Morgenstern Rudolf, Morgenstern Christian
Morgenstern Spine Institute, Centro Médico Teknon, Barcelona, Spain.
Int J Spine Surg. 2018 Dec 21;12(6):665-672. doi: 10.14444/5083. eCollection 2018 Dec.
We evaluated the feasibility of a full percutaneous approach with an expandable interbody cage and an interspinous spacer for a segmental stabilization of the anterior and posterior columns of the lumbar spine, respectively, with local anesthesia.
Patients were prospectively included between 2012 and 2018 in this single-center, feasibility case series. An expandable interbody cage was inserted with endoscopy-based, facet-sparing percutaneous transforaminal lumbar interbody fusion (pTLIF). An interspinous spacer was percutaneously placed through the same skin incision. Pre- and postoperative Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) outcomes at 1, 3, 6, 12, and 24 months were obtained and evaluated with the Student test. Postoperative outcome was classified according to modified Macnab criteria.
A total of 16 patients were included, presenting mean preoperative scores for VAS back of 6.9 ± 2.5, VAS leg 7.9 ± 1.2, and ODI 30.1 ± 4.5. Postoperative mean scores for VAS back of 1.9 ± 2.1, VAS leg 2.1 ± 3.4, and ODI 14.8 ± 13.0 significantly ( < .001) decreased with a mean follow-up of 18.1 ± 16.6 months (range 1-65.2). Postoperative outcome was excellent and good for 13 (81%) cases, fair for 2 (13%), and poor for 1 (6%) case with a preoperative spondylolisthesis, which required revision surgery due to persisting instability. Postoperative complications included 3 cases with transitory, ipsilateral dysesthesia and 2 cases with radiologic cage subsidence but no clinical symptoms. Median postoperative time until hospital discharge was 16 hours.
Our preliminary results for this full percutaneous technique show a similar outcome compared to conventional surgery with a fast patient recovery and early postoperative hospital discharge, opening the way to instrumented, outpatient surgery.
我们评估了在局部麻醉下，分别使用可扩张椎间融合器和棘突间撑开器对腰椎前后柱进行节段性稳定的全经皮入路的可行性。
在2012年至2018年期间，将患者前瞻性纳入这个单中心可行性病例系列研究。通过基于内镜、保留小关节的经皮椎间孔腰椎椎间融合术（pTLIF）植入可扩张椎间融合器。通过相同的皮肤切口经皮放置棘突间撑开器。获取术前及术后1、3、6、12和24个月时的视觉模拟量表（VAS）评分和Oswestry功能障碍指数（ODI）结果，并采用Student检验进行评估。根据改良Macnab标准对术后结果进行分类。
共纳入16例患者，术前VAS背痛平均评分为6.9±2.5，VAS腿痛平均评分为7.9±1.2，ODI平均评分为30.1±4.5。术后VAS背痛平均评分为1.9±2.1，VAS腿痛平均评分为2.1±3.4，ODI平均评分为14.8±13.0，在平均随访18.1±16.6个月（范围1 - 65.2个月）时显著降低（P <.001）。术后结果为优和良的有13例（81%），可的有2例（13%），差的有1例（6%），该例术前存在椎体滑脱，因持续不稳定需要翻修手术。术后并发症包括3例短暂性同侧感觉异常和2例影像学上的椎间融合器下沉但无临床症状。术后直至出院的中位时间为16小时。
我们这项全经皮技术的初步结果显示，与传统手术相比，其结果相似，患者恢复快且术后早期出院，为器械辅助的门诊手术开辟了道路。
