经前路椎间融合器治疗腰椎失稳症

Anterior lumbar interbody fusion with cage for the surgical treatment of mechanical back pain

目的:探讨经前路应用椎间融合器(cage)治疗腰椎失稳症的适应证、技术要点及效果.方法:选择2l例经临床诊断存在严重腰痛的患者实施前路椎间盘摘除和cage置入椎间融合术,并进行术前和术后影像学评价及JOA评分.结果:所有患者术后即时X线片显示手术节段椎间隙增宽、根管扩大、脊柱生理曲度恢复,腰腿痛症状缓解或消失.随访6～24个月(平均18.6个月),动态X线检查显示融合节段稳定,JOA评分从术前平均9.5分提高到术后23.5分(P＜0.01).结论:前路应用cage行椎间融合固定术具有提供生物力学稳定性和恢复脊柱生理平衡的优势,是治疗腰椎失稳症的一种安全、有效的手术方式.

Objective:To study the indications and surgical techniques of anterior lumbar cage for the patients with chronic mechanical back pain,and to evaluate its clinical effect.Method:21cases with severe chronic me-chanical back pain were underwent,lumbar interbody fusion using bone-filled cage via anterior approache.The preoperative and postoperative radiographic evaluation were done and the clinical result was classified accord-ing to JOA back pain score.Result:The immediate posteoperative radiograph showed the increase of the height of intervertebral space,the opening of the foramina and the restoration of the lumbar lordosis.Consequently,total or partial relief of radicular and back pain was found in all cases.At least6(mean18.6)months followup,dy-namic radiograph demonstrated the stability in the fused segments,the JOA score increased significantly from mean9.5points to mean23.5points postoperatively(P<0.01).Conclusion:The anterior lumbar cage provides biomechanical stability and associated spinal balance in the surgical procedure of lumbar arthrodeses,clinical studies prove that this treatment are safe and effective for severe chronic mechanical back pain sufferers.