Abi-Hanna David, Kerferd Jack, Phan Kevin, Rao Prashanth, Mobbs Ralph
NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Barker Street, Randwick, New South Wales, Australia.
NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Barker Street, Randwick, New South Wales, Australia.
World Neurosurg. 2018 Jan;109:188-196. doi: 10.1016/j.wneu.2017.09.153. Epub 2017 Oct 4.
Low back pain is the principal cause of long-term disability worldwide. We intend to address one of its main causes, degenerative disk disease, a spinal condition involving degradation of an intervertebral disk. Following unsuccessful conservative treatment, patients may be recommended for surgery. The two main surgical treatments for lumbar degenerative disk disease are lumbar fusion: traditional standard surgical treatment and lumbar disk arthroplasty, also known as lumbar total disk replacement. Lumbar fusion aims to relieve pain by fusing vertebrae together to eliminate movement at the joint, but it has been criticized for problems involving insignificant pain relief, a reduced range of motion, and an increased risk of adjacent segment degeneration. This leads to development of the lumbar total disk replacement technique, which aims to relieve pain replacing a degenerated intervertebral disk with a moveable prosthesis, thus mimicking the functional anatomy and biomechanics of a native intervertebral disk. Over the years a large range of prosthetic disks has been developed. The efficacy and current evidence for these prostheses are discussed in this review. The results of this study are intended to guide clinical practice and future lumbar total disk replacement device choice and design.
下腰痛是全球长期残疾的主要原因。我们打算解决其主要病因之一——椎间盘退变疾病,这是一种涉及椎间盘退变的脊柱疾病。在保守治疗失败后,患者可能会被建议进行手术。腰椎间盘退变疾病的两种主要手术治疗方法是腰椎融合术:传统的标准手术治疗方法,以及腰椎间盘置换术,也称为腰椎全椎间盘置换术。腰椎融合术旨在通过将椎体融合在一起以消除关节处的活动来缓解疼痛,但它因疼痛缓解不明显、活动范围减小以及相邻节段退变风险增加等问题而受到批评。这促使了腰椎全椎间盘置换技术的发展,该技术旨在通过用可移动的假体替换退变的椎间盘来缓解疼痛,从而模拟天然椎间盘的功能解剖结构和生物力学。多年来,已经开发出了大量的人工椎间盘。本综述讨论了这些假体的疗效和当前证据。本研究结果旨在指导临床实践以及未来腰椎全椎间盘置换装置的选择和设计。