微创经椎间孔腰椎椎体间融合固定治疗椎间盘源性脊柱侧凸:冠状面和矢状面平衡的2年随访

Minimally invasive transforaminal lumbar interbody fusion in the treatment of sciatic scoliosis caused by lumbar disc herniation:a 2-year follow-up of coronal and sagittal balance

背景:椎间盘源性脊柱侧凸为神经根受到激惹刺激后所引起的身体躯干偏移倾斜,若治疗不及时,极有可能发展成为结构性侧凸畸形,关于其治疗仍存在较大争议。目的:比较微创经椎间孔腰椎椎体间融合治疗椎间盘源性脊柱侧凸的安全性和有效性。方法:回顾性分析2010年1月至2014年1月北京大学人民医院收治的47例椎间盘源性脊柱侧凸患者,主诉为严重腰背痛伴下肢放射痛,同时伴躯干倾斜。25例行开放经椎间孔腰椎椎体间融合治疗(开放组),22例行微创经椎间孔腰椎椎体间融合治疗(微创组),2组患者均行单节段手术,随访时间均在2年以上。比较2组患者的临床疗效和影像学参数变化情况。结果与结论:①2组患者术前一般资料包括年龄、性别、手术节段以及冠状面和矢状面参数差异均无显著性意义(P>0.05);②2组患者手术时间差异无显著性意义(P>0.05),微创组出血量、术后下地时间、平均住院日均优于开放组,差异有显著性意义(P<0.05);③临床疗效评分:与术前相比,术后6个月、2年2组患者目测类比评分和Oswestry功能障碍指数均得到明显改善(P<0.05),同一时间点2组间比较差异无显著性意义(P>0.05);④冠状面和矢状面平衡:术后2年畸形情况均较术前得到明显改善(P<0.05),同一时间点2组间比较差异无显著性意义(P>0.05);⑤2组患者均获得坚固融合;⑥提示微创经椎间孔腰椎椎体间融合治疗单节段椎间盘源性脊柱侧凸能够获得与开放手术相似的安全有效的效果,并且具有出血少、恢复快、住院时间短等优点。

BACKGROUND:The sciatic scoliosis is considered as a compensatory attempt of the body to relieve nerve irritation.If dealt with inappropriate and delayed,it may be developed in structural scoliosis.There was controversial about the treatment of such cases.OBJECTIVE:To compare the safety and effectiveness of single-level open versus minimally invasive transforaminal lumbar interbody fusion in the treatment of sciatic scoliosis caused by lumbar disc herniation.METHODS:Data of 47 patients with sciatic scoliosis caused by lumbar disc herniation who were treated in Peking University People’s Hospital from January 2010 to January 2014 were retrospectively analyzed.The main symptom was severe back and lower limb pain,complicated with trunk tilt.Twenty-five patients underwent single-level open transforaminal lumbar interbody fusion therapy(open group).Twenty-two patients underwent minimally invasive transforaminal lumbar interbody fusion therapy(minimal invasion group).The single-level surgery was conducted in both groups.The patients were followed up for at least 2 years.The clinical effects and photographic parameters were compared between the two groups.RESULTS AND CONCLUSION:(1)There was no significant difference in age,gender,spinal levels operated and all the coronal and sagittal parameters preoperatively between the two groups(P>0.05).(2)There was no significant difference in operation time between the two groups(P>0.05).The amount of bleeding,postoperative time to the ground,and average length of hospital stay were better in the minimal invasion group than in the open group(P<0.05).(3)Clinical efficacy score:Compared with preoperatively,visual analogue scale score and Oswestry disability index were significantly improved in both groups at 6 months and 2 years after operation(P<0.05).No significant difference was found at the same time point in both groups(P>0.05).(4)Balance of coronal plane and sagittal plane:The deformity at 2 years after operation was significantly improved compared with that before operation(P<0.05).There was no significant difference between the two groups at the same time point(P>0.05).(5)Solid fusion was achieved in both groups.(6)It is concluded that minimally invasive transforaminal lumbar interbody fusion in the treatment of single-level sciatic scoliosis caused by lumbar disc herniation obtained similar effect as open fusion.Moreover,it has the advantages of less bleeding,faster recovery and shorter hospital stay.