Vermesan D, Prejbeanu R, Daliborca C Vlad, Haragus H, Magureanu M, Marrelli M, Promenzio L, Caprio M, Cagiano R, Tatullo M
Victor Babeş University of Medicine and Pharmacy, Timisoara, Romania.
Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
Med Devices (Auckl). 2014 May 29;7:157-63. doi: 10.2147/MDER.S60945. eCollection 2014.
Facet degeneration can lead to spinal stenosis and instability, and often requires stabilization. Interbody fusion is commonly performed, but it can lead to adjacent-segment disease. Dynamic posterior stabilization was performed using a total facet arthroplasty system. The total facet arthroplasty system was originally intended to restore the natural motion of the posterior stabilizers, but follow-up studies are lacking due to limited clinical use. We studied the first 14 cases (long-term follow-up) treated with this new device in our clinic. All patients were diagnosed with lumbar stenosis due to hypertrophy of the articular facets on one to three levels (maximum). Disk space was of normal height. The design of this implant allows its use only at levels L3-L4 and L4-L5. We implanted nine patients at the L4-L5 level and four patients at level L3-L4. Postoperative follow-up of the patients was obtained for an average of 3.7 years. All patients reported persistent improvement of symptoms, visual analog scale score, and Oswestry Disability Index score. Functional scores and dynamic radiographic imaging demonstrated the functional efficacy of this new implant, which represents an alternative technique and a new approach to dynamic stabilization of the vertebral column after interventions for spine decompression. The total facet arthroplasty system represents a viable option for dynamic posterior stabilization after spinal decompression. For the observed follow-up, it preserved motion without significant complications or apparent intradisk or adjacent-disk degeneration.
小关节退变可导致椎管狭窄和不稳定，通常需要进行稳定手术。椎间融合术是常用的手术方式，但可能导致相邻节段疾病。采用全小关节置换系统进行动态后路稳定手术。全小关节置换系统最初旨在恢复后稳定器的自然运动，但由于临床应用有限，缺乏随访研究。我们研究了在我们诊所使用这种新装置治疗的首批14例患者（长期随访）。所有患者均被诊断为因一至三个节段（最多）关节突肥大导致的腰椎管狭窄。椎间盘间隙高度正常。该植入物的设计使其仅适用于L3-L4和L4-L5节段。我们在L4-L5节段植入了9例患者，在L3-L4节段植入了4例患者。对患者进行了平均3.7年的术后随访。所有患者均报告症状、视觉模拟评分和Oswestry功能障碍指数评分持续改善。功能评分和动态影像学检查证明了这种新植入物的功能疗效，它代表了脊柱减压干预后动态稳定脊柱的一种替代技术和新方法。全小关节置换系统是脊柱减压后动态后路稳定的一个可行选择。在观察到的随访中，它保留了运动，没有明显并发症或明显的椎间盘内或相邻椎间盘退变。
