Introduction: Since the earliest description of spinal fusion in 1911 and later by Dr. Fred H. Albee, it has become one of the most commonly performed procedures by orthopedist and neurosurgeons. The spinal fusion is ...Introduction: Since the earliest description of spinal fusion in 1911 and later by Dr. Fred H. Albee, it has become one of the most commonly performed procedures by orthopedist and neurosurgeons. The spinal fusion is now used to treat a variety of indications, such as traumatic injuries, deformities, primary and secondary tumors, infections and degenerative conditions of the spine. The risk of iatrogenic injury during traditional anterior, posterior, and transforaminal open fusion surgery is significant. The axial lumbar interbody fusion (Axia-LIF) is a minimal invasive technique which uses the retroperitoneumpresacral anatomical corridor to fuse the lumbar vertebral bodies L4-L5-S1 avoiding manipulation of the annular ligament, paravertebral muscles and facet joints. Methods: In this retrospective series, we report all the cases made in the Centro Medico Naval in México City in two years. A total of eleven patients with degenerative disc disease and spondylolisthesis underwent Axia-LIF one or two level systems with a 36 months clinical and radiographic follow-up. The outcomes included Oswestry Disability Index (ODI) score and leg/back pain severity. Radiographic outcome was evaluated with dynamics and orthogonal x-ray, as well as lumbosacral tomography scan to evaluate fusion status. Results: Nine patients underwent Axia-LIF one level system (L5-S1) and the rest two levels system (L4-S1). Ten patients were fixated with transpedicular percutaneous screws and one with facets joints screws. No intraoperative complications were reported. The mean back pain severity improved 57% in 12 months, and the mean leg pain severity improved 50% in the same time (P < 0.001). Mean ODI scores improved 58%, from 60% ± 16% at baseline to 25% ± 8% at twelve months (P < 0.001). At one year, a patient developed pseudoarthrosis that required posterolateral arthrodesis with transpedicular percutaneous screws. At 36 months monitoring, 100% patients presented a total interbody fusion in the tomography scans. At final follow-up, mean ODI score improved 73% (16% ± 5%;P < 0.001). Conclusion: The Axial Lumbar Interbody Fusion has demonstrated to be a safe treatment for the degenerative disc disease L5-S1 and L4-S1. The patients who underwent one or two level Axia-LIF showed an improvement in ODI and back/leg pain severity scores, with no intraoperative complications. The use of this technique and its indications are still in controversy;nevertheless, its use has increased as for pathologies such as spondylitis, scoliosis, patients with residual pain with previous surgeries. We recommended complementary pedicular fixation to avoid complications and improved interbody fusion.展开更多
目的探讨Bryan人工颈椎间盘置换术与颈前路椎间融合术后颈部轴性症状(axial symptom,AS)的发生,并进行对比分析。方法2004年10月-2006年4月,对22例患者行Bryan人工颈椎间盘置换术(A组),男13例,女9例;年龄33～54岁,平均43.3岁。病程1～2...目的探讨Bryan人工颈椎间盘置换术与颈前路椎间融合术后颈部轴性症状(axial symptom,AS)的发生,并进行对比分析。方法2004年10月-2006年4月,对22例患者行Bryan人工颈椎间盘置换术(A组),男13例,女9例;年龄33～54岁,平均43.3岁。病程1～21个月,平均6个月。其中脊髓型颈椎病16例,神经根型颈椎病6例。单节段置换20例,2个节段置换2例。对同期30例患者行颈前路椎间盘切除减压植骨融合内固定术(B组),男17例,女13例;年龄35～64岁,平均50.3岁。病程1～23个月,平均7个月。其中脊髓型颈椎病19例,神经根型颈椎病11例。单节段融合26例,2个节段融合4例。观察两组患者术后随访时神经功能恢复情况,手术节段颈椎曲度、颈椎总活动度(range of motion,ROM)的变化情况及颈部AS的发生情况,并进行比较分析。结果两组患者术中、术后均无严重并发症发生。所有患者均获随访,随访时间24～42个月,平均30.6个月。A组术后无假体移位、脱落等并发症发生;B组术后6个月X线片示植骨全部达骨性融合,内固定无松动、脱落、断裂等。两组神经根型患者术后随访时临床症状均明显缓解,疗效满意。两组脊髓型患者JOA评分术后随访时均较术前有明显提高(P<0.01);两组术前及随访期末差异均无统计学意义(P>0.05)。B组术后手术节段颈椎后凸发生率明显增高,且高于A组(P<0.05)。B组ROM较术前明显减小(P<0.01),A组手术前后差异无统计学意义(P>0.05);两组术后差异有统计学意义(P<0.05)。术后颈部AS发生率A组为18.18%,B组为46.67%,两组比较差异有统计学意义(P<0.05)。结论与前路融合手术相比,Bryan人工颈椎间盘置换治疗颈椎病在取得良好临床疗效的同时能维持手术节段ROM及曲度,避免ROM的减少及术后颈部AS的发生。展开更多
