Scientific Center of Reconstructive and Restorative Surgery, Siberian Branch of the Russian Academy of Medical Sciences, Irkutsk, Russia; Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia; Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Scientific Center of Reconstructive and Restorative Surgery, Siberian Branch of the Russian Academy of Medical Sciences, Irkutsk, Russia; Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia; Irkutsk Railway Clinical Hospital, Irkutsk, Russia.
World Neurosurg. 2018 Jun;114:e959-e968. doi: 10.1016/j.wneu.2018.03.121. Epub 2018 Mar 26.
Anterior, direct lateral, and transforaminal lumbar interbody fusions (ALIF, DLIF, and TLIF) are usually combined with posterior fixation to treat degenerative spinal diseases. Outcomes of ALIF, TLIF, or DLIF combined with a new wedge-shaped interfacet cage plate have not been reported. We assessed early clinical outcomes of patients treated with interbody fusion and facet fixation using a titanium wedge-shaped cage plate.
This retrospective observational cohort study included patients (n = 80) who underwent 1-level interbody fusion and facet joint fixation via ALIF (n = 24) or DLIF (n = 26) with bilateral facet fixation or TLIF with ipsilateral pedicle screws and contralateral facet fixation (n = 30). Duration of surgery, estimated blood loss, pain (visual analog scale), Oswestry Disability Index (ODI) scores, and Macnab score were assessed up to 12 months after surgery.
All patients had a significant decrease in pain scores (P < 0.01) and an increase in ODI scores (P < 0.01), without significant differences between treatment groups. Most surgical outcomes were excellent or good (n = 75, 93.8%) with 5 patients (6.2%) having satisfactory outcomes. Within 2 months, all patients returned to their previous work (66, 82.5%) or lighter work (14, 17.5%). Two patients had fusion failure requiring reoperation.
Facet fixation with the wedge-shaped cage plate was associated with minimal soft tissue damage and a low level of postoperative pain. ALIF, DLIF, and TLIF combined with this technique showed good early postoperative clinical and radiologic outcomes. Further studies are needed to assess long-term results and compare them with other fusion methods.
前路、直接侧方和经椎间孔腰椎体间融合术（ALIF、DLIF 和 TLIF）通常与后路固定相结合，用于治疗退行性脊柱疾病。目前尚未报道 ALIF、TLIF 或 DLIF 联合新型楔形椎间融合 cage 板的治疗效果。我们评估了使用椎间融合和小关节固定钛楔形 cage 板治疗患者的早期临床结果。
本回顾性观察性队列研究纳入了 80 例接受 1 节段椎间融合和小关节固定的患者，其中 ALIF（n=24）或 DLIF（n=26）行双侧小关节固定，或 TLIF 行同侧椎弓根螺钉和对侧小关节固定（n=30）。评估手术时间、估计失血量、疼痛（视觉模拟评分）、Oswestry 功能障碍指数（ODI）评分和 Macnab 评分，直至术后 12 个月。
所有患者疼痛评分均显著降低（P<0.01），ODI 评分显著升高（P<0.01），但不同治疗组之间无显著差异。大多数手术结果为优或良（n=75，93.8%），5 例（6.2%）为可接受结果。术后 2 个月内，所有患者均恢复至先前工作（66 例，82.5%）或较轻工作（14 例，17.5%）。2 例患者发生融合失败，需再次手术。
使用楔形 cage 板进行小关节固定可减少软组织损伤，术后疼痛程度较低。ALIF、DLIF 和 TLIF 联合该技术具有良好的早期术后临床和影像学结果。需要进一步研究来评估长期结果，并与其他融合方法进行比较。
