窄面 cage 在全内镜微创经椎间孔腰椎间融合术中的应用。

Application of a narrow-surface cage in full endoscopic minimally invasive transforaminal lumbar interbody fusion.

机构信息

Spine Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Orthopaedic Institute, Guangzhou, China.

出版信息

Int J Surg. 2017 Jun;42:83-89. doi: 10.1016/j.ijsu.2017.04.053. Epub 2017 Apr 27.

DOI:10.1016/j.ijsu.2017.04.053

PMID:28456707

Abstract

BACKGROUND

Spinal endoscopy has been widely applied in lumbar discectomy and decompression. However, endoscopic lumbar interbody fusion still remains a technical challenge due to the limited space within the working trocar for cage implantation. The purpose of this study was to investigate the feasibility and effectiveness of using a narrow-surface fusion cage in full endoscopic minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for the treatment of lumbar degenerative disease.

MATERIALS AND METHODS

From Jun 2013 to Dec 2014, a total of 42 patients (23 males, 19 females) underwent full endoscopic MIS-TLIF at our hospital was recruited. An 8-mm-wide narrow-surface fusion cage was selected for all cases. Perioperative parameters and complications were recorded. Comparisons on visual analog scale (VAS) and oswestry disability index (ODI) scores before and after surgery were performed. At the last follow-up, Nakai grading system was applied to assess patients' satisfaction; meanwhile, interbody fusion was evaluated by computed tomography.

RESULTS

Mean operation time was 233.1 ± 69.5 min, and mean blood loss during surgery was 221.8 ± 98.5 ml. Two patients (4.8%) developed neurological complications. Postoperative follow-up ranged from 24 to 36 months (mean 27.6 ± 3.8 months). VAS and ODI scores were significantly improved 3 months after surgery and at the final follow-up, respectively (P < 0.05). Outcome of surgery was graded as excellent for 32 patients, good for 8 patients, and acceptable for 2 patients, corresponding to a success rate ("good" and "excellent") of 95.2%. Thirty-nine of the 42 patients demonstrated solid interbody fusion at the last follow-up, indicating a fusion rate of 92.9%.

CONCLUSION

Application of a narrow-surface fusion cage in full endoscopic MIS-TLIF for the treatment of lumbar degenerative disease is feasible and effective. The clinical outcome and fusion success of this procedure were acceptable and promising.

摘要

背景

脊柱内窥镜已广泛应用于腰椎间盘切除术和减压术。然而，由于工作套管内空间有限，对于内镜下腰椎椎间融合术而言， cage 植入仍然是一个技术挑战。本研究旨在探讨使用窄面融合 cage 在全内镜微创经椎间孔腰椎间融合术（MIS-TLIF）中治疗腰椎退行性疾病的可行性和有效性。

材料与方法

自 2013 年 6 月至 2014 年 12 月，我院共收治 42 例（男 23 例，女 19 例）接受全内镜 MIS-TLIF 的患者。所有患者均选择 8mm 宽的窄面融合 cage。记录围手术期参数和并发症。比较手术前后视觉模拟评分（VAS）和 Oswestry 功能障碍指数（ODI）评分。末次随访时，采用 Nakai 分级系统评估患者满意度；同时，通过 CT 评估椎间融合情况。

结果

平均手术时间为 233.1±69.5 分钟，术中平均出血量为 221.8±98.5ml。2 例（4.8%）患者发生神经并发症。术后随访时间为 24-36 个月（平均 27.6±3.8 个月）。术后 3 个月和末次随访时，VAS 和 ODI 评分均显著改善（P<0.05）。手术结果评定为优 32 例，良 8 例，可 2 例，优良率为 95.2%。42 例患者中有 39 例在末次随访时融合良好，融合率为 92.9%。