Seong Ji-Hoon, Lee Jong-Won, Kwon Ki-Young, Rhee Jong-Joo, Hur Jin-Woo, Lee Hyun-Koo
Department of Neurosurgery, Cheongju St. Mary's Hospital, Cheongju, Korea.
J Korean Neurosurg Soc. 2011 Oct;50(4):363-9. doi: 10.3340/jkns.2011.50.4.363. Epub 2011 Oct 31.
We investigated the clinical and radiological advantages of unilateral laminectomy in posterior lumbar interbody fusion (PLIF) procedure comparing with bilateral laminectomy, under the same procedural condition including bilateral instrumentation and insertion of two cages, in patients with degenerative lumbar disease with unilateral leg symptoms.
We retrospectively reviewed 124 consecutive cases of PLIF via unilateral or bilateral approach between January 2006 and April 2010. In 80 cases (bilateral group), two cages were inserted via bilateral laminectomy, and in 44 cases (unilateral group), via unilateral laminectomy. The average follow-up duration was 29.5 months. The clinical outcomes were evaluated with the Visual Analogue Scale (VAS) and the Oswestry disability index (ODI). The fusion rates and disc space heights were determined by dynamic standing radiographs and/or computed tomography. Operative times, intra-operative and post-operative blood losses and hospitalization periods were also evaluated.
In clinical evaluation, the VAS and ODI scores showed excellent outcomes in both groups. There were no significant differences in term of fusion rate, but the perioperative blood loss and the operative time of the unilateral group were lower than that of the bilateral group.
Unilateral laminectomy can minimize the operative time and perioperative blood loss in PLIF procedure. However, the different preoperative disc height between two groups is a limitation of this study. Despite this limitation, solid fusion and satisfactory symptomatic improvement could be achieved uniquely by our surgical method. This surgical method can be an alternative surgical technique in patients with unilateral leg pain.
在相同手术条件（包括双侧器械固定和植入两个椎间融合器）下，比较单侧椎板切除术与双侧椎板切除术在治疗单侧腿部症状的退变性腰椎疾病患者行后路腰椎椎间融合术（PLIF）时的临床和影像学优势。
回顾性分析2006年1月至2010年4月间连续124例行PLIF的病例，其中80例（双侧组）经双侧椎板切除术植入两个椎间融合器，44例（单侧组）经单侧椎板切除术植入。平均随访时间为29.5个月。采用视觉模拟评分法（VAS）和Oswestry功能障碍指数（ODI）评估临床疗效。通过动态站立位X线片和/或计算机断层扫描确定融合率和椎间隙高度。同时评估手术时间、术中及术后失血量和住院时间。
临床评估中，两组的VAS和ODI评分均显示出良好的效果。融合率方面无显著差异，但单侧组的围手术期失血量和手术时间低于双侧组。
在PLIF手术中，单侧椎板切除术可使手术时间和围手术期失血量降至最低。然而，两组术前椎间盘高度不同是本研究的一个局限性。尽管有此局限性，但通过我们的手术方法可唯一实现坚实的融合和令人满意的症状改善。这种手术方法可为单侧腿痛患者提供一种替代手术技术。
