腰椎融合术后融合器向后移位16例临床分析

Cage Retropulsion After Lumbar Interbody Fusion:A Report of 16 Cases

目的:探讨腰椎融合术后融合器(cage)向后移位的原因及处理对策。方法:回顾性研究2004年1月至2013年1月间在我院诊治的腰椎融合术后cage向后移位的病例16例,总结分析cage移位的原因,探讨临床处理对策及原则。结果:cage移位的原因包括初次手术时cage过小、残留髓核组织过多或终板刮除不足或过多、内固定物断裂后脊柱不稳定、双枚cage之间距离太近、cage置入位置偏后。6例行保守治疗,4例有效;12例行手术翻修,其中6例单纯取出cage,6例更换更大型号的cage并加用或更换内固定。所有患者均达到骨性融合,未残留神经症状。结论:腰椎融合术后cage移位的原因复杂、多样,可能存在多种因素共同作用;并非所有病例均需要手术翻修,对于存在神经功能症状的或伴有脊柱不稳定的需要手术翻修;手术翻修时尽量从正常组织处开始分离。

Objective：To explore the cause and treatment strategy of cage retropulsion after lumbar interbody fusion.Methods：Retrospective studies were performed on 16 patients with cage retropulsion after lumbar interbody fusion during Jan 1 2004 to Jan 1 2013.The cause and treatment strategy of cage retropulsion after lumbar interbody fusion were analyzed.Results：The causes included the undersize cage,too much residual nucleus pulposus or inadequate or excessive curettage of endplate,unstable spine fixation after failure,shorten distance between the two-piece cages and position bias of cage.Six cases were treated conservatively,and four of them were effective.Revision were adopted in 12 cases,of which 6cases removed cage purely and 6cases exchanged larger size cage with internal fixation.All patients rearched the bony fusion withnot residual neurological symptoms.Conclusion：The cause of cage retropulsion after lumbar interbody fusion are complicated and varied.There might be a combination of many factors.Not all the cases need revision.The patients with neurologic symptoms or with spinal instability needs revision.The approach for the revision should not damage the neighboring normal tissue.