腰椎间盘突出伴与不伴继发脊柱侧凸手术前后比较

Comparison of lumbar disc herniation with or without secondary scoliosis treated by minimally invasive transforaminal lumbar interbody fusion in adult

[目的]比较微创经椎间孔椎间融合术(MIS-TLIF)治疗成人腰椎间盘突出症(LDH)伴与不伴继发性脊柱侧凸的临床疗效及影像学结果。[方法]2014年1月~2016年12月因单节段LDH行MIS-TLIF手术的78例患者,按有无继发性脊柱侧凸分为两组:侧凸组32例,非侧凸组46例。比较两组临床与影像资料,分析临床与影像学指标相关性。[结果]两组均顺利手术,无严重并发症。术后2年VAS及ODI评分较术前减小(P<0.05),相应时间点,两组间差异无统计学意义(P>0.05)。侧凸组术后PT、SVA、PI-LL、主弯Cobb角、AVT、C7PL-CSVL较术前减小,SS、LL、TK较术前增大(P<0.05);非侧凸组术后2年SVA较术前显著增大(P<0.05)。侧凸组VAS腰痛评分差值与PI-LL、主弯Cobb角差值呈正相关(P<0.05),与LL差值呈负相关(P<0.05);VAS腿痛评分差值与SVA差值呈正相关(P<0.05);ODI评分差值与PI-LL差值呈正相关(P<0.05)。非侧凸组VAS腰痛评分、ODI评分差值与SVA差值呈负相关(P<0.05)。[结论]MIS-TLIF治疗成人LDH伴与不伴继发侧凸可取得相似的临床疗效;侧凸组与非侧凸组术前、术后的影像学参数存在较多差异,影像学参数与临床疗效有一定相关性。

[Objective]To compare the clinical and radiographic outcomes of lumbar disc herniation(LDH)with or without secondary scoliosis treated by minimally invasive transforaminal interbody fusion(MIS-TLIF)in adult.[Methods]From January2014 to December 2016,78 patients underwent MIS-TLIF for single-segment LDH.Based on whether or not secondary scoliosis was found before operation,32 patients fell into the scoliosis group,while the remaining 46 patients were in the non-scoliosis group.The clinical and radiographic parameters were compared between the two group,and correlations between the clinical and imaging data were searched.[Results]All the patients in both groups received successful operation without serious complications.The VAS and ODI scores significantly decreased at 2 years after operation in both groups compared with those before operation(P<0.05),but which were not statistically different between the two groups at any matching time point(P>0.05).The scoliosis group had significant decrease in pelvic tilt(PT),sagittal vertical axis(SVA),difference between pelvic incidence and lumbar lordosis(PI-LL),main curve Cobb’s angle,apical vertebral translation(AVT)and C7plumb line-central sacral vertical line(C7PL-CSVL),whereas significant increase in sacral slope(SS),LL and thoracic kyphosis(TK)postoperatively compared with those before operation(P<0.05).On the other hand,the non-scoliosis group got significant increase in SVA at 2 years postoperatively in contrast to that before operation(P<0.05).In the scoliosis group,the difference of VAS score for low back pain proved positively correlated to the differences of PI-LL and main curve Cobb’s angle,whereas negatively correlated to the difference of LL(P<0.05),the difference of VAS score for leg pain was positively correlated to difference of SVA(P<0.05),and the difference of ODI was positively correlated to the difference of PI-LL(P<0.05).However,in the non-scoliosis group the differences of VAS score for low back pain and ODI were negatively correlated to the difference of SVA(P<0.05).[Conclusion]MIS-TLIF does achieve similar clinical outcomes for LDH with or without secondary scoliosis in adult,with many variations in imaging parameters of the scoliosis group and the non-scoliosis group before and after surgery,which might be correlated to clinical consequences.