Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China.
Orthop Surg. 2021 May;13(3):1077-1085. doi: 10.1111/os.12929. Epub 2021 Mar 21.
The aim of the present study was to use a gelatin sponge impregnated with dexamethasone, combined with minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and no drainage tube after the operation for early postoperative recurrence of root pain caused by edema.
A prospective case series study was designed. From September 2015 to January 2018, eligible patients diagnosed with lumbar degenerative disease underwent MIS-TLIF combined with a gelatin sponge impregnated with dexamethasone and no drainage tube after surgery. The short-term clinical data were collected, such as visual analog scale (VAS) scores for low back pain and leg pain preoperatively and on postoperative days (POD) 1-10, time bedridden postoperatively, and length of hospital stay postoperatively. Long-term indicators include the Japanese Orthopaedic Association (JOA) score, the Oswestry Disability Index (ODI) score, and the 36-Item Short-Form Health Survey (SF-36) score, evaluated preoperatively and 1 week, 3 months, and more than 1 year postoperatively.
Complete clinical data was obtained for 139 patients. All patients were followed up for more than 12 months (13.7 ± 3.3 months). The average bedridden period was 1.5 ± 0.4 days and hospital stays were 2.7 ± 0.9 days. The VAS score of leg and back pain on POD 1-10 were all decreased compared with preoperation (all P < 0.0001). At the last follow up, the VAS scores for back pain and leg pain (0.69 ± 0.47; 1.02 ± 0.55) and the ODI score (11.1 ± 3.5) decreased (all P < 0.0001), and the JOA score (27.1 ± 3.2) and the SF-36 (physical component summary, 50.5 ± 7.3; mental component summary, 49.4 ± 8.9) increased (all P < 0.0001) compared with preoperative values. Patients' early and long-term levels of satisfaction postoperatively were 92.8% and 97.8%, respectively. At POD 7 and the last follow-up, the improvement rate of the JOA score, respectively, was 41.8% ± 10.6% and 87.7% ± 8.2%, and clinical effects assessed as significantly effective according to the improvement rate of the JOA score was 16.5% and 66.9%, respectively. There were 2 (1.4%) cases with complications, including 1 (0.7%) case of wound infection and 1 (0.7%) case of deep vein thrombosis. There were no device-related complications or neurological injuries.
Use of a gelatin sponge impregnated with dexamethasone combined with MIS-TLIF and no drainage tube after the operation, compared with previous studies, appears to be safe and feasible to reduce recurrent back pain and leg pain after decompression in the treatment of lumbar degenerative disease.
本研究旨在使用浸有地塞米松的明胶海绵，结合微创经椎间孔腰椎体间融合术（MIS-TLIF）和术后不放置引流管，以治疗因水肿导致的根痛术后早期复发。
设计前瞻性病例系列研究。从 2015 年 9 月至 2018 年 1 月，符合条件的腰椎退行性疾病患者接受了 MIS-TLIF 联合使用浸有地塞米松的明胶海绵和术后不放置引流管。收集了短期临床数据，如术前和术后第 1-10 天的视觉模拟评分（VAS）评分，术后卧床时间和住院时间。长期指标包括日本矫形协会（JOA）评分、Oswestry 残疾指数（ODI）评分和 36 项简明健康调查（SF-36）评分，分别在术前和术后 1 周、3 个月和 1 年以上进行评估。
139 例患者获得完整的临床数据。所有患者均随访超过 12 个月（13.7±3.3 个月）。平均卧床时间为 1.5±0.4 天，住院时间为 2.7±0.9 天。术后第 1-10 天的腿部和背部 VAS 评分均低于术前（均 P<0.0001）。末次随访时，背部和腿部疼痛的 VAS 评分（0.69±0.47；1.02±0.55）和 ODI 评分（11.1±3.5）均降低（均 P<0.0001），JOA 评分（27.1±3.2）和 SF-36（生理成分摘要，50.5±7.3；心理成分摘要，49.4±8.9）均升高（均 P<0.0001）与术前相比。患者术后早期和长期的满意度分别为 92.8%和 97.8%。术后第 7 天和末次随访时，JOA 评分的改善率分别为 41.8%±10.6%和 87.7%±8.2%，根据 JOA 评分改善率评估的临床效果显著有效率分别为 16.5%和 66.9%。有 2 例（1.4%）发生并发症，包括 1 例（0.7%）伤口感染和 1 例（0.7%）深静脉血栓形成。无器械相关并发症或神经损伤。
与以往研究相比，使用浸有地塞米松的明胶海绵联合 MIS-TLIF 和术后不放置引流管似乎是安全可行的，可降低腰椎退行性疾病减压术后背部和腿部疼痛的复发率。
