Department of Spinal Surgery, 1st Affiliated Hospital, University of South China, 69 Chuanshan Road, Hengyang 412001, Hunan, People's Republic of China.
Arch Orthop Trauma Surg. 2011 Jun;131(6):791-6. doi: 10.1007/s00402-010-1222-0. Epub 2010 Dec 16.
Posterior lumbar interbody fusion (PLIF) is biomechanically sound as it ablates the degenerated disc, restores the intervertebral height, relieves foraminal stenosis, and positions the bone graft along the weight-bearing axis. But this conventional procedure also results in significant traction on the dural sac and the cauda equina and is thereby a potential source of neurologic damage. Therefore, we performed a minimally invasive technique: percutaneous endoscopic discectomy and interbody fusion (PEDIF) with B-Twin expandable spinal spacer (B-twin ESS) to treat symptomatic lumbar degenerative disc disease and explored the clinical outcome.
From June 2004 to December 2006, 43 consecutive patients with symptomatic lumbar degenerative disc disease were included in this study. There were 28 males and 15 females, with average age of 47 years (range 26-63). Following a routine micro-endoscopic discectomy or percutaneous nucleotomy, endplate curettage was meticulously carried out. The intervertebral space was packed with autograft cancellous bone cut from lumbar delivered through a 5-mm diameter funnel. The B-twin ESS was introduced into the intervertebral space and then expanded. Both stages were monitored by C-arm fluoroscopy.
The mean operative time was 110 ± 36 min (80-150). The mean blood loss was 350 ± 68 ml (210-700). The mean length of hospitalization was 6.6 ± 2.9 days (3-10). All patients were evaluated in follow-up of 12-30 months (mean 18). According to radiological evidence of fusion on dynamic X-ray plain film, 31 cases (72.1%) achieved bone graft fusion after 6 months postoperatively; at the final follow-up, union of the bone graft has been established in all but one patient (97.7%). The subsidence degree of the B-twin ESS was 20-30% in 2 cases and in rest of the cases less than 10%. According to the modified criteria of Chinese Orthopaedic Association, excellent in 31 cases, good in 8 cases, fair in 3 cases, poor in 1 case, and the rate of excellent and good cases was 91%.
The PEDIF technique provided an option for percutaneous interbody fusion similar to that in open surgery while minimizing destruction to adjacent tissues. This technique was safe and exhibited a trend toward decreased intraoperative blood loss, length of stay and the risk of neurological complications.
后路腰椎体间融合术（PLIF）通过切除退变的椎间盘、恢复椎间高度、缓解椎间孔狭窄，并使骨移植物沿承重轴定位，在生物力学上是合理的。但这种传统方法也会对硬脑膜囊和马尾神经造成明显的牵拉，因此是潜在的神经损伤源。因此，我们采用经皮内镜椎间盘切除术和椎间融合术（PEDIF）联合 B-Twin 可扩张椎间融合器（B-twin ESS）治疗有症状的腰椎退行性椎间盘疾病，并探讨其临床疗效。
自 2004 年 6 月至 2006 年 12 月，我们对 43 例有症状的腰椎退行性椎间盘疾病患者进行了此项研究。其中男 28 例，女 15 例，平均年龄 47 岁（26-63 岁）。在常规微创椎间盘切除术或经皮髓核切除术之后，我们仔细进行终板切除术。通过一个 5mm 直径的漏斗将取自腰椎的自体松质骨填入椎间间隙。将 B-twin ESS 引入椎间间隙，然后使其扩张。两个阶段均通过 C 臂透视进行监测。
手术时间平均为 110±36 分钟（80-150 分钟）。平均失血量为 350±68ml（210-700ml）。平均住院时间为 6.6±2.9 天（3-10 天）。所有患者均在术后 12-30 个月（平均 18 个月）进行随访。根据动力位 X 线平片融合的影像学证据，术后 6 个月时 31 例（72.1%）实现了植骨融合；在最终随访时，除 1 例患者外（97.7%）均建立了骨移植物融合。B-twin ESS 的沉降程度在 2 例中为 20-30%，在其余病例中小于 10%。根据中华骨科协会的改良标准，优 31 例，良 8 例，可 3 例，差 1 例，优良率为 91%。
PEDIF 技术为经皮椎间融合术提供了一种与开放手术相似的选择，同时最大限度地减少对邻近组织的破坏。该技术安全，术中出血量、住院时间和神经并发症风险均有降低趋势。
