Postacchini Franco, Postacchini Roberto, Menchetti Pier Paolo Maria, Sessa Pasquale, Paolino Michela, Cinotti Gianluca
Department of Saimlal, Section of Orthopedic Surgery, Clinica Ortopedica, Università Sapienza, Rome, Italy.
Ospedale Israelitico, Rome, Italy.
Asian Spine J. 2016 Feb;10(1):27-37. doi: 10.4184/asj.2016.10.1.27. Epub 2016 Feb 16.
Prospective cohort study.
To assess the ability of a stand-alone lumbar interspinous implant (interspinous/interlaminar lumbar instrumented fusion, ILIF) associated with bone grafting to promote posterior spine fusion in degenerative spondylolisthesis (DS) with vertebral instability.
A few studies, using bilateral laminotomy (BL) or bilateral decompression by unilateral laminotomy (BDUL), found satisfactory results in stenotic patients with decompression alone, but others reported increased olisthesis, or subsequent need for fusion in DS with or without dynamic instability.
Twenty-five patients with Grade I DS, leg pain and chronic low back pain underwent BL or BDUL and ILIF implant. Olisthesis was 13% to 21%. Follow-up evaluations were performed at 4 to 12 months up to 25 to 44 months (mean, 34.4). Outcome measures were numerical rating scale (NRS) for back and leg pain, Oswestry disability index (ODI) and short-form 36 health survey (SF-36) of body pain and function.
Fusion occurred in 21 patients (84%). None had increased olisthesis or instability postoperatively. Four types of fusion were identified. In Type I, the posterior part of the spinous processes were fused. In Type II, fusion extended to the base of the processes. In Type III, bone was present also around the polyetheretherketone plate of ILIF. In Type IV, even the facet joints were fused. The mean NRS score for back and leg pain decreased by 64% and 80%, respectively. The mean ODI score was decreased by 52%. SF-36 bodily pain and physical function mean scores increased by 53% and 58%, respectively. Computed tomography revealed failed fusion in four patients, all of whom still had vertebral instability postoperatively.
Stand-alone ILIF with interspinous bone grafting promotes vertebral fusion in most patients with lumbar stenosis and unstable Grade I DS undergoing BL or BDUL.
前瞻性队列研究。
评估一种独立的腰椎棘突间植入物（棘突间/椎板间腰椎器械融合术，ILIF）联合植骨在伴有椎体不稳的退变性腰椎滑脱（DS）中促进后脊柱融合的能力。
一些采用双侧椎板切开术（BL）或单侧椎板切开双侧减压术（BDUL）的研究发现，仅行减压的狭窄患者取得了满意的结果，但其他研究报告了DS患者（无论有无动态不稳）滑脱增加或随后需要融合的情况。
25例I度DS、腿痛和慢性下腰痛患者接受了BL或BDUL及ILIF植入术。滑脱率为13%至21%。随访评估在4至12个月进行，最长至25至44个月（平均34.4个月）。结果指标包括背部和腿部疼痛的数字评分量表（NRS）、Oswestry功能障碍指数（ODI）以及身体疼痛和功能的简短健康调查（SF-36）。
21例患者（84%）实现了融合。术后无一例患者滑脱增加或出现不稳。确定了四种融合类型。I型中，棘突后部融合。II型中，融合延伸至棘突基部。III型中，ILIF的聚醚醚酮板周围也有骨组织。IV型中，甚至小关节也发生了融合。背部和腿部疼痛的平均NRS评分分别下降了64%和80%。平均ODI评分下降了52%。SF-36身体疼痛和身体功能的平均评分分别提高了53%和58%。计算机断层扫描显示4例患者融合失败，所有这些患者术后仍存在椎体不稳。
对于大多数接受BL或BDUL的腰椎管狭窄症和I度不稳定DS患者，独立的ILIF联合棘突间植骨可促进椎体融合。
