Voyadzis Jean-Marc, Anaizi Amjad Nasr
Department of Neurosurgery, Georgetown University Hospital, Washington, DC 20007, USA.
J Spinal Disord Tech. 2013 Apr;26(2):98-106. doi: 10.1097/BSD.0b013e318241f6c3.
Prospective evaluation of 10 patients undergoing minimally invasive lumbar interbody fusion for degenerative disk disease and radiculopathy.
To assess the feasibility of percutaneous lumbar transfacet screw fixation in the lateral decubitus position after lateral interbody fusion.
Lumbar interbody fusion is commonly performed for the treatment of degenerative disk disease with associated radiculopathy due to foraminal stenosis or disk protrusion. Minimally invasive techniques, such as the lateral interbody fusion, have been developed to achieve this while reducing operative morbidity. Subsequent vertebral fixation is best achieved with a pedicle screw and rod construct in the prone position. Transfacet screw placement has been shown to have near biomechanical equivalence and may reduce operative time and morbidity if placed while the patient remains in the lateral decubitus position.
Ten patients with back pain and radicular pain due to single-level degenerative disk disease at L3-L4 or L4-L5 underwent minimally invasive lateral interbody arthrodesis with placement of bilateral percutaneous transfacet screws in the lateral decubitus position. Patients had close perioperative follow-up including recordings of intraoperative blood loss, operative time, and hospital length of stay. Clinical outcome measures including visual analog scores (VAS) were assessed preoperatively and at last follow-up with a minimum of 6 months. Dynamic radiographs were obtained at last follow-up to evaluate the instrumentation and fusion rate.
The procedure was well tolerated by all patients. Mean operative time was 2 hours and 42 minutes. Mean blood loss was 26.5 mL. Mean hospital length of stay was 46.5 hours. Nine of 10 patients had good-to-excellent relief of their preoperative back pain and leg pain. Mean preoperative VAS score for back pain was 8.9 and for leg pain was 8. At a mean follow-up of 8.2 months, mean postoperative VAS score for back pain was 0.9 and for leg pain was 0.9. There were no complications. One patient suffered persistent mild leg dysesthesias. There were no instances of graft or screw dislodgement on follow-up imaging.
Minimally invasive percutaneous transfacet screw fixation can be performed safely and effectively in the lateral decubitus position. This is an attractive option for posterior percutaneous fixation that can lead to a reduction of operative time and surgical morbidity in select cases.
对10例因退行性椎间盘疾病和神经根病接受微创腰椎椎间融合术的患者进行前瞻性评估。
评估在侧方椎间融合术后侧卧位行经皮腰椎经关节突螺钉固定的可行性。
腰椎椎间融合术常用于治疗因椎间孔狭窄或椎间盘突出导致的伴有神经根病的退行性椎间盘疾病。已经开发出诸如侧方椎间融合术等微创技术来实现这一目的，同时降低手术发病率。随后的椎体固定在俯卧位时采用椎弓根螺钉和棒结构效果最佳。经关节突螺钉置入已显示出近乎等同的生物力学效果，并且如果在患者保持侧卧位时置入，可能会减少手术时间和发病率。
10例因L3 - L4或L4 - L5单节段退行性椎间盘疾病导致背痛和神经根性疼痛的患者，在侧卧位接受了微创侧方椎间关节融合术，并置入双侧经皮经关节突螺钉。患者在围手术期进行密切随访，包括记录术中失血量、手术时间和住院时间。临床结局指标包括视觉模拟评分（VAS）在术前和至少随访6个月时的最后一次随访时进行评估。在最后一次随访时获取动态X线片以评估内固定情况和融合率。
所有患者对该手术耐受性良好。平均手术时间为2小时42分钟。平均失血量为26.5毫升。平均住院时间为46.5小时。10例患者中有9例术前背痛和腿痛得到良好至极佳的缓解。术前背痛的平均VAS评分为8.9，腿痛为8。在平均随访8.2个月时，术后背痛的平均VAS评分为0.9，腿痛为0.9。无并发症发生。1例患者持续存在轻度腿部感觉异常。随访影像学检查未发现植骨或螺钉移位情况。
微创经皮经关节突螺钉固定可在侧卧位安全有效地进行。对于后入路经皮固定来说，这是一个有吸引力的选择，在某些情况下可减少手术时间和手术发病率。
