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经皮双侧椎弓根螺钉固定辅助下的微创经椎间孔腰椎椎体间融合术治疗腰骶部脊柱退行性疾病:40例连续病例回顾性数据库分析及文献综述

Minimally Invasive Transforaminal Lumbar Interbody Fusion with Percutaneous Bilateral Pedicle Screw Fixation for Lumbosacral Spine Degenerative Diseases. A Retrospective Database of 40 Consecutive Cases and Literature Review.

作者信息

Millimaggi Daniele Francesco, Norcia Valerio di, Luzzi Sabino, Alfiero Tommaso, Galzio Renato Juan, Ricci Alessandro

机构信息

University of L'Aquila, Department of Life, Health and Environmental Sciences (MESVA), L'Aquila, Italy.

出版信息

Turk Neurosurg. 2018;28(3):454-461. doi: 10.5137/1019-5149.JTN.19479-16.0.

Abstract

AIM

To report our results about minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) with bilateral pedicle screw fixation, in patients with degenerative lumbosacral spine disease. To describe the indications, surgical technique and results of a consecutive series of 40 patients who had undergone MI-TLIF. Despite the limited number of clinical studies, published data suggest tremendous potential advantages of this technique.

MATERIAL AND METHODS

Forty patients with radiological findings of degenerative lumbosacral spine disease had undergone MI-TLIF between July 2012 and January 2015. Clinical outcomes were assessed by means of Oswestry Disability Index (ODI) and Health Survey Scoring (SF36) before surgery and at first year follow-up. Furthermore, the following parameters were retrospectively reviewed: age, sex, working activity, body mass index (BMI), type of degenerative disease, number of levels of fusion, operative time, blood loss, length of hospital stay.

RESULTS

Average operative time was 230 minutes, mean estimated blood loss 170 mL, average length of hospital stay 5 days. The ODI improved from a score of 59, preoperatively, to post-operative score of 20 at first year follow-up. Average SF36 score increased from 36 to 54 (Physical Health) and from 29 to 50 (Mental Health) at first year outcome evaluation.

CONCLUSION

MI-TLIF with bilateral pedicle screw fixation is an excellent choice for selected patients suffering from symptomatic degenerative lumbosacral spine disease, especially secondary to recurrent disc herniations.

摘要

目的

报告我们关于采用双侧椎弓根螺钉固定的微创经椎间孔腰椎椎体间融合术(MI-TLIF)治疗退行性腰骶椎疾病患者的结果。描述连续40例行MI-TLIF手术患者的手术指征、技术及结果。尽管临床研究数量有限,但已发表的数据表明该技术具有巨大的潜在优势。

材料与方法

2012年7月至2015年1月期间,40例有退行性腰骶椎疾病影像学表现的患者接受了MI-TLIF手术。通过Oswestry功能障碍指数(ODI)和健康调查评分(SF36)在术前及术后第一年随访时评估临床结果。此外,还对以下参数进行了回顾性分析:年龄、性别、工作活动情况、体重指数(BMI)、退行性疾病类型、融合节段数、手术时间、失血量、住院时间。

结果

平均手术时间为230分钟,平均估计失血量为170毫升,平均住院时间为5天。ODI评分从术前的59分改善至术后第一年随访时的20分。在第一年结果评估时,SF36评分的身体健康部分从36分提高到54分,心理健康部分从29分提高到50分。

结论

对于有症状的退行性腰骶椎疾病患者,尤其是继发于复发性椎间盘突出症的患者,采用双侧椎弓根螺钉固定的MI-TLIF是一个极佳的选择。

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