Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan.
Yonsei Med J. 2011 Mar;52(2):314-21. doi: 10.3349/ymj.2011.52.2.314.
To evaluate the clinical outcomes of cantilever transforaminal lumbar interbody fusion (c-TLIF) for upper lumbar diseases.
Seventeen patients (11 males, 6 females; mean ± SD age: 62 ± 14 years) who underwent c-TLIF using kidney type spacers between 2002 and 2008 were retrospectively evaluated, at a mean follow-up of 44.1 ± 12.3 months (2 year minimum). The primary diseases studied were disc herniation, ossification of posterior longitudinal ligament (OPLL), degenerative scoliosis, lumbar spinal canal stenosis, spondylolisthesis, and degeneration of adjacent disc after operation. Fusion areas were L1-L2 (5 patients), L2-L3 (9 patients), L1-L3 (1 patient), and L2-L4 (2 patients). Operation time, blood loss, complications, Japanese Orthopaedic Association (JOA) score for back pain, bone union, sagittal alignment change of fusion level, and degeneration of adjacent disc were evaluated.
JOA score improved significantly after surgery, from 12 ± 2 to 23 ± 3 points (p < 0.01). We also observed significant improvement in sagittal alignment of the fusion levels, from - 1.0 ± 7.4 to 5.2 ± 6.1 degrees (p < 0.01). Bony fusion was obtained in all cases. One patient experienced a subcutaneous infection, which was cured by irrigation. At the final follow-up, three patients showed degenerative changes in adjacent discs, and one showed corrective loss of fusion level.
c-TLIF is a safe procedure, providing satisfactory results for patients with upper lumbar degenerative diseases.
评估单节段经椎间孔腰椎体间融合术（c-TLIF）治疗上腰椎疾病的临床疗效。
回顾性分析了 2002 年至 2008 年间使用肾型椎间融合器行 c-TLIF 治疗的 17 例患者（11 例男性，6 例女性；平均年龄±标准差：62±14 岁），随访时间平均为 44.1±12.3 个月（最短随访时间 2 年）。主要研究的疾病包括椎间盘突出症、后纵韧带骨化（OPLL）、退变性脊柱侧凸、腰椎管狭窄症、腰椎滑脱症和术后邻近节段椎间盘退变。融合节段为 L1-L2（5 例）、L2-L3（9 例）、L1-L3（1 例）和 L2-L4（2 例）。评估手术时间、出血量、并发症、日本骨科协会（JOA）腰痛评分、骨融合情况、融合节段矢状面排列变化和邻近节段椎间盘退变情况。
术后 JOA 评分显著改善，由 12±2 分提高至 23±3 分（p<0.01）。融合节段矢状面排列也得到显著改善，由-1.0±7.4 度改善至 5.2±6.1 度（p<0.01）。所有患者均获得骨性融合。1 例患者发生皮下感染，经灌洗治愈。末次随访时，3 例患者出现邻近节段椎间盘退变，1 例患者出现融合水平矫正丢失。
c-TLIF 是一种安全的手术方法，可治疗上腰椎退行性疾病，获得满意的疗效。
