Tegos Stergios, Charitidis Charalampos, Korovessis Panagiotis G
*Neurosurgical Department, NIMTS Army Veterans Hospital Athens, Athens, Greece; and †Orthopedic Department General Hospital "Agios Andreas," Patras, Greece.
Spine (Phila Pa 1976). 2014 Apr 1;39(7):E441-9. doi: 10.1097/BRS.0000000000000210.
Retrospective study on circumferential hybrid instrumentation with posterior lumbar interbody fusion (PLIF) and the novel posterior Universal Clamp (UC) instrumentation.
This study evaluated the roentgenographic and clinical outcome after PLIF with PEEK cage augmented with UC posterior sublaminar fixation without posterior fusion.
Although UC has been successfully used in scoliosis surgery, to our knowledge, this is the first report on its use in degenerative lumbosacral disease. Rigid pedicle screw lumbosacral fixation is associated with several intraoperative screw-related complications. The use of sublaminar bands and rods combined with PEEK PLIF should increase fusion rate and avoid screw-related complications.
From a total of 295 consecutive patients who experienced degenerative lumbosacral disease and received posterior decompression, implantation of PLIF with PEEK cages and semirigid posterior fixation with sublaminar UC bands-rods without posterolateral fusion, 150 patients were eligible for this study with a follow-up of more than 2 years. Interbody fusion rate and global plus segmental sagittal spinal lordosis restoration were recorded pre- and postoperatively. Visual analogue scale and Oswestry Disability Index were used to assess functional outcome.
Hybrid instrumentation expanded over 1 to 5 levels. Surgical time ranged from 45 to 225 minutes. Only 12.6% of the patients were transfused. There was no nerve root lesion or deep wound infection. Laminar fracture occurred intraoperatively in one case during band insertion. Interbody fusion was achieved in 94% of the operated segments. Lumbar lordosis improved from -36 ± 9° preoperatively to -53 ± 6° postoperatively. Segmental lordosis improved in L4-L5 segment from -5 ± 3° preoperatively to -12 ± 2° postoperatively and in L5-S1 from -9 ± 4° to -14 ± 2° postoperation. Oswestry Disability Index score improved from 44.9 preoperatively to 2.2 postoperatively (P < 0.001). No patient required further spinal surgery until the final evaluation.
UC, a novel semirigid sublaminar posterior instrumentation, combined with wedge-shaped PEEK PLIF corrected both global and segmental sagittal lumbar alignment and achieved fusion rate similar to that historically reported with pedicle screw-PLIF techniques, however, avoiding intraoperative complications associated with the use of pedicle screws.
对采用后路腰椎椎间融合术（PLIF）及新型后路通用夹（UC）器械进行的环形混合器械固定术的回顾性研究。
本研究评估了采用UC后路椎板下固定增强聚醚醚酮（PEEK）椎间融合器的PLIF术后的影像学及临床结果，该手术未进行后路融合。
尽管UC已成功应用于脊柱侧弯手术，但据我们所知，这是其在退行性腰骶部疾病中应用的首份报告。刚性椎弓根螺钉腰骶部固定与多种术中螺钉相关并发症有关。使用椎板下带和棒结合PEEK PLIF应能提高融合率并避免螺钉相关并发症。
在总共295例连续接受退行性腰骶部疾病治疗并接受后路减压、植入PEEK椎间融合器以及采用椎板下UC带 - 棒进行半刚性后路固定且未进行后外侧融合的患者中，150例患者符合本研究标准并进行了超过2年的随访。记录术前和术后的椎间融合率以及整体和节段性矢状面脊柱前凸恢复情况。使用视觉模拟评分法和Oswestry功能障碍指数评估功能结果。
混合器械固定范围为1至5个节段。手术时间为45至225分钟。仅12.6%的患者接受了输血。未出现神经根损伤或深部伤口感染。在1例患者术中插入带时发生了椎板骨折。94%的手术节段实现了椎间融合。腰椎前凸从术前的-36±9°改善至术后的-53±6°。L4 - L5节段的节段性前凸从术前的-5±3°改善至术后的-12±2°，L5 - S1节段从术前的-9±4°改善至术后的-14±2°。Oswestry功能障碍指数评分从术前的44.9改善至术后的2.2（P < 0.001）。直至最终评估，无患者需要进一步的脊柱手术。
UC是一种新型的半刚性椎板后半器械，与楔形PEEK PLIF相结合，纠正了整体和节段性矢状面腰椎排列，并实现了与历史报道的椎弓根螺钉 - PLIF技术相似的融合率，然而，避免了与使用椎弓根螺钉相关的术中并发症。
