Rieger Bernhard, Jiang Hongzhen, Ruess Daniel, Reinshagen Clemens, Molcanyi Marek, Zivcak Jozef, Tong Huaiyu, Schackert Gabriele
Department of Neurosurgery, Carl Gustav Carus University Hospital, Technical University of Dresden, 01307, Dresden, Germany.
Spine Center DWG Level I, Carl Gustav Carus University Hospital, Technical University of Dresden, 01307, Dresden, Germany.
Eur Spine J. 2017 Dec;26(12):3147-3155. doi: 10.1007/s00586-016-4928-z. Epub 2016 Dec 27.
First description of MIS-VLIF, a minimally invasive lumbar stabilization, to evaluate its safety and feasibility in patients suffering from weak bony conditions (lumbar spondylodiscitis and/or osteoporosis).
After informed consent, 12 patients suffering from lumbar spondylodiscitis underwent single level MIS-VLIF. Eight of them had a manifest osteoporosis, either. Pre- and postoperative clinical status was documented using numeric rating scale (NRS) for leg and back pain. In all cases, the optimal height for the cage was preoperatively determined using software-based range of motion and sagittal balance analysis. CT scans were obtained to evaluate correct placement of the construct and to verify fusion after 6 months.
Since 2013, 12 patients with lumbar pyogenic spondylodiscitis underwent MIS-VLIF. Mean surgery time was 169 ± 28 min and average blood loss was less than 400 ml. Postoperative CT scans showed correct placement of the implants. Eleven patients showed considerable postoperative improvement in clinical scores. In one patient, we observed screw loosening. After documented bony fusion in the CT scan, the fixation system was removed in two cases to achieve lower material load.
The load-bearing trajectories (vectors) of MIS-VLIF are different from those of conventional coaxial pedicle screw implantation. The dorsally converging construct combines the heads of the dorsoventral pedicle screws with laminar pedicle screws following cortical bone structures within a small approach. In case of lumbar spondylodiscitis and/or osteoporosis, MIS-VLIF relies on cortical bony structures for all screw vectors and the construct does not depend on conventional coaxial pedicle screws in the presence of inflamed, weak, cancellous or osteoporotic bone. MIS-VLIF allows full 360° lumbar fusion including cage implantation via a small, unilateral dorsal midline approach.
首次描述微创腰椎椎间融合术（MIS-VLIF），评估其在骨质薄弱（腰椎化脓性脊柱炎和/或骨质疏松症）患者中的安全性和可行性。
在获得知情同意后，12例腰椎化脓性脊柱炎患者接受了单节段MIS-VLIF手术。其中8例还患有明显的骨质疏松症。使用数字评分量表（NRS）记录术前和术后腿部及背部疼痛的临床状况。在所有病例中，术前使用基于软件的活动范围和矢状面平衡分析确定椎间融合器的最佳高度。术后6个月进行CT扫描，以评估植入物的正确放置情况并验证融合情况。
自2013年以来，12例腰椎化脓性脊柱炎患者接受了MIS-VLIF手术。平均手术时间为169±28分钟，平均失血量少于400毫升。术后CT扫描显示植入物放置正确。11例患者的临床评分术后有显著改善。1例患者出现螺钉松动。在CT扫描记录到骨融合后，2例患者取出了固定系统以降低材料负荷。
MIS-VLIF的承重轨迹（向量）与传统同轴椎弓根螺钉植入不同。背侧汇聚结构在小切口内沿着皮质骨结构将背腹侧椎弓根螺钉的头部与椎板椎弓根螺钉相结合。在腰椎化脓性脊柱炎和/或骨质疏松症的情况下，MIS-VLIF的所有螺钉向量均依赖皮质骨结构，并且在存在炎症、薄弱、松质骨或骨质疏松骨的情况下，该结构不依赖传统同轴椎弓根螺钉。MIS-VLIF可通过小的单侧后正中切口实现包括椎间融合器植入在内的全360°腰椎融合。
