Liu Jinping, Feng Hailong
Department of Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
Department of Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
World Neurosurg. 2020 Feb;134:e944-e950. doi: 10.1016/j.wneu.2019.11.046. Epub 2019 Nov 14.
This study aimed to evaluate the technical details, clinical effectiveness, and complications of oblique lateral interbody fusion supplemented with anterolateral screw-rod instrumentation in managing degenerative lumbar diseases.
The clinical data of 14 patients with lumbar degenerative diseases who underwent oblique lateral interbody fusion and anterolateral screw-rod instrumentation in the Department of Neurosurgery, Sichuan Provincial People's Hospital, from April 2015 to May 2018, were retrospectively analyzed. The duration of operation, estimated blood loss, radiological exposure, length of hospital stay, and complications were recorded. The visual analog scale score, Oswestry Disability Index, and radiologic parameters were evaluated before and after surgery.
The diagnosis included degenerative/isthmic spondylolisthesis (grade I), degenerative lumbar stenosis, disc hernia with instability, and adjacent segment disease. The follow-up period was 12-45 months. The clinical symptoms improved significantly after the operation according to the visual analog scale and Oswestry Disability Index scores. The average operation time, blood loss, and length of hospital stay were 72.50 ± 21.46 minutes, 53.21 ± 19.07 mL, and 5.57 ± 2.21 days, respectively. The postoperative radiographic examination demonstrated increased intervertebral height and foramen area (P < 0.05). The radiologic fusion rate was 95% at the last follow-up; cage subsidence was found in 1 case. No major complications, such as vascular injury, ureteral injury, or infection, occurred.
As an alternative method of instrumentation, anterolateral screw-rod fixation minimized the total operation time, blood loss, radiological exposure, and soft tissue disruption, and realized 1-stage intervertebral fusion and instrumentation through a single small incision.
本研究旨在评估斜外侧椎间融合术联合前外侧螺钉-棒系统内固定治疗退变性腰椎疾病的技术细节、临床疗效及并发症。
回顾性分析2015年4月至2018年5月在四川省人民医院神经外科接受斜外侧椎间融合术及前外侧螺钉-棒系统内固定的14例腰椎退变性疾病患者的临床资料。记录手术时间、估计失血量、放射暴露、住院时间及并发症情况。评估术前及术后的视觉模拟评分、Oswestry功能障碍指数及影像学参数。
诊断包括退变性/峡部裂性椎体滑脱（I度）、退变性腰椎管狭窄症、椎间盘疝伴不稳及相邻节段疾病。随访时间为12 - 45个月。根据视觉模拟评分和Oswestry功能障碍指数评分，术后临床症状明显改善。平均手术时间、失血量及住院时间分别为72.50±21.46分钟、53.21±19.07毫升及5.57±2.21天。术后影像学检查显示椎间高度及椎间孔面积增加（P<0.05）。末次随访时影像学融合率为95%；1例出现椎间融合器下沉。未发生血管损伤、输尿管损伤或感染等严重并发症。
作为一种替代的内固定方法，前外侧螺钉-棒固定可使总手术时间、失血量、放射暴露及软组织损伤最小化，并通过单一小切口实现一期椎间融合及内固定。
