6 ± 5.9 degrees, and the correction rate was 80%. Besides, the segmental deformity and vertebral translation were also corrected. The mean preoperative Japanese Orthopedic Association score of 14.1 ± 4.2 was increased to 22.2 ± 4.8 (t = 11.453, P < 0.001), and 81% of patients would undergo this surgery again with the same results.
Selective segmental TLIF is helpful in correcting lumbar lordosis, segmental deformity, and translation, and thus obtaining satisfactory outcome in the treatment of degenerative lumbar scoliosis.
对46例退行性腰椎侧弯患者进行回顾性研究，这些患者均接受了选择性节段经椎间孔腰椎椎体间融合术（TLIF）治疗。
探讨单纯后路选择性节段TLIF治疗退行性腰椎侧弯的手术效果。
退行性腰椎侧弯通常发生在无脊柱侧弯病史的老年患者中。TLIF已成功应用于腰椎其他退行性疾病的手术治疗。
回顾性研究46例接受选择性节段TLIF治疗的退行性腰椎侧弯患者。其中男性14例，女性32例，平均年龄66.4岁。运动节段TLIF的指征包括腰椎节段性后凸、任何方向的明显椎体移位、节段性不稳定以及L3或L4的明显上端椎倾斜。所有患者术后平均随访42个月。影像学评估包括脊柱侧弯的Cobb角、腰椎前凸角和节段性前凸角。临床疗效通过日本骨科协会评分和患者满意度指数进行评估。
末次随访时，术前平均Cobb角31.7±14.4度矫正至10.2±6.5度（t = 15.262，P < 0.001），矫正率为67.8%。术前平均腰椎前凸角-27.5±12.6度矫正至-39.3±9.7度（t = 12.165，P < 0.001），矫正率为44.4%。TLIF节段术前平均节段性前凸角-6.5±5.1度增加至-11.6±5.9度，矫正率为80%。此外，节段性畸形和椎体移位也得到矫正。术前日本骨科协会平均评分为14.1±4.2，提高至22.2±4.8（t = 11.453，P < 0.001），81%的患者愿意再次接受相同手术并获得相同结果。
选择性节段TLIF有助于矫正腰椎前凸、节段性畸形和移位，从而在退行性腰椎侧弯的治疗中获得满意疗效。
