Miyashita Tomohiro, Ataka Hiromi, Kato Kei, Tanno Takaaki
*Spine Center, Matsudo City Hospital, Matsudo, Japan; and †Spine Center, Matsudo Orthopaedic Hospital, Matsudo, Japan.
Spine (Phila Pa 1976). 2015 May 1;40(9):E552-7. doi: 10.1097/BRS.0000000000000842.
STUDY DESIGN: A retrospective clinical and radiographical study. OBJECTIVE: To assess the clinical outcomes and fusion rate of facet fusion (FF) for degenerative lumbar spondylolisthesis (DLS). SUMMARY OF BACKGROUND DATA: On the basis of the long-term clinical and radiological follow-up studies of posterolateral fusion (PLF)-that is, intertransverse process fusion with pedicle screw instrumentation-for DLS, we recognized that FF alone would be sufficient for spinal fusion. METHODS: Eighty-eight patients who underwent FF for single-level DLS were retrospectively reviewed after at least 1 year of follow-up. The control group comprised 21 patients who underwent conventional PLF. The operative technique involved a 5-cm midline skin incision, bilateral laminar fenestration, and FF with autologous bone harvested from the spinous process. Percutaneous pedicle screws were then inserted through the fascia. The fusion rate of FF was evaluated using computed tomography, and the change in the range of motion at the fused level was assessed on flexion-extension lateral radiographs. The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire was used to assess the therapeutic effectiveness of FF. The results of the Roland-Morris Disability Questionnaire and the visual analogue scales of low back pain, buttock and lower limb pain, and buttock and lower limb numbness were evaluated. RESULTS: The fusion rate was 88.6% (78/88 cases). Among 10 patients with inadequate fusion, the average range of motion significantly decreased from 14.4° preoperatively to 4.3° postoperatively. The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire category scores demonstrated therapeutic effectiveness in 93.0% of the patients for walking ability and in 73.0% of the patients for low back pain. The average preoperative scores of the Roland-Morris Disability Questionnaire and the visual analogue scales of low back pain, buttock and lower limb pain, and buttock and lower limb numbness were significantly reduced postoperatively in the FF group. CONCLUSION: FF achieved good clinical outcomes that were superior to those of conventional PLF with a comparable fusion rate. It is useful for managing DLS and is a minimally invasive evolution of PLF. LEVEL OF EVIDENCE: 3.
研究设计：一项回顾性临床和影像学研究。 目的：评估小关节融合术（FF）治疗退变性腰椎滑脱症（DLS）的临床疗效和融合率。 背景数据总结：基于对DLS后外侧融合术（PLF）（即经椎弓根螺钉器械辅助的横突间融合术）的长期临床和放射学随访研究，我们认识到单纯FF足以实现脊柱融合。 方法：对88例行单节段DLS的FF患者进行至少1年的随访后进行回顾性分析。对照组包括21例行传统PLF的患者。手术技术包括5厘米的中线皮肤切口、双侧椎板开窗以及取自棘突的自体骨进行FF。然后经筋膜插入经皮椎弓根螺钉。使用计算机断层扫描评估FF的融合率，并在屈伸位侧位X线片上评估融合节段活动度的变化。采用日本骨科协会背痛评估问卷评估FF的治疗效果。评估罗兰-莫里斯功能障碍问卷结果以及腰背痛、臀部和下肢疼痛及臀部和下肢麻木的视觉模拟量表。 结果：融合率为88.6%（78/88例）。在10例融合不足的患者中，平均活动度从术前的14.4°显著降至术后的4.3°。日本骨科协会背痛评估问卷分类评分显示，93.0%的患者行走能力及73.0%的患者腰背痛有治疗效果。FF组术后罗兰-莫里斯功能障碍问卷及腰背痛、臀部和下肢疼痛及臀部和下肢麻木的视觉模拟量表的术前平均评分显著降低。 结论：FF取得了良好的临床疗效，优于传统PLF，融合率相当。它对治疗DLS有用，是PLF的微创演进。 证据等级：3级。
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