Boktor Joseph Gamal, Pockett Rhys D, Verghese Navin
Department of Spine, Morriston Hospital, Swansea, UK.
Swansea Centre for Health Economics, College of human and Health Sciences, Swansea University, Swansea, UK.
J Craniovertebr Junction Spine. 2018 Jan-Mar;9(1):50-55. doi: 10.4103/jcvjs.JCVJS_21_18.
This was a retrospective, observational study.
We hypothesize that the expandable transforaminal lumbar interbody fusion (TLIF) cage achieves satisfactory clinical outcomes while allowing for safe placement, improvement, and maintenance of foraminal and disc dimensions at 24 months postsurgery with low risk of cage migration, subsidence, and nerve injury.
TLIF with expandable cages was performed in 54 patients (62 levels) over a 24-month-period using open midline or minimally invasive surgery techniques with placement of Globus Caliber, Rise, or Altera expandable cages. All patients underwent clinical and radiological assessment at 6 weeks, 6 months, 1, and 2 years postoperatively. Clinical outcome was measured by Oswestry disability index (ODI), visual analog pain score for both back and leg (visual analog scores [VASs]). Radiological assessment was done by X-ray standing lateral position.
There were significant clinical improvements in ODI, VAS leg, and VAS back at all postoperative time points. Disc height, foraminal height, focal Cobb angle, and global Cobb angle were significantly increased and maintained at all time points for 24 months ( < 0.001). Dural tear occurred in one patient (1.9%). There were neither intra- or postoperative neurological complications nor cage subsidence nor migration.
These preliminary results indicate that the use of an expandable interbody cage achieves good clinical outcomes by improving and maintaining foraminal dimensions and disc height with minimal complication rate.
这是一项回顾性观察研究。
我们假设，可扩张经椎间孔腰椎椎间融合（TLIF）椎间融合器在术后24个月能实现令人满意的临床效果，同时能安全置入，并改善和维持椎间孔及椎间盘尺寸，且椎间融合器移位、下沉及神经损伤风险低。
在24个月期间，对54例患者（62个节段）采用开放中线或微创手术技术进行带可扩张椎间融合器的TLIF手术，置入Globus Caliber、Rise或Altera可扩张椎间融合器。所有患者在术后6周、6个月、1年和2年接受临床和影像学评估。临床疗效通过Oswestry功能障碍指数（ODI）、腰背部和腿部视觉模拟疼痛评分（视觉模拟评分[VAS]）进行测量。影像学评估通过站立位X线侧位片进行。
在所有术后时间点，ODI、腿部VAS和腰背部VAS均有显著临床改善。椎间盘高度、椎间孔高度、局部Cobb角和整体Cobb角在所有时间点均显著增加并在24个月内保持稳定（<0.001）。1例患者（1.9%）发生硬脊膜撕裂。术中及术后均未出现神经并发症，也没有椎间融合器下沉或移位。
这些初步结果表明，使用可扩张椎间融合器通过改善和维持椎间孔尺寸及椎间盘高度，并发症发生率极低，从而取得了良好的临床效果。
