采用带螺纹圆柱形聚醚醚酮椎间融合器的独立前凸内镜下楔形腰椎椎间融合术(LEW-LIF™):两例报告。
Standalone lordotic endoscopic wedge lumbar interbody fusion (LEW-LIF™) with a threaded cylindrical peek cage: report of two cases.
作者信息
Ramírez León Jorge Felipe, Ardila Álvaro Silva, Rugeles Ortíz José Gabriel, Martínez Carolina Ramírez, Alonso Cuéllar Gabriel Oswaldo, Infante Jefferson, Lewandrowski Kai-Uwe
机构信息
Fundación Universitaria Sanitas, Bogotá, D.C., Colombia.
Research Team, Centro de Columna, Bogotá, Colombia.
出版信息
J Spine Surg. 2020 Jan;6(Suppl 1):S275-S284. doi: 10.21037/jss.2019.06.09.
We report two cases of a standalone lordotic endoscopic wedge lumbar interbody fusion (LEW-LIF™) with a stress-neutral non-expandable cylindrical threaded polyether ether ketone (PEEK) interbody fusion implant. Patients underwent full-endoscopic transforaminal decompression and fusion for symptomatic lateral recess stenosis due to disc herniation, and hypertrophy of the facet joint complex and ligamentum flavum and no more than grade I spondylolisthesis. Lumbar interbody fusion with cages traditionally calls for posterior supplemental fixation with pedicle screws for added stability. A more simplified version of lumbar decompression and fusion without pedicle screws would allow treating patients suffering from stenosis and instability induced sciatica-type low back and leg pain in an outpatient ambulatory surgery center setting (ASC). This would realize a significant reduction in cost as well as the burden to the patient with decreased postoperative pain and earlier return to function. A 62-year-old female patient had surgery at L4/5 for a 6-year history of worsening right sided sciatica-type leg- and low back pain. Another 79-year-old female had the same surgical management at L4/5 for a 5-year history of unrelenting left-sided spondylolisthesis-related symptoms. Both patients had an uneventful postoperative course until the last available follow-up of 24 weeks with greater than 60% VAS and Oswestry disability index (ODI) reductions. There was no evidence of implant expulsion, subsidence, or postoperative instability. We concluded that standalone outpatient lumbar transforaminal endoscopic interbody fusion with a non-expandable threaded cylindrical cage is feasible, and favorable clinical outcomes provide proof of concept to study long-term clinical outcomes in larger groups of patients.
我们报告了两例采用应力中性、不可扩张的圆柱形带螺纹聚醚醚酮(PEEK)椎间融合器进行独立前凸内镜下楔形腰椎椎间融合术(LEW-LIF™)的病例。患者因椎间盘突出、小关节复合体和黄韧带肥大以及不超过I度椎体滑脱导致症状性侧隐窝狭窄,接受了全内镜下经椎间孔减压融合术。传统上,腰椎椎间融合器融合需要使用椎弓根螺钉进行后路辅助固定以增加稳定性。一种更简化的无椎弓根螺钉的腰椎减压融合术版本,将允许在门诊流动手术中心环境(ASC)中治疗患有狭窄和不稳定引起的坐骨神经痛型腰腿痛的患者。这将显著降低成本,并减轻患者负担,减少术后疼痛并更早恢复功能。一名62岁女性患者因右侧坐骨神经痛型腰腿痛加重6年,在L4/5节段接受手术。另一名79岁女性因左侧椎体滑脱相关症状持续5年,在L4/5节段接受了相同的手术治疗。两名患者术后过程均顺利,直至最后一次随访24周时,视觉模拟评分(VAS)和奥斯维斯特残疾指数(ODI)降低超过60%。没有植入物脱出、下沉或术后不稳定的证据。我们得出结论,采用不可扩张的带螺纹圆柱形椎间融合器进行独立的门诊腰椎经椎间孔内镜下椎间融合术是可行的,良好的临床结果为在更大患者群体中研究长期临床结果提供了概念验证。