Zhao Chang-Qing, Ding Wei, Zhang Kai, Zhao Jie
Department of Orthopaedics, Shanghai Key Laboratory of Orthopaedic Implants, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, P. R. China.
Department of Orthopaedics, Jiangyin People' Hospital, Jiangyin 214400, P. R. China.
Indian J Orthop. 2016 Sep;50(5):473-478. doi: 10.4103/0019-5413.189595.
Large lumbar or lumbosacral (LS) disc herniations usually expand from the paramedian space to the neuroforamen and compress both the transversing (lower) and the exiting (upper) nerve roots, thus leading to bi-radicular symptoms. Bi-radicular involvement is a statistically significant risk factor for poor outcome in patients presenting with far lateral or foraminal disc herniation after facet preserving microdecompression. There is evidence showing that patients suffering from large lumbar disc herniations treated with interbody fusion have significant superior results in comparison with those who received a simple discectomy. We report our experiences on managing large LS disc herniation with bi-radicular symptoms by transforaminal lumbar interbody fusion (TLIF) using one diagonal fusion cage with unilateral pedicle screw/rod fixation.
Twenty-three patients who suffered from single level lumbar or LS disc herniation with bi-radicular symptoms treated with unilateral decompression and TLIF using one diagonal fusion cage with ipsilateral pedicle screw/rod fixation operated between January 2005 and December 2009, were included in this study. Operation time and blood loss were recorded. The pain and disability status were pre- and postoperatively evaluated by the visual analog score (VAS) and Oswestry Disability Index (ODI). Interbody bony fusion was detected by routine radiographs and computed tomography scan. Adjacent segment degeneration was detected by routine radiographs and magnetic resonance imaging examination. Overall outcomes were categorized according to modified Macnab classification.
The patients were followed up for an average of 44.7 months. Pain relief in the VAS and improvement of the ODI were significant after surgery and at final followup. No severe complications occurred during hospital stay. Interbody bony fusion was achieved in every case. No cage retropulsion was observed, while 3 cases experienced cage subsidence. Adjacent segment degeneration occurred at 3 discs cephalic to the fusion segment at followup. No patients underwent revised surgery. Overall outcome was excellent in 5 patients (21.7%), good in 13 (56.5%), fine in 4 (17.5%), and poor in 1 (4.3%).
TLIF using one cage with ipsilateral pedicle screw/rod fixation is an effective treatment option for massive lumbar or LS disc herniation with bi-radicular involvement.
大型腰椎或腰骶部（LS）椎间盘突出症通常从中线旁间隙扩展至神经孔，压迫下行（低位）和穿出（高位）神经根，从而导致双侧神经根症状。双侧神经根受累是保留小关节的显微减压术后远外侧或椎间孔型椎间盘突出症患者预后不良的一个具有统计学意义的危险因素。有证据表明，与单纯行椎间盘切除术的患者相比，接受椎间融合术治疗的大型腰椎间盘突出症患者的疗效显著更优。我们报告了采用一枚斜向融合器联合单侧椎弓根螺钉/棒固定的经椎间孔腰椎椎间融合术（TLIF）治疗伴有双侧神经根症状的大型LS椎间盘突出症的经验。
本研究纳入了2005年1月至2009年12月期间接受单侧减压及采用一枚斜向融合器联合同侧椎弓根螺钉/棒固定的TLIF治疗的23例单节段腰椎或LS椎间盘突出症且伴有双侧神经根症状的患者。记录手术时间和失血量。术前及术后通过视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）评估疼痛和功能障碍状况。通过常规X线片和计算机断层扫描检测椎间骨融合情况。通过常规X线片和磁共振成像检查检测相邻节段退变情况。根据改良Macnab分类法对总体疗效进行分类。
患者平均随访44.7个月。术后及末次随访时，VAS疼痛缓解及ODI改善均显著。住院期间未发生严重并发症。所有病例均实现椎间骨融合。未观察到融合器后移，3例出现融合器下沉。随访时，融合节段上方3个椎间盘出现相邻节段退变。无患者接受翻修手术。总体疗效优5例（21.7%），良13例（56.5%），可4例（17.5%），差1例（4.3%）。
采用一枚融合器联合同侧椎弓根螺钉/棒固定的TLIF是治疗伴有双侧神经根受累的大型腰椎或LS椎间盘突出症的一种有效治疗选择。
