Kale Aydemir, Oz Ibrahim Ilker, Onk Ayhan, Kalaycı Murat, Büyükuysal Çağatay
Department of Neurosurgery, Bülent Ecevit University, Faculty of Medicine, Zonguldak, Turkey.
Department of Radiology, Bülent Ecevit University, Faculty of Medicine, Zonguldak, Turkey.
Neurol Neurochir Pol. 2017 Jan-Feb;51(1):53-59. doi: 10.1016/j.pjnns.2016.11.001. Epub 2016 Nov 17.
Posterior lumbar interbody fusion (PLIF) is usually bilateral procedure, and it is combined with posterior by bilateral pedicle screw support or with fixation. The purpose of this retrospective study was to compare the surgical outcomes of simple discectomy and PLIF without pedicle screw support in patients with lumbar disc herniation (LDH).
60 patients with single segment LDH were operated between February 2010 and June 2013. 40 patients were treated with simple discectomy (Group 1) and 20 patients were treated with PLIF using double expandable polyetheretherketone (PEEK) cages without instrumentation (Group 2) unilaterally. Pain and function were evaluated by the visual analog scale (VAS) and Oswestry disability index (ODI) before and 18 months after surgery. Besides, PLIF patients were evaluated with computerized tomography (CT) scan of lumbar vertebra for the evaluation of the height of the disc, instability and fusion.
Both leg and low back pain VAS scores were significantly improved 18 months after surgery in both of the groups (p<0.001). Significant decrease in VAS low back pain scores was seen in group 2 when compared to group 1 (p<0.001). Height of the intervertebral disc space was preserved and no instability was detected in group 2. No recurrence and 80% fusion rate was achieved in group 2.
This study showed that unilateral PLIF intervention with double expandable PEEK cages without pedicle screw support would be sufficient in the management of single segment lumbar disc herniation in patients whom are thought to have lumbar stabilization.
腰椎后路椎间融合术（PLIF）通常是双侧手术，且通过双侧椎弓根螺钉支撑或固定与后路相结合。本回顾性研究的目的是比较腰椎间盘突出症（LDH）患者单纯椎间盘切除术和无椎弓根螺钉支撑的PLIF的手术效果。
2010年2月至2013年6月期间，对60例单节段LDH患者进行了手术。40例患者接受单纯椎间盘切除术（第1组），20例患者单侧使用双扩张聚醚醚酮（PEEK）椎间融合器进行PLIF（第2组），未使用内固定器械。在手术前和术后18个月，通过视觉模拟量表（VAS）和Oswestry功能障碍指数（ODI）评估疼痛和功能。此外，对接受PLIF的患者进行腰椎计算机断层扫描（CT），以评估椎间盘高度、不稳定性和融合情况。
两组患者术后18个月时腿部和下背部疼痛的VAS评分均显著改善（p<0.001）。与第1组相比，第2组的VAS下背部疼痛评分显著降低（p<0.001）。第2组椎间盘间隙高度得以保留，未检测到不稳定情况。第2组无复发，融合率达到80%。
本研究表明，对于被认为具有腰椎稳定性的患者，单侧使用双扩张PEEK椎间融合器且无椎弓根螺钉支撑的PLIF干预足以治疗单节段腰椎间盘突出症。
