Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan; Graduate Institute of Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.
Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan; Graduate Institute of Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.
World Neurosurg. 2014 Nov;82(5):891-6. doi: 10.1016/j.wneu.2014.06.009. Epub 2014 Jun 13.
To evaluate the efficiency and safety of a unilateral approach for bilateral foramen decompression in minimally invasive transforaminal lumbar interbody fusion (miTLIF) for the treatment of bilateral foraminal stenosis.
Treatment of 52 levels of bilateral foraminal stenosis in 48 patients was performed using a unilateral approach for bilateral foramen decompression in miTLIF. The foramen areas on bilateral sides, the cross-sectional areas of the dura mater, and the structural preservation of the multifidus muscle on bilateral sides were compared preoperatively and 1 year postoperatively. Visual analog scale scores of pain, 36-item short form health survey results, and complications were recorded after reviewing patient charts. Fusion rates were evaluated 1 year postoperatively.
The average age of patients was 62.48 years. The mean follow-up period was 12.78 months. The foramen areas on bilateral sides and the cross-sectional area of the dura mater increased significantly postoperatively (P < 0.05). Structural preservation of the multifidus muscle was observed in 20 of 54 levels (37%) on ipsilateral sides and in 48 of 54 levels (89%) on contralateral sides. No major complications were observed, and the incidences of minor complications and incidental durotomy were 28% and 4%, respectively. Improvements in average visual analog scale pain and 36-item short form health survey 6 (preoperative to 1 year postoperatively) scores were from 5.9 to 1.8 (P < 0.05) and from 51.3 to 71.3 (P < 0.01), respectively. The radiologic criteria of bony fusion were met by 40 patients (83%).
A unilateral approach for bilateral foramen decompression in miTLIF provides a safe and efficient method for the treatment of bilateral foramen stenosis in patients with degenerative spinal disorders.
评估微创经椎间孔腰椎体间融合术（miTLIF）中单侧双侧椎间孔减压治疗双侧椎间孔狭窄的效率和安全性。
对 48 例 52 个节段的双侧椎间孔狭窄患者采用单侧双侧椎间孔减压 miTLIF 治疗。比较术前和术后 1 年双侧侧孔面积、硬脑膜横截面积及双侧多裂肌结构保留情况。通过查阅病历记录疼痛视觉模拟评分（VAS）、36 项简短健康调查（SF-36）结果及并发症。术后 1 年评估融合率。
患者平均年龄为 62.48 岁，平均随访时间为 12.78 个月。术后双侧侧孔面积和硬脑膜横截面积均显著增大（P < 0.05）。同侧 54 个节段中有 20 个（37%），对侧 54 个节段中有 48 个（89%）保留多裂肌结构。未观察到重大并发症，轻微并发症和意外硬脊膜切开的发生率分别为 28%和 4%。平均 VAS 疼痛评分（术前至术后 1 年）从 5.9 分改善至 1.8 分（P < 0.05），SF-36 评分从 51.3 分改善至 71.3 分（P < 0.01）。40 例（83%）患者符合影像学骨融合标准。
miTLIF 中单侧双侧椎间孔减压为退行性脊柱疾病患者双侧椎间孔狭窄的治疗提供了一种安全有效的方法。
