单节段腰椎退变不稳并神经根管狭窄手术治疗的初步报告

Surgical treatment of single level unstable degeneration with foraminal stenosis

目的 探讨应用腰椎侧后方斜向单枚BAK椎间融合器椎间融合及小关节螺钉固定术治疗单节段腰椎退变不稳并神经根管狭窄的治疗效果。 方法 采用后路腰椎侧后方对神经根管彻底减压 ,由侧后方斜向植入单枚BAK椎间植骨融合器 ,再经棘突根部向对侧未减压的小关节植入 1枚小关节螺钉固定的方法 ,治疗单节段腰椎退变不稳并神经根管狭窄患者 30例 ,男 13例 ,女 17例 ,平均年龄 46 5岁 ;其中融合节段为L3～ 4 者 4例 ,L4～ 5者 15例 ,L5～S1者 11例。 结果 全部患者均安全完成手术 ,未出现神经系统并发症 ,术前症状完全缓解。经 6～ 18个月随访 ,临床融合率为93 3% ;临床疗效 :优 2 3例 ,良 4例 ,可 3例 ,优良率 90 %。 结论 采用上述手术方法能尽可能的保留脊柱后部结构 ,从而在充分减压的前提下 ,保持了脊柱的稳定性 ,同时完成了植骨融合 ;近期随访结果表明 ,临床疗效是肯定的。

Objectives [WT5”BZ]Lumbar spine single level unstable degeneration with foraminal stenosis was treated with unilateral decompression, disc excision, posterolateral interbody fusion utilizing single BAK cage and count lateral facet joint screw fixation. The short term and mid term clinical results were evaluated. [WT5”HZ]Methods [WT5”BZ]There were thirty patients (13 male, 17 female) with an average age of 46 5 years. From posterior approach, all patients underwent unilateral decompression, disc excision, interbody fusion with posterolateral inserted single BAK cage, and count lateral facet joint screw fixation. [WT5”HZ]Results [WT5”BZ]All patients underwent surgery safely without severe complications occurred such as infection and neurological damages. The average follow up time was 12 months (6-18 months) with complete relief of symptoms. Solid fusion was achieved in all but 2 patients at final follow up. 90% of the patients obtained successful clinical outcome. [WT5”HZ]Conclusions [WT5”BZ]Complete decompression of the neural foramen can relief the symptoms, and interbody fusion utilizing threaded cage can restore the height of disc space and withstand axial loading of the spine. Addition of the facet joint fixation increased the postoperative segment stability and enhances solid fusion. With less invasive and preservation of part of the posterior elements of the lumbar spine and the solid fusion achieved, we consider it a sound procedure for the treatment of single level unstable degeneration with foraminal stenosis of lumbar spine. Long term follow up results needs to be observed. [WT5”HZ]