Tsai Cheng-Yu, Su Yu-Feng, Kuo Keng-Liang, Ko Huey-Jiun, Su Hui-Yuan, Wu Chieh-Hsin, Chou Yu-Lin, Lin Chih-Lung, Tsai Tai-Hsin
PhD Program in Environmental and Occupational Medicine, College of Medicine, Kaohsiung Medical University, National Health Research Institutes, Kaohsiung, Taiwan.
School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Oper Neurosurg. 2021 May 13;20(6):535-540. doi: 10.1093/ons/opab009.
Spine fusion surgery in osteoporosis remains controversial because it is related to a high incidence of osteoporosis-related complications, such as cage nonfusion, pedicle screw loosening, and new vertebral compression fractures (VCFs).
To treat 2-level degenerative lumbar disease in osteoporosis patients as an effective and safe surgical treatment for long-term results using minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).
We retrospectively assessed 12 patients with osteoporosis who underwent MIS-TLIF on L4 and L5 between 2011 and 2012 to assess the clinical and radiographic results for 2-level lumbar degenerative spine disease. All patients were followed-up for at least 2 yr after surgery and assessed by using X-ray. Basic patient data and clinical and radiological outcomes were collected and analyzed.
Of all 12 patients, 11/12 (91.6%) and 1/12 (8.3%) demonstrated cage fusion and cage subsidence, respectively. Pedicle screw loosening was found in 1/12 (8.3%) patients. The P-values calculated using the F-test for changes in the vertebral body height pre- and postoperation in L3, L4, and L5 were .69, .87, and .39, respectively. The data revealed no significant variants of new VCFs.
MIS-TLIF provided a high cage fusion rate and low pedicle screw loosening rate in patients with osteoporosis with 2-level degenerative spine disease. Furthermore, no new VCFs were found in long-term follow-up. The clinical outcomes also demonstrated no significant difference compared with traditional open spine fusion surgery. Therefore, MIS-TLIF could be considered an effective and safe surgical treatment modality for 2-level degenerative spine disease in osteoporosis.
骨质疏松症患者的脊柱融合手术仍存在争议，因为它与骨质疏松相关并发症的高发生率有关，如椎间融合器不融合、椎弓根螺钉松动和新的椎体压缩骨折（VCF）。
采用微创经椎间孔腰椎椎体间融合术（MIS-TLIF）作为一种有效且安全的手术治疗方法，治疗骨质疏松症患者的二级退变性腰椎疾病，并观察长期疗效。
我们回顾性评估了2011年至2012年间接受L4和L5节段MIS-TLIF手术的12例骨质疏松症患者，以评估二级腰椎退变性脊柱疾病的临床和影像学结果。所有患者术后至少随访2年，并通过X线进行评估。收集并分析患者的基本数据以及临床和放射学结果。
12例患者中，11/12（91.6%）椎间融合器融合，1/12（8.3%）椎间融合器下沉。1/12（8.3%）的患者出现椎弓根螺钉松动。L3、L4和L5椎体高度术前和术后变化的F检验计算的P值分别为0.69、0.87和0.39。数据显示新的VCF无明显变化。
MIS-TLIF在患有二级退变性脊柱疾病的骨质疏松症患者中提供了较高的椎间融合器融合率和较低的椎弓根螺钉松动率。此外，长期随访未发现新的VCF。临床结果与传统开放性脊柱融合手术相比也无显著差异。因此，MIS-TLIF可被认为是治疗骨质疏松症患者二级退变性脊柱疾病的一种有效且安全的手术治疗方式。
