Discectomy plus Waveflex dynamic system for lumbar disc protrusion: no regeneration of adjacent segments

doi:10.3969/j.issn.2095-4344.2014.53.011

Abstract

Abstract:

BACKGROUND: Spine rigid fixation and fusion are the traditional surgical methods for treatment of lumbar degeneration and instability. However, there are corresponding complications and clinical satisfaction rate is not high enough. Waveflex is a dynamic semi-rigid non-fusion pedicle screw fixation system for the treatment of Iumbar degeneration and instability. It can maintain appropriately the dynamic movement at the operative segments, retain and restore the function of the damaged nucleus, and have no adverse impact on adjacent segments.
OBJECTIVE: To evaluate the short-term results of small-window discectomy combined with Waveflex non-fusion pedicle screw fixation system in treatment of lumbar disc protrusion.
METHODS: Sixty-four patients with lumbar disc protrusion were involved in this study, among them 34 cases follow-ups. Low back pains were evaluated by VAS score, JOA score and ODI. The anterioposterior and lateral X-ray and MRI of the lumbar vertebrae were recorded.
RESULTS AND CONCLUSION: The involved patients were followed up for 12-22 months. At final follow-up in two groups, the lower back pain VAS scores, JOA scores and ODI were significantly improved compared with before surgery (P < 0.05). The remission rate of lower back pain in the dynamic fixation group was better than that in the discectomy group (P < 0.05). The range of motion in the dynamic fixation group was less than that before surgery, while intervertebral height and MRI T1 values were more than before surgery (P < 0.05). There was no significant difference in the discectomy group at final follow-up and before surgery. At the final follow-up, the dynamic fixation group was better than the discectomy group in terms of controlling the range of motion, intervertebral height and nucleus pulposus restoration, but the impact on the adjacent segments was similar between the two groups. Compared with posterior discectomy surgery, small-window discectomy combined with Waveflex non-fusion pedicle screw fixation system can achieve satisfactory short-term efficacy in treatment of lumbar disc protrusion. It could promote the stability of surgical segments and accelerate the restoration of nucleus pulposus, without any impact on the degeneration of adjacent segments within a short term.

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 displacement, internal fixators, follow-up studies

CLC Number:

R318

Sun Yu-yu, Cui Zhi-ming, Zhang Jin-long, Li Wei-dong, Bao Guo-feng, Xu Guan-hua, Wang Ling-ling, Chen Jia-jia, Chen Li-min. Discectomy plus Waveflex dynamic system for lumbar disc protrusion: no regeneration of adjacent segments[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(53): 8584-8589.

Figures/Tables 1

2.1 参与者数量分析按意向性处理，纳入腰椎间盘突出症患者64例，其中弹性固定组34例，髓核摘除组30例。全部进入结果分析，无脱落。 2.2 基线资料比较见表1。 2.3 术后临床疗效比较见表2，3。所有患者手术均顺利完成，无马尾损伤、硬膜撕裂、神经根损伤、腰椎后凸畸形或棘突骨折等并发症等，患者均获随访12-22个月。两组患者术前腰痛目测类比评分、JOA评分、ODI及影像学指标的比较差异均无显著性意义(P > 0.05），弹性固定组和髓核摘除组术后1周及末次随访腰痛目测类比评分，JOA评分和ODI均较术前明显改善(P < 0.05)。同组相比末次随访手术上下节段的椎间盘高度、运动范围、髓核MRI T1值较术前无明显变化。弹性固定组末次随访手术节段的椎间盘高度、髓核MRI T1值较术前明显增加(P < 0.05)、运动范围较术前明显减少(P < 0.05)；而髓核摘除组末次随访与术前无明显差异。所有病例均未出现硬膜撕裂、内固定松动断裂、腰椎后凸畸形或棘突骨折等并发症。弹性固定组与髓核摘除组组间比较，术后1周两组腰痛目测类比评分、JOA评分及ODI差异均无显著性意义(P > 0.05)，而末次随访时两组之间差异有显著性意义(P < 0.05)，弹性固定组明显优于髓核摘除组。末次随访时手术节段的椎间盘高度及髓核MRI T1值弹性固定组也明显优于髓核摘除组。而对于手术节段活动范围的适度控制上，弹性固定组明显优于髓核摘除组 (P < 0.05)。 2.4 典型病例男性患者，45岁，左侧腰腿痛5年，入院诊断为“L5/S1椎间盘突出”，行Waveflex动态固定修复腰椎间盘突出症，治疗前后影像学资料见图1。 2.5 不良事件在患者治疗及随访过程中，无不良事件发生。"

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