Humke T, Grob D, Dvorak J, Messikommer A
Spine Unit, Schulthess Hospital, Zürich, Switzerland.
Spine (Phila Pa 1976). 1998 May 15;23(10):1180-4. doi: 10.1097/00007632-199805150-00021.
In a retrospective study, the long-term results of translaminar facet screw fixation of the lumbar and lumbosacral spine are reviewed.
To evaluate the clinical results, fusion rates and complications of this posterior fusion technique in various conditions of the lumbar spine.
Posterior fusion of the lumbar and lumbosacral spine is one of the possible methods to relieve pain and eliminate instability in degenerative conditions. Data in the literature support the use of internal fixation to optimize the rate of fusion.
Posterior lumbar and lumbosacral fixation with translaminar screws and fusion in 173 patients with degenerative changes with or without compressive syndromes including failed back syndromes, monosegmental hypermobilities, and posttraumatic conditions were investigated. Fixation and fusion with translaminar screws was performed in 57% monosegmentally, in 40% across two segments and in 2% over three segments. Decompressive surgery was performed in addition in 52% and nucleotomy in 30% of the cases. Clinical and radiologic assessment with flexion/extension x-rays was performed in 145 (83%) patients by two independent orthopedic surgeons. After an average follow-up of 68 months (range, 52-83).
Ninety-four percent of the patients showed solid bony fusion in the radiologic follow-up. Loosening of the screws was noted in 3%, and two screws were broken without apparent motion on the functional x-rays. Pain scores decreased from 7.6 before surgery to 2.9 after surgery on a 10-point pain scale. The results were further analyzed according to Stauffer and Coventry with 99 good results, 70 satisfactory results, and 4 bad results.
Translaminar screw fixation offers an immediate postoperative stability of the lumbar and lumbosacral spine and enhances fusion. In the present series no neurologic complications were noted. It represents a useful and inexpensive technique for short segment fusion of the nontraumatic lumbar and lumbosacral spine.
在一项回顾性研究中，对腰椎和腰骶椎经椎板小关节螺钉固定的长期结果进行了回顾。
评估这种后路融合技术在腰椎各种情况下的临床结果、融合率及并发症。
腰椎和腰骶椎后路融合是缓解退行性疾病疼痛和消除不稳定的可能方法之一。文献数据支持使用内固定来优化融合率。
对173例有或无压迫综合征（包括腰椎术后失败综合征、单节段活动度过大及创伤后情况）的退行性改变患者进行经椎板螺钉后路腰椎和腰骶椎固定及融合术。经椎板螺钉固定融合单节段的占57%，跨两个节段的占40%，超过三个节段的占2%。另外，52%的病例进行了减压手术，30%的病例进行了髓核摘除术。由两名独立的骨科医生对145例（83%）患者进行了屈伸位X线片的临床和影像学评估。平均随访68个月（范围52 - 83个月）。
在影像学随访中，94%的患者显示有坚实的骨融合。3%的患者出现螺钉松动，2枚螺钉断裂，但在功能位X线片上未见明显移位。疼痛评分从术前的7.6分（满分10分）降至术后的2.9分。根据Stauffer和Coventry标准进一步分析结果，99例结果良好，70例结果满意，4例结果不佳。
经椎板螺钉固定可提供腰椎和腰骶椎术后即刻稳定性并促进融合。在本系列研究中未发现神经并发症。它是一种用于非创伤性腰椎和腰骶椎短节段融合的实用且经济的技术。
