Gu Guang-fei, Zhang Hai-long, He Shi-sheng, Gu Xin, Zhang Li-guo, Ding Yue, Jia Jian-bo, Zhou Xu
Department of Orthopedics, Shanghai Tenth People's Hospital, Shanghai 200072, China.
Zhonghua Wai Ke Za Zhi. 2011 Dec;49(12):1081-5.
To investigate the clinical results of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar spinal stenosis with lumbar instability.
Retrospective study was done on 42 cases of lumbar spinal stenosis with lumbar instability treated with bilateral decompression via unilateral approach and MIS-TLIF through an expandable tubular retractor from March 2010 to January 2011. There were 18 males and 24 females, and mean age was 61.7 years (rang, 48 - 79 years). The level of surgery was L(3-4) in 4 patients, L(4-5) in 26 patients, and L(5)-S(1) in 12 patients. All patients had symptoms of intermittent claudication. And 24 patients had symptoms of lower extremity pain and numbness in one side, and 18 patients had same symptoms in both legs. Operation time, intra-operative bleeding, postoperative hospital stay and complications were recorded. Visual analogue scale (VAS) scores for low back pain and leg pain were recorded before and after surgery. Oswestry disability index (ODI) scores were also recorded before and after surgery. The Bridwell criterion was used for evaluating the interbody fusion, and the MacNab criterion was used for assessment after surgery.
The mean operative time was 150.4 minutes (range, 120 - 170 minutes), and mean blood loss was 147.1 ml (range, 50 - 400 ml). The hospitalization time after surgery was 5 - 18 d, an average of 8.8 d. All cases were followed-up for 6 - 14 months (average 11 months). VAS score of low back pain before surgery was 7.3 ± 1.0, and were 2.9 ± 0.8 and 2.0 ± 0.8 at three months after surgery and the last follow-up respectively. VAS score of leg pain before surgery was 7.9 ± 0.7, and were 2.0 ± 0.5 and 1.0 ± 0.7 at three months after surgery and the last follow-up respectively. ODI score was 75% ± 6% before surgery, were 16% ± 6% and 12% ± 5% at three months after surgery and the last follow-up respectively. VAS and ODI scores showed statistically significant improvements (t = 3.110 - 56.323, P < 0.01). There were 40 cases were grade I and II, according to the Bridwell criteria. The clinical results were excellent in 16 cases, good in 22 cases and fair in 4 cases to the MacNab criteria at the final follow-up.
MIS-TLIF is an ideal surgical method for single segment lumbar spinal stenosis with lumbar instability, but close attention should be paid to specific patients, surgeons and hospitals.
探讨微创经椎间孔腰椎椎体间融合术（MIS-TLIF）治疗腰椎管狭窄症合并腰椎不稳的临床效果。
回顾性分析2010年3月至2011年1月采用单侧入路双侧减压联合可扩张通道撑开器辅助下的MIS-TLIF治疗的42例腰椎管狭窄症合并腰椎不稳患者。其中男18例，女24例，平均年龄61.7岁（范围48 - 79岁）。手术节段为L(3-4) 4例，L(4-5) 26例，L(5)-S(1) 12例。所有患者均有间歇性跛行症状。24例患者有单侧下肢疼痛麻木症状，18例患者双下肢有相同症状。记录手术时间、术中出血量、术后住院时间及并发症。记录术前及术后腰背痛和腿痛的视觉模拟评分（VAS）。术前及术后也记录Oswestry功能障碍指数（ODI）评分。采用Bridwell标准评估椎间融合情况，采用MacNab标准进行术后评估。
平均手术时间为150.4分钟（范围120 - 170分钟），平均出血量为147.1毫升（范围50 - 400毫升）。术后住院时间为5 - 18天，平均8.8天。所有病例随访6 - 14个月（平均11个月）。术前腰背痛VAS评分为7.3±1.0，术后3个月及末次随访时分别为2.9±0.8和2.0±0.8。术前腿痛VAS评分为7.9±0.7，术后3个月及末次随访时分别为2.0±0.5和1.0±0.7。术前ODI评分为75%±6%，术后3个月及末次随访时分别为16%±6%和12%±5%。VAS和ODI评分改善有统计学意义（t = 3.110 - 56.323，P < 0.01）。根据Bridwell标准，40例为Ⅰ级和Ⅱ级。末次随访时，根据MacNab标准，临床结果优16例，良22例，可4例。
MIS-TLIF是治疗单节段腰椎管狭窄症合并腰椎不稳的理想手术方法，但应关注特定患者、术者及医院。
