Application of expandable intervertebral cage in treating recurrent lumbar intervertebral disc via posterior mini-incision

English Keywords:Lumbar disc herniation  Recurrent  Minimally invasive  Spine fusion  Lumbar instability

English Abstract:

  【Abstract】 Objectives: To explore the clinical effect of expandable intervertebral cage via posterior mini-incision for recurrent lumbar disc herniation. Methods: Retrospective analysis on patients with recurrent lumbar disc herniation from March 2014 to May 2010 was performed. In group A, 28 cases were treated with the expansion of fusion cage. Group B included 29 cases undergoing pedicle internal fixation system for lumbar interbody fusion. The Japanese Orthopedic Association(JOA) score was used to assess clinical outcome; visual analog scale(VAS) was used to evaluate low back pain; The segmental lumbar lordosis angle change was also evaluated. Postoperative lumbar X-ray and dynamic X-ray film was used to evaluate intervertebral bone graft fusion. According to the standard of Suk judgment, the cage stability was evaluated under the hyper extension and flexion position. All data were statistically analyzed. Results: In group A, the operation time was 73.0±28.6min, the length of incision was 4.1±0.4cm, the bleeding volume was 159.0±50.4ml, the drainage was 180±88.6ml, the hospitalization time was 7.5±1.2d; while in group B, the operation time was 131.0±26.8min, the length of incision was 12.3±1.6cm, the bleeding volume was 358.0±46.7ml, the drainage was 360±78.6ml, the hospitalization time was 16.6±1.5d. There were significant differences in operation time, incision length, bleeding volume, drainage volume and hospitalization time between the two groups. Follow-up time ranged from 12 to 26 months, with an average of 13.8±6.9 months. There were 3 cases in group A and 2 cases in group B suffering from cerebrospinal fluid leakage. No infection, nerve injury and instrument failure were noted. At final follow-up, bony fusion were obtained in 2 groups.In group A, JOA scores increased from 4.52±1.87 points preoperatively to 12.57±2.95 points postoperatively, with an improvement rate of (76.81±7.2)%, VAS score decreased from 4.45±1.66 points preoperatively to 1.92±0.64 points, segmental lordosis angle increased from 16.82°±1.78° preoperatively to 21.9°±1.59°; in group B, JOA scores increased from 4.71±1.62 points preoperatively to 12.31±2.86 points, with the improvement rate of (73.86±8.6)%, VAS score decreased from 4.68±1.13 points preoperatively to 2.13±1.92 points, segmental lordosis angle decreased from 17.33°±2.61° preoperatively to 15.9°±3.26°. Conclusions: The application of the expansive fusion device for recurrent lumbar disc herniation has good clinical effect, and has the advantages of less invasion, shorter hospitalization time and well maintaining of the lumbar curvature.