Zhang Xifeng, Wang Yan, Xiao Songhua, Liu Zhengsheng, Liu Baowei, Zhang Yonggang, Zhu Shourong, Lu Ning, Wang Zheng, Mao Keya, Zhang Xuesong
Hospital of Orthopaedics, General Hospital of Chinese PLA, Beijing 100853, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011 Oct;25(10):1153-7.
To investigate the effectiveness and significance of percutaneous endoscopic discectomy followed by interbody fusion using B-Twin expandable spinal spacer for degenerative lumbosacral disc
Between January 2007 and August 2008, 21 patients with degenerative lumbosacral disc disease were treated with endoscopic discectomy followed by interbody fusion using B-Twin expandable spinal spacer. Among them, there were 13 males and 8 females with an average age of 52 years (range, 28-79 years). And the disease duration ranged from 3 months to 40 years (median, 9 months). The affected segments included T11, 12, T12-L1, L1.2, and L2, 3 in 1 case respectively, L4, 5 in 4 cases, and L5, S1 in 13 cases. All patients had intractable low back pain or lower extremity radicular symptoms. The placement methods of B-Twin expandable spinal spacer were double sides in 15 cases and single side in 6 cases. Oswestry Disability Index (ODI) and Macnab grading were used to determine the function recovery after operation. And Suk's standard was used to determine the fusion effects by X-ray.
All 21 patients were followed up 18 months to 3 years (mean, 23.8 months). Sciatica symptoms disappeared after operation in 19 cases, no significant improvement occurred in 2 cases of thoracic disease. The ODI scores were 79% +/- 16% at preoperation, 30% +/- 9% at 1 month, 26% +/- 10% at 3 months, 21% +/- 12% at 6 months, and 20% +/- 10% at 18 months after operation, showing significant differences between pre- and postoperation (P < 0.05). According to Macnab grading at 6 months postoperatively, the results were excellent in 14 cases, good in 5 cases, and fair in 2 cases with an excellent and good rate of 90.5%. According to Suk et al. standard, the results were excellent in 1 case, good in 19 cases, and poor in 1 case with an excellent and good rate of 95.2%. The muscle strength of the lower extremities had no improvement in 1 case of T11, 12 disc protrusion; pedicle screws fixation and decompression laminectomy were given after 6 months, but no improvement was achieved during follow-up. Protrusion recurred after 4 months in 1 case of L4, 5 disc protrusion, then was cured by laminectomy discectomy. The remaining patients achieved postoperative relief.
Endoscope combined with interbody fusion is a good combination to solve lumbar instability. B-Twin expandable spinal spacer is a minimally invasive fusion choice of 4, 5 and L5, S1.
探讨经皮内镜下椎间盘切除术联合使用B-Twin可扩张椎间融合器治疗退变性腰骶椎间盘疾病的有效性及意义。
2007年1月至2008年8月，21例退变性腰骶椎间盘疾病患者接受了内镜下椎间盘切除术并联合使用B-Twin可扩张椎间融合器进行椎间融合。其中，男性13例，女性8例，平均年龄52岁（范围28 - 79岁）。病程3个月至40年（中位数9个月）。受累节段分别为T11、12各1例，T12-L1 1例，L1、2 1例，L2、3 1例，L4、5 4例，L5、S1 13例。所有患者均有顽固性腰痛或下肢根性症状。B-Twin可扩张椎间融合器的置入方式为双侧15例，单侧6例。采用Oswestry功能障碍指数（ODI）和Macnab分级评估术后功能恢复情况。通过X线片采用Suk标准评估融合效果。
21例患者均获随访，时间18个月至3年（平均23.8个月）。术后19例坐骨神经痛症状消失，2例胸椎疾病患者无明显改善。术前ODI评分为79%±16%，术后1个月为30%±9%，3个月为26%±10%，6个月为21%±12%，18个月为20%±10%，术前与术后比较差异有统计学意义（P<0.05）。术后6个月根据Macnab分级，优14例，良5例，可2例，优良率为90.5%。根据Suk等标准，优1例，良19例，差1例，优良率为95.2%。1例T11、12椎间盘突出患者下肢肌力无改善；6个月后行椎弓根螺钉固定及减压椎板切除术，但随访期间无改善。1例L4、5椎间盘突出患者术后4个月复发，再次行椎板切除髓核摘除术治愈。其余患者术后均获缓解。
内镜联合椎间融合是解决腰椎不稳的良好组合。B-Twin可扩张椎间融合器是L4、5及L5、S1节段微创融合的选择。