文摘Introduction: Since the earliest description of spinal fusion in 1911 and later by Dr. Fred H. Albee, it has become one of the most commonly performed procedures by orthopedist and neurosurgeons. The spinal fusion is now used to treat a variety of indications, such as traumatic injuries, deformities, primary and secondary tumors, infections and degenerative conditions of the spine. The risk of iatrogenic injury during traditional anterior, posterior, and transforaminal open fusion surgery is significant. The axial lumbar interbody fusion (Axia-LIF) is a minimal invasive technique which uses the retroperitoneumpresacral anatomical corridor to fuse the lumbar vertebral bodies L4-L5-S1 avoiding manipulation of the annular ligament, paravertebral muscles and facet joints. Methods: In this retrospective series, we report all the cases made in the Centro Medico Naval in México City in two years. A total of eleven patients with degenerative disc disease and spondylolisthesis underwent Axia-LIF one or two level systems with a 36 months clinical and radiographic follow-up. The outcomes included Oswestry Disability Index (ODI) score and leg/back pain severity. Radiographic outcome was evaluated with dynamics and orthogonal x-ray, as well as lumbosacral tomography scan to evaluate fusion status. Results: Nine patients underwent Axia-LIF one level system (L5-S1) and the rest two levels system (L4-S1). Ten patients were fixated with transpedicular percutaneous screws and one with facets joints screws. No intraoperative complications were reported. The mean back pain severity improved 57% in 12 months, and the mean leg pain severity improved 50% in the same time (P < 0.001). Mean ODI scores improved 58%, from 60% ± 16% at baseline to 25% ± 8% at twelve months (P < 0.001). At one year, a patient developed pseudoarthrosis that required posterolateral arthrodesis with transpedicular percutaneous screws. At 36 months monitoring, 100% patients presented a total interbody fusion in the tomography scans. At final follow-up, mean ODI score improved 73% (16% ± 5%;P < 0.001). Conclusion: The Axial Lumbar Interbody Fusion has demonstrated to be a safe treatment for the degenerative disc disease L5-S1 and L4-S1. The patients who underwent one or two level Axia-LIF showed an improvement in ODI and back/leg pain severity scores, with no intraoperative complications. The use of this technique and its indications are still in controversy;nevertheless, its use has increased as for pathologies such as spondylitis, scoliosis, patients with residual pain with previous surgeries. We recommended complementary pedicular fixation to avoid complications and improved interbody fusion.
文摘目的探讨Bryan人工颈椎间盘置换术与颈前路椎间融合术后颈部轴性症状(axial symptom,AS)的发生,并进行对比分析。方法2004年10月-2006年4月,对22例患者行Bryan人工颈椎间盘置换术(A组),男13例,女9例;年龄33～54岁,平均43.3岁。病程1～21个月,平均6个月。其中脊髓型颈椎病16例,神经根型颈椎病6例。单节段置换20例,2个节段置换2例。对同期30例患者行颈前路椎间盘切除减压植骨融合内固定术(B组),男17例,女13例;年龄35～64岁,平均50.3岁。病程1～23个月,平均7个月。其中脊髓型颈椎病19例,神经根型颈椎病11例。单节段融合26例,2个节段融合4例。观察两组患者术后随访时神经功能恢复情况,手术节段颈椎曲度、颈椎总活动度(range of motion,ROM)的变化情况及颈部AS的发生情况,并进行比较分析。结果两组患者术中、术后均无严重并发症发生。所有患者均获随访,随访时间24～42个月,平均30.6个月。A组术后无假体移位、脱落等并发症发生;B组术后6个月X线片示植骨全部达骨性融合,内固定无松动、脱落、断裂等。两组神经根型患者术后随访时临床症状均明显缓解,疗效满意。两组脊髓型患者JOA评分术后随访时均较术前有明显提高(P<0.01);两组术前及随访期末差异均无统计学意义(P>0.05)。B组术后手术节段颈椎后凸发生率明显增高,且高于A组(P<0.05)。B组ROM较术前明显减小(P<0.01),A组手术前后差异无统计学意义(P>0.05);两组术后差异有统计学意义(P<0.05)。术后颈部AS发生率A组为18.18%,B组为46.67%,两组比较差异有统计学意义(P<0.05)。结论与前路融合手术相比,Bryan人工颈椎间盘置换治疗颈椎病在取得良好临床疗效的同时能维持手术节段ROM及曲度,避免ROM的减少及术后颈部AS的发生。
