极外侧入路腰椎间融合术联合双侧椎弓根螺钉固定治疗腰椎滑脱症

Bilateral pedicle screw instrumented extreme lateral interbody fusion for the treatment of lumbar spondylolisthesis

中文关键词:  侧路椎间融合  微创  腰椎滑脱症  间接减压

英文关键词:Lateral interbody fusion  Minimally invasive  Spondylolisthesis  Indirect decompression

中文摘要:

  【摘要】 目的：探讨极外侧入路腰椎间融合术（extreme lateral interbody fusion，XLIF）联合双侧椎弓根螺钉固定治疗腰椎滑脱症的临床及影像学疗效。方法：回顾性分析2014年9月~2016年8月广州军区广州总医院采用XLIF联合双侧椎弓根螺钉固定治疗的单节段腰椎滑脱症患者的资料，共21例，其中女性18例，男性3例；年龄57.0±13.3岁（45~77岁），随访时间18.0±5.0个月（12~29个月）。术前及末次随访时采用疼痛视觉模拟评分（visual analogue scale，VAS） 及Oswestry功能障碍指数（Oswestry disability index，ODI）对临床疗效进行评估。术前及术后3d在轴位MRI上测量轴位椎管前后径（anterior-posterior diameter of the canal，APDC）；术前及末次随访时在侧位X线片测量椎间孔高度（foraminal height，FH）、椎间隙高度（disc height，DH），并计算滑移百分比（slipping percentage，SP）。末次随访时应用CT评估融合率及融合器塌陷率。结果：术前及末次随访时腰痛VAS评分分别为5.9±1.7分、1.7±0.7分，腿痛VAS评分分别为6.1±2.1分、1.4±0.7分，ODI分别为（42.6±24.8）%、（12.1±4.2）%，术前与末次随访比较差异均有统计学差异（P＜0.05）。术前及术后3d的APDC分别为11.2±3.8mm、12.7±4.0mm，差异具有统计学意义（P＜0.05），术前及末次随访手术节段DH分别为7.2±1.2mm、10.2±1.4mm，FH分别为17.3±2.9mm、20.0±1.7mm，SP分别为（16.4±7.0）%、（6.1±6.6）%，术前与末次随访比较差异均有统计学意义（P＜0.05）。术中无大血管损伤、腹腔脏器损伤、生殖股神经损伤等严重并发症，术后5例患者出现大腿前方麻木，症状均在3个月内缓解。2例患者出现融合器塌陷，无明显不适。所有手术节段均获得植骨融合，无内固定松动、断裂。结论：XLIF联合双侧椎弓根螺钉固定技术治疗腰椎滑脱症，椎体复位及椎管间接减压效果满意，是一种治疗腰椎滑脱症安全、有效的术式。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical outcomes and radiographic evaluation of bilateral pedicle screw instrumented (XLIF)extreme lateral interbody fusion for the treatment of lumbar spondylolisthesis. Methods: Clinical data of patients with lumbar spondylolisthesis treated with bilateral pedicle screw instrumented XLIF in Guangzhou General Hospital of Guangzhou Military Command from September 2014 to August 2016 were analyzed retrospectively. The study cohort consisted of 18 females and 3 males with an average age of 57.0±13.3(45-77) years. The mean follow-up was 18.0±5.0(12-29) months. Clinical outcomes were evaluated by using ODI(Oswestry disability index) and VAS(visual analogue scale) scores before surgery and at final follow-up. Anterior-posterior diameter of canal was assessed by MRI before surgery and 3 days after surgery. Foraminal height, disc height and slipping percentage were evaluated with plain lateral radiographs before surgery and at final follow-up. Fusion rate and cage subsidence were assessed on CT scans at final follow-up. Results: VAS scores for back pain before surgery and at final follow-up were 5.9±1.7 and 1.7±0.7 respectively. VAS scores for leg pain before surgery and at final follow-up were 6.1±2.1 and 1.4±0.7 respectively. ODI scores before surgery and at final follow-up were (42.6±24.8)% and (12.1±4.2)% respectively. VAS and ODI scores showed statistically significant improvements(P<0.05). Disc height was 7.2±1.2mm before surgery and 10.2±1.4mm at final follow-up. Foraminal height was 17.3±2.9mm before surgery and 20.0±1.7mm at final follow-up. Anterior-posterior diameter of canal was 11.2±3.8mm before surgery and 12.7±4.0mm at final follow-up. Slipping percentage was (16.4±7.0)% before surgery, and (6.1±6.6)% at final follow-up. These radiographic parameters showed statistically significant improvements(P<0.05). No severe complications associated with great vessel, abdominal visceras or genitofemoral nerve were observed. 5 patients presented with transient anterior thigh numbness, and the symptoms were resolved within 3 months. 2 patients showed cage subsidence, without obvious discomfort. Solid fusion was observed in all patients, and no fixation failure was found. Conclusions: The bilateral pedicle screw instrumented XLIF for the treatment of lumbar spondylolisthesis results in effective restoration of spondylolisthesis vertebra and an increase of the spinal canal at the operated levels via indirect decompression. XLIF is a treatment option available for lumbar spondylolisthesis, which is safe and efficienct.