单侧TLIF单边固定治疗复发性腰椎间盘突出症

Surgical treatment of recurrent lumbar disc herniation by transforaminal lumbar interbody fusion using unilateral pedicle screw fixation

目的探讨运用单侧TLIF单边固定治疗复发性腰椎间盘突出症的临床疗效。方法 25例经保守治疗无效的复发性腰突症患者采用单侧TLIF辅以单边固定治疗,24例为同侧单节段突出,其中L_（4/5）节段18例,L_5/S_1节段6例;1例为对侧双节段突出。根据术前术后JOA评分、满意度指数及影像学结果评价手术疗效,并分析并发症。结果 JOA平均评分由术前9.9分提升至术后26.0分,平均改善率为83.7%（55.6%-100%）,对手术的满意度为93.8%。所有节段均获融合,无内固定失效,椎间隙高度恢复并维持良好。1例患者出现浅层感染。结论单侧TLIF单边固定治疗复发性腰椎间盘突出症有良好的早中期疗效,远期疗效有待进一步观察。

Objective The aim was to evaluate the efficacy of transforaminal lumbar interbody fusion（TLIF） using unilateral pedicle screw fixation in the treatment of recurrent lumbar disc herniation（RLDH）. Methods Twenty-five RLDH patients underwent reoperation with the TLIF after failure of conservative treatment. 24 patients were ipsilateral reherniation（L_（4/5）18 cases and L_5/S_16 cases）. 1 was two levels（L_（4/5）and L_5/S_1） contralateral disc reherniation. The surgical results were evaluated using Japanese Orthopedic Association score（JOA score） and patient satisfied index（PSI）. Complications and radiographic were reviewed. Results The mean JOA score increased from 9.9 to 26.0, the mean recovery rate was 83.7%（55.6% to 100%）. Satisfactory clinical results rate was 93.8%. All levels achieved successful fusions,the disc space height at the herniated levels was fairly well reconstructed and maintained, no patient had evidence of implant failure. Only one underwent superficial infection. Conclusion The early and mid-term efficacy of transforaminal lumbar interbody fusion（TLIF） with unilateral pedicle screw fixation in the treatment of recurrent lumbar disc herniation was satisfied, the long-term efficacy need further study.