Lateral and posterior single cage combined with unilateral pedicle screw fixation for lumbar degenerative disease

doi:10.3969/j.issn.2095-4344.2014.04.009

Abstract

Abstract:

BACKGROUND: Most of lumbar degenerative diseases, such as lumbar instability, lumbar disc herniation and discogenic lumbago, need lumbar spinal fusion for the spine stability, but the choice of internal fixation approaches is controversial.

OBJECTIVE: To compare the effectiveness between lateral lumbar interbody fusion with single cage and single cage combined with unilateral pedicle screw fixation for the 4^th and 5^th single-level lumbar degenerative disease.

METHODS: The clinical data of patients with single-level lumbar degenerative diseases (L₄ and L₅) undergoing lateral lumbar interbody fusion with single cage in 30 cases (experimental group) and single cage combined with unilateral pedicle screw fixation in 45 cases (control group) were analyzed retrospectively, and the curative effects were compared between the two groups.

RESULTS AND CONCLUSION: All patients in the two groups were followed up for 13 months on average (ranged from 10 to 37 months). The incisions in the two groups were stage I healing. One case in the experimental group occurred cage displacement, but no obvious syndromes were detected. No significant difference in the effective rate after operation, hospital stay, and volume of drainage was detected (P > 0.05). The operative time and bleeding volume in experimental group were better than those in the control group (P < 0.05). ODI and JOA scores were significantly improved after treatment when compared with preoperative ones in the two groups (P < 0.05), but no significant difference was visible between the two groups (P > 0.05). The effectiveness of lateral lumbar interbody fusion with single cage and single cage combined with unilateral pedicle screw fixation for single-level degenerative lumbar diseases was similar. However, the former has the advantages of less invasion and quick recovery.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: lumbar vertebrae, intervertebral disk, intervertebral disk degeneration, internal fixators, bone transplantation

CLC Number:

R318

Yan Dong-xue, Huang Yong-ji, Ma Guang-bin, Luo Jun, Hu Jun-zu, Xiao Rong-chi. Lateral and posterior single cage combined with unilateral pedicle screw fixation for lumbar degenerative disease[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(4): 541-546.

Figures/Tables 2

2.4 两组患者ODI指数及JOA评分结果内固定前、内固定后2周、末次随访的ODI指数及JOA评分，与内固定前比较，内固定后2周及末次随访的ODI指数及JOA评分均有明显改善(P < 0.05)，末次随访的ODI及JOA均优于内固定后2周。组间比较内固定前、内固定后2周、末次随访两组比较，差异均无显著性意义(P > 0.05)(表3)。 2.5 典型病例分析病例一：试验组，男性患者，47岁，下腰部疼痛两年，诊断为腰椎间盘突出症，椎间盘源性腰痛。采用侧路单椎间融合器椎间融合治疗，术后随访12个月以上患者X射线平片见骨桥形成，椎间融合器周围有骨桥连接上下椎体效果满意(图1)。病例二：对照组，男性患者，54岁，腰部疼痛5年伴左下肢麻木胀痛2年，诊断为腰椎间盘突出症并神经根受压，椎间盘源性腰痛。采用后路单椎间融合器联合单侧钉棒内固定椎间融合，内固定后随访12个月以上患者X射线平片见钉棒固定位置良好，椎间融合器位置良好，周围骨桥形成，融合效果满意(图2)。 2.6 不良反应及并发症分析试验组30例患者内固定后随访12-36个月(平均14个月)，内固定后症状明显缓解者28例，轻度缓解者2例，有效率100%。末次随访腰痛改善情况：优23例，良4例，可3例，优良率90%，内固定后随访12个月以上患者X射线平片见骨桥形成，椎间融合器周围有骨桥连接上下椎体。治疗前Ⅱ度滑脱1例内固定后出现椎间融合器右侧移位，但未引起疼痛等不是症状。对照组45例患者随访10-37个月(平均12.5个月)，内固定过程中1例硬脊膜破裂立即行修补后未发生脑脊液漏；1例有神经根牵拉损伤术后引起下肢疼痛，对症处理1周后症状消失；内固定后无切口感染，钉棒断裂、松动及椎间融合器移位、脱出者。末次随访腰痛改善情况：优35例，良6例，可4例，优良率91.1%，椎间融合率100%。"

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