小切口XLIF联合侧路椎弓根钉固定治疗腰椎不稳

Clinical outcomes of XLIF through small incision approach combined with lateral pedicle screw fixation for degenerative lumbar segmental instability

目的探讨极外侧椎间融合术治疗退行性腰椎不稳的近期临床疗效。方法回顾性分析2017年01月至2018年02月应用小切口单节段XLIF联合侧路椎弓根钉棒内固定治疗退行性腰椎不稳的32例病例资料,L4/511例,L3/415例,L2/36例。采用术前及末次随访疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)及腰椎JOA评分评估临床疗效。测量术前及末次随访融合节段椎间隙高度,前凸角,活动度评估椎间融合情况。结果所有患者均获得随访,随访时间为6~18个月,平均12.5个月。手术时间(46±15)min;术中出血量(65±38)ml。VAS评分、0DI及腰椎JOA评分均较术前显著改善。术后融合节段椎间隙背侧和腹侧高度增加3.8 mm和4.4 mm,融合节段前凸角为12.4°,节段活动度为2.15°和2.35mm。总体并发症发生率为15.6%,在随访过程中得到完全缓解。结论对于退行性腰椎不稳,XLIF联合侧路椎弓根钉固定作为一种微创脊柱融合技术,可获得良好的短期疗效,具有临床应用价值。

Objective To evaluate the clinical outcomes of extreme lateral interbody fusion for the treatment of degenerative lumbar segmental instability. Methods 32 cases underwent XLIF through small incision approach combined with lateral pedicle screw fixation from January 2017 to February 2018. The distribution of operative level was 11 cases at L4/5,15 cases at L3/4,and 6 cases at L2/3. Clinical outcomes were evaluated using visual analogue scale(VAS),Oswestry disability questionnaire(ODI)scores and JOA score of lumbar spine before surgery and at the last follow-up outcomes.The pre- and postoperative edge height of intervertebral space, segmental lordotic angle and lumbar range of motion were tested and compared. Results All patients were followed up for 6 to 18 months.The operation lasted with a mean duration of(46± 15)min.Blood loss was a mean of(65±38)ml. Overall,VAS score,ODI score and JOA score of lumbar spine at the last follow-up were significantly improved. Trailing edge and leading edge height of intervertebral space increased by 3.8 mm and 4.4 mm, respectively. Postoperative segmental lordotic angle was 12.4° and lumbar range motion were 2.15° and 2.35 mm. The total incidence of complications was 15.6%,and all symptoms resided during follow-up.Conclusions Treatment of degenerative lumbar segmental instability with XLIF through small incision approach combined with lateral pedicle screw fixation is an effective minimally invasive spine surgery that has showed excellent short-term outcomes.