Pakzaban Peyman
Houston Microneurosurgery, Houston, TX.
Spine (Phila Pa 1976). 2016 Sep 15;41(18):E1124-E1130. doi: 10.1097/BRS.0000000000001510.
Retrospective case series.
To describe a modified technique for mini-open transforaminal lumbar interbody fusion (TLIF) that improves visualization for decompression, fusion, and freehand pedicle screw insertion. Accuracy of freehand pedicle screw placement with this technique was assessed.
Mini-open TLIF is a minimally invasive technique that allows limited visualization of the bone and neural anatomy via an expandable tubular retractor inserted through the Wiltse plane. No significant modification that of this technique has been described in detail.
In this study, 92 consecutive patients underwent one-level modified mini-open TLIF (MOTLIF). MOTLIF modifications consisted of (i) transmuscular dissection through the multifidus muscle rather than intermuscular dissection in the Wiltse plane; (ii) microsurgical detachment of multifidus from the facet rather than muscle dilation; (iii) en bloc total facetectomy (unilateral or bilateral, as needed for decompression); (iv) facet autograft used for interbody fusion; and (v) solid pedicle screws placed bilaterally by a freehand technique under direct vision.
The mean age was 53 years. Mean follow-up was 35 months (minimum 2 yrs). By 6 months, mean Visual Analog Scale for back and leg pain had improved from 51 to 19 and from 58 to 17, respectively, and mean Oswestry Disability Index (ODI) improved from 53 to 16. These improvements persisted at 2 years. Solid fusion, defined by computed tomography at 1 year, was achieved in 88.1%, whereas satisfactory fusion was achieved in 95.2% of patients. Pedicle screws were accurately placed in 335 of 336 imaged pedicles (pedicle breach grades: 91.1% grade 1; 8.6% grade 2; and 0.3% grade 3). Mean fluoroscopy time was 29.3 seconds.
MOTLIF is a safe and effective minimally invasive technique with a high fusion rate. It allows accurate pedicle screw placement by a freehand technique. By eliminating bi-planar fluoroscopy, it helps reduce radiation exposure. This is the largest published report of mini-open TLIF to date.
回顾性病例系列研究。
描述一种改良的微创经椎间孔腰椎椎体间融合术（TLIF）技术，该技术可改善减压、融合及徒手椎弓根螺钉置入的视野，并评估该技术徒手置入椎弓根螺钉的准确性。
微创TLIF是一种微创手术技术，通过经Wiltse平面插入的可扩张管状牵开器对骨骼和神经解剖结构进行有限视野观察。目前尚未详细描述对该技术的重大改良。
本研究中，92例连续患者接受了单节段改良微创TLIF（MOTLIF）手术。MOTLIF的改良包括：（i）经多裂肌进行肌层切开，而非在Wiltse平面进行肌间隙切开；（ii）在显微镜下将多裂肌从关节突上分离，而非进行肌肉扩张；（iii）整块切除关节突（单侧或双侧，根据减压需要）；（iv）使用关节突自体骨进行椎体间融合；（v）在直视下通过徒手技术双侧置入实心椎弓根螺钉。
平均年龄为53岁。平均随访时间为35个月（最短2年）。到6个月时，背部和腿部疼痛的视觉模拟评分平均分别从51分改善至19分、从58分改善至17分，Oswestry功能障碍指数（ODI）平均从53分改善至16分。这些改善在2年时持续存在。根据1年时的计算机断层扫描结果，88.1%实现了坚固融合，而95.2%的患者实现了满意融合。在336个成像椎弓根中，335个椎弓根螺钉置入准确（椎弓根穿破分级：1级占91.1%；2级占8.6%；3级占0.3%）。平均透视时间为29.3秒。
MOTLIF是一种安全有效的微创手术技术，融合率高。它允许通过徒手技术准确置入椎弓根螺钉。通过消除双平面透视，有助于减少辐射暴露。这是迄今为止已发表的关于微创TLIF的最大规模报告。
4级。
