Single-cage interbody fusion combined with single-side pedicle screw fixation for single-side lumbar disc herniation

doi:10.3969/j.issn.2095-4344.2013.43.009

Abstract

Abstract:

BACKGROUND: As for patients with one-side backleg pain who were candidates for surgery treatment of lumbar intervertebral disc herniation, the common treatment includes lumbar vertebral plate opening and decompression, and laminectomy in combination with compression and bilateral pedicle screw fixation. However, these therapeutic approaches are not satisfactory.
OBJECTIVE: To explore the feasibility and efficiency of single-side lumbar interbody fusion and unilateral pedicle screw fixation for treatment of lumbar intervertebral disc herniation patients with one-side backleg pain.
METHODS: Forty patients with single-side lumbar disc herniation, suffering from unilateral backleg pain, were recruited from Shihezi People’s Hospital, China and were treated with single-side lumbar interbody fusion and unilateral pedicle screw internal fixation. The neurological function of patients was assayed using Japanese Orthopaedic Association score system before and after treatment, the improvement rate and excellent/good rate were calculated. Suk criterion was used to determine fusion status.
RESULTS AND CONCLUSION: The mean follow-up period for 40 patients was ranging from 6 months to
60 months. All incisions healed well, with no infection. The Japanese Orthopaedic Association score after
6 months of treatment was significantly higher than that before treatment (P < 0.05), with the excellent and good rate up to 88%. According to Suk criterion, 38 patients achieved bone graft fusion or possible fusion, with interbody fusion rate 95%, as revealed by radiographic and CT evidence. The remaining two patients were detected fusion at 9 months after treatment. Our findings indicate that, single-cage lumbar interbody fusion combined with single-side pedicle screw fixation is the feasible surgical technique and provides satisfactory effects in treating single-side lumbar disc herniation.

Key words: vertebral column, intervertebral disk displacement, internal fixator, spinal fusion, follow-up study

CLC Number:

R318

Chen Ji-feng, Sheng Wei-bin, Huang Bo, He Bo, Xu Tao. Single-cage interbody fusion combined with single-side pedicle screw fixation for single-side lumbar disc herniation[J]. Chinese Journal of Tissue Engineering Research, doi: 10.3969/j.issn.2095-4344.2013.43.009.

Figures/Tables 3

2.1 参与者数量分析按意向性处理分析，纳入短节段单侧椎弓根螺钉内固定加单枚椎间融合器置入治疗一侧腰腿疼痛为主要症状的患者40例，全部进入结果分析，无脱落。 2.2 随访结果 40例患者均获随访，时间6-60个月，按日本骨科学会(JOA)1984年制定的腰背痛手术疗效评分标准(29分法)评定，治疗前(7.65±4.97)分，治疗后(22.1±3.58)分，采用配对t 检验，差异有显著性意义 (P < 0.05)。治疗后平均改善率为77%，其中优级改善率(75%-100%)23例(58%)，良级改善率(50%-74%)12例(30%)，可级改善率为(25%-49%)5例(12.5%)，无差级改善率(0-24%)，优良率为88%。术中出血100-800 mL，平均(478±150) mL；手术时间120-270 min，平均(175±40) min。患者治疗后症状均减轻，生活质量提高。治疗后6个月行腰椎正侧位、屈伸侧位X射线片提示椎弓根螺钉位置良好，无松动、断裂；腰椎椎间融合，椎间融合器无移位，无沉降，内固定无松动、断裂。对于可疑融合的患者，行CT检查，进一步判断融合情况。按Suk标准评定治疗后6个月后复查的影像学资料，有38例患者影像学资料符合确认植骨融合或可能融合，椎间融合率为95%。剩余2例患者在治疗后9个月随访时达到上述标准。 2.3 典型病例女性患者，41岁，以“腰背部及右下肢酸胀疼痛9月余”为主诉入院。查体：患者腰椎有明显侧弯畸形，腰背部叩痛明显，右下肢放射痛，椎旁肌紧张，腰椎活动因疼痛明显受限，尤以前屈位最甚。右下肢股神经牵拉试验(-)，直腿抬高试验(+)加强试验(+)，右小腿外侧皮肤感觉麻木，鞍区无麻木，肛门括约肌收缩功能存在，双下肢肌力肌张力未见异常。采用短节段单侧椎弓根螺钉内固定加单枚椎间融合器置入治疗，治疗前后影像学资料见图1-6。"

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