Huang Yifan, Chen Jian, Gao Peng, Gu Changjiang, Fan Jin, Hu Zhiyi, Cao Xiaojian, Yin Guoyong, Zhou Wei
Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, People's Republic of China.
BMC Musculoskelet Disord. 2021 Feb 8;22(1):156. doi: 10.1186/s12891-021-04026-w.
Bilateral decompression via unilateral approach (BDUA) is an effective surgical approach for treating lumbar degenerative diseases. However, no studies of prognosis, especially the recovery of the soft tissue, have reported using BDUA in an elderly population. The aims of these research were to investigate the early efficacy of the bilateral decompression via unilateral approach versus conventional approach transforaminal lumbar interbody fusion (TLIF) for the treatment of lumbar degenerative disc disease in the patients over 65 years of age, especially in the perioperative factors and the recovery of the soft tissue.
The clinical data from 61 aging patients with lumbar degenerative disease who received surgical treatment were retrospectively analyzed. 31 cases who received the lumbar interbody fusion surgery with bilateral decompression via unilateral approach (BDUA) were compared with 30 cases who received conventional approach transforaminal lumbar interbody fusion. The radiographic parameters were measured using X-ray including lumbar lordosis angle and fusion rate. Japanese Orthopedic Association (JOA), Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores were used to evaluate the clinical outcomes at different time points. Fatty degeneration ratio and area of muscle/vertebral body were used to detect recovery of soft tissue.
The BDUA approach group was found to have significantly less intraoperative blood loss(p < 0.05) and postoperative drainage(p < 0.05) compared to conventional approach transforaminal lumbar interbody fusion group. Symptoms of spinal canal stenosis and nerve compression were significantly relieved postoperatively, as compared with the preoperative state. However, the opposite side had a lower rate of fatty degeneration (9.42 ± 3.17%) comparing to decompression side (11.68 ± 3.08%) (P < 0.05) six months after surgery in the BDUA group. While there were no significant differences (P > 0.05) in two sides of conventional transforaminal lumbar interbody fusion approach group six months after surgery.
Bilateral decompression via unilateral approach (BDUA) is able to reduce the intraoperative and postoperative body fluid loss in the elderly. The opposite side of decompression in BDUA shows less fatty degeneration in 6 months, which indicates better recovery of the soft tissue of the aging patients.
单侧入路双侧减压（BDUA）是治疗腰椎退行性疾病的一种有效手术方法。然而，尚无关于预后，尤其是软组织恢复情况的研究报道在老年人群中使用BDUA。本研究的目的是探讨单侧入路双侧减压与传统经椎间孔腰椎椎体间融合术（TLIF）治疗65岁以上腰椎间盘退变疾病患者的早期疗效，尤其是围手术期因素和软组织的恢复情况。
回顾性分析61例接受手术治疗的老年腰椎退行性疾病患者的临床资料。将31例行单侧入路双侧减压腰椎椎体间融合术（BDUA）的患者与30例行传统经椎间孔腰椎椎体间融合术的患者进行比较。使用X线测量影像学参数，包括腰椎前凸角和融合率。采用日本骨科学会（JOA）评分、视觉模拟量表（VAS）和Oswestry功能障碍指数（ODI）评估不同时间点的临床疗效。通过脂肪变性率和肌肉/椎体面积检测软组织的恢复情况。
与传统经椎间孔腰椎椎体间融合术组相比，BDUA组术中出血量（p < 0.05）和术后引流量（p < 0.05）明显更少。与术前状态相比，术后椎管狭窄和神经受压症状明显缓解。然而，BDUA组术后6个月时，减压对侧的脂肪变性率（9.42±3.17%）低于减压侧（11.68±3.08%）（P < 0.05）。而传统经椎间孔腰椎椎体间融合术组术后6个月两侧无显著差异（P > 0.05）。
单侧入路双侧减压（BDUA）能够减少老年人术中及术后的体液丢失。BDUA减压对侧在6个月时脂肪变性较少，这表明老年患者软组织恢复较好。
