Neurosurgery Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
Eur Spine J. 2011 May;20 Suppl 1(Suppl 1):S46-56. doi: 10.1007/s00586-011-1755-0. Epub 2011 Mar 15.
Chronic lumbar pain due to degenerative disc disease affects a large number of people, including those of fully active age. The usual self-repair system observed in nature is a spontaneous attempt at arthrodesis, which in most cases leads to pseudoarthrosis. In recent years, many possible surgical fusion techniques have been introduced; PLIF is one of these. Because of the growing interest in minimally invasive surgery and the unsatisfactory results reported in the literature (mainly due to the high incidence of morbidity and complications), a new titanium lumbar interbody cage (I-FLY) has been developed to achieve solid bone fusion by means of a stand-alone posterior device. The head of the cage is blunt and tapered so that it can be used as a blunt spreader, and the core is small, which facilitates self-positioning. From 2003 to 2007, 119 patients were treated for chronic lumbar discopathy (Modic grade III and Pfirrmann grade V) with I-FLY cages used as stand-alone devices. All patients were clinically evaluated preoperatively and after 1 and 2 years by means of a neurological examination, visual analogue score (VAS) and Prolo Economic and Functional Scale. Radiological results were evaluated by polyaxial computed tomography (CT) scan and flexion-extension radiography. Fusion was defined as the absence of segmental instability on flexion-extension radiography and Bridwell grade I or II on CT scan. Patients were considered clinical "responders" if VAS evaluation showed any improvement over baseline values and a Prolo value >7 was recorded. At the last follow-up examination, clinical success was deemed to have been achieved in 90.5% of patients; the rate of bone fusion was 99.1%, as evaluated by flexion-extension radiography, and 92.2%, as evaluated by CT scan. Morbidity (nerve root injury, dural lesions) and complications (subsidence and pseudoarthrosis) were minimal. PLIF by means of the stand-alone I-FLY cage can be regarded as a possible surgical treatment for chronic low-back pain due to high-degree DDD. This technique is not demanding and can be considered safe and effective, as shown by the excellent clinical and radiological success rates.
慢性腰椎疼痛由于退行性椎间盘疾病影响大量的人，包括那些完全活跃的年龄。通常的自我修复系统在自然界中观察到的是自发的融合企图，这在大多数情况下导致假关节。近年来，许多可能的手术融合技术已经推出; PLIF 就是其中之一。由于对微创外科的兴趣日益浓厚，以及文献中报道的结果不尽如人意（主要是由于发病率和并发症高），一种新的钛腰椎椎间融合器（I-FLY）已经被开发出来，通过独立的后路装置实现坚固的骨融合。笼子的头部是钝的和锥形的，以便它可以用作钝的扩压器，核心很小，便于自我定位。从 2003 年到 2007 年，119 例慢性腰椎间盘病（Modic 级 III 和 Pfirrmann 级 V）患者采用 I-FLY 笼作为独立装置进行治疗。所有患者均在术前、术后 1 年和 2 年通过神经检查、视觉模拟评分（VAS）和 Prolo 经济和功能量表进行临床评估。影像学结果通过多轴向计算机断层扫描（CT）扫描和屈伸位放射摄影进行评估。融合的定义是屈伸位放射摄影无节段不稳定，CT 扫描为 Bridwell 分级 I 或 II。如果 VAS 评估显示基线值有任何改善，并且记录 Prolo 值>7，则患者被认为是临床“反应者”。在最后一次随访检查时，90.5%的患者认为临床成功；屈伸位放射摄影评估的骨融合率为 99.1%，CT 扫描评估的骨融合率为 92.2%。发病率（神经根损伤、硬脑膜损伤）和并发症（沉降和假关节）最小。通过独立的 I-FLY 笼进行 PLIF 可被视为治疗高度 DDD 引起的慢性腰痛的一种可能的手术治疗方法。这种技术并不苛刻，可以被认为是安全有效的，因为优秀的临床和影像学成功率。
