改良腰椎侧方融合加后路固定治疗退变性侧凸

Staged modified lumbar lateral fusion combined with posterior instrumentation for degenerative lumbar scoliosis

[目的]探讨改良腰椎直接侧路椎间矫形融合手术联合后路椎弓根螺钉固定,对腰椎退变性侧凸冠状位和矢状位失衡矫正的安全性和疗效。[方法]腰椎退变性侧凸患者36例,一期行改良腰椎直接侧路椎间矫形融合手术治疗,二期经椎旁肌间隙植入椎弓根螺钉,必要时选择性减压。记录手术时间、术中出血量、术后并发症发生率,比较不同时间点ODI功能障碍指数、腰背VAS评分以及SF-36评分,以及腰椎侧凸角度(Cobb角)、腰椎前凸角度(LL)、椎间孔高度、椎间隙高度、椎间孔面积及椎管面积变化。[结果]所有患者均顺利接受2次手术,其中4例二期同时行神经根减压。随访3～15个月,所有患者术后腰痛症状明显缓解,腿痛症状消失。术后ODI评分和腰背VAS评分均较术前明显降低(P<0.01),并随术后时间延长显著降低(P<0.05)。术后6个月SF-36因子评分较术前明显升高,差异具有统计学意义(P<0.05)。影像测量方面,术后侧凸Cobb角较术前明显降低,差异具有统计学意义(P<0.01),而前凸角度、椎间孔高度、椎间隙高度、椎间孔面积、椎管面积较术前明显升高,差异具有统计学意义(P<0.01)。[结论]改良直接侧路椎间融合术治疗腰椎退变性侧凸安全、有效,可同时纠正的冠状面和矢状面失稳并增加椎管容积,二期后路固定到达360°的稳定。

[Objective] To evaluate the safety and clinical outcomes of staged modified lumbar lateral intervertebral fusion combined with posterior instrumentation for the correction of coronal and sagittal imbalance of lumbar degenerative scoliosis.[Methods] A total of 36 patients underwent modified intervertebral fusion through direct lateral approach at the first stage, combined with posterior instrumentation through paraspinal approach at the second stage, and decompression added if necessary.The operation time, intraoperative blood loss and postoperative complication were recorded. The ODI, VAS and SF-36 scores,as well as radiographic measurements including lumbar scoliosis Cobb angle, lumbar lordosis angle, intervertebral foramen height, intervertebral space height, the foramen area and canal area were compared between different time points. [Results] All patients had two times operation performed smoothly and 4 patients were added with decompression at the second stage. The follow-up period lasted from 3 to 15 months. All the patients got considerably relief of back pain and complete disappearance of leg pain after operation. The ODI and VAS scores significantly decreased after operation compared those before operation(P<0.05), and further significantly declined as time went on postoperatively(P<0.05). In addition, the SF-36 scores significantly increased at 6 months after operation compared with that preoperatively(P<0.05). Regarding to radiographic measures, the scoliosis Cobb angle significantly decreased, while the lordosis angle, intervertebral foramen height, intervertebral space height, the foramen area and canal area significantly increased postoperatively by comparison with those before operation(P<0.05). [Conclusion] The modified direct lateral interbody fusion is safe and effective for treatment of lumbar degenerative scoliosis, and takes advantages of concurrent correction of the imbalances in both coronal and sagittal planes, enlargement of the spinal canal area, and improvement of stable circumferential fusion by combination with the posterior instrumentation at the second stage.