Correlation study between the changes of motor evoked potential and the improvement of spinal canal volume in minimally invasive transforaminal lumbar interbody fusion

Objective:To analyze the correlation between the amplitude changes of motor evoked potential(MEP),the 3D volume changes of spinal canal measuring by postoperative CT and the improvement rate of clinical symptoms after the spinal canal decompression in minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF),and to explore the predictive value of the changes of both MEP amplitude and spinal canal volume in the assessment of long-term clinical prognosis in MIS-TLIF.Methods:A retrospective study of 68 patients with L4/5 spinal stenosis treated with MIS-TLIF was performed.The changes of both intraoperative MEP amplitude and 3D spinal canal volume during the spinal canal decompression,as well as the visual analogue scale(VAS)and Oswestry dysfunction index(ODI)scores in the long-term follow-up were all recorded.Results:The values of intraoperative MEP amplitude was 159.04%higher in 68 patients with MIS-TLIF after spinal canal decompression(P<0.01).The 3 postoperative 3D spinal canal volume(4.89±1.27)cm increased by 31.22%in comparison 3 with preoperative date(3.78±1.08)cm(P<0.01).The VAS and ODI scores were improved to 78.55%and 80.60%,respectively at the last follow-up(P<0.01).The improvement rate of MEP amplitude on the decompression side was positively correlated with the improvement rate of postoperative spinal canal volume(r=0.272,P=0.025).The improvement rate of postoperative spinal canal volume was positively correlated with the improvement rate of VAS and ODI at the last follow-up(r=0.656,r=0.490,P<0.01).Moreover,the improvement rate of MEP amplitude on the decompression side was also positively correlated with the improvement rate of VAS and ODI at the last follow-up(r=0.322 and 0.235,respectively,P<0.05).Conclusion:The increase of MEP amplitude after spinal canal decompression in patients with lumbar spinal stenosis treated by MIS-TLIF was closely correlated with both of the increase of spinal canal volume and the improvement of clinical symptoms.Therefore,MEP amplitude monitoring was not only the one of the important monitoring methods for predicting the prognosis of MIS-TLIF but also the reliably predictive value in the long-term clinical prognosis in MIS-TLIF.

Two-Year Outcomes of Midline lumbar Fusion Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion in the Treatment of L4-L5 Degenerative Disease

Objective We aimed to compare the clinical and radiological outcomes of midline lumbar fusion(MIDLF)versus minimally invasive transforaminal lumbar interbody fusion(MI-TLIF)in patients with degenerative spondylolisthesis and/or stenosis in L4-L5 two years after surgery.Methods Consecutively treated patients with lumbar pathology who underwent MIDLF(n=16)and a historical control group who underwent MI-TLIF(n=34)were included.Clinical symptoms were evaluated using Oswestry Disability Index(ODI),the 36-Item Short-Form Health Survey,and visual analog scale(VAS)scores before surgery and 3,6,12,and 24 months after surgery.Results The mean operative time and hematocrit(HCT,Day 1)were significantly shorter and lower in MIDLF cases(174 min vs.229 min,P<0.001;0.34 vs.0.36,P=0.037).The MI-TLIF group showed better improvement than the MIDLF group in ODI and VAS back and leg pain at 3 months postoperatively.VAS leg pain was higher in MIDLF than in MI-TLIF cases at 6 months.At 24 months follow-up,VAS back pain was higher in MI-TLIF than in MIDLF cases(P=0.018).Conclusion MIDLF is comparable to MI-TLIF at L4-5 in clinical outcomes and fusion rates,and the results verified the meaningful advantage of using MIDLF for the elderly with osteoporosis.

Minimally invasive procedures on the lumbar spine

Degenerative disease of the lumbar spine is a common and increasingly prevalent condition that is often implicated as the primary reason for chronic low back pain and the leading cause of disability in the western world. Surgical management of lumbar degenerative disease has historically been approached by way of open surgical procedures aimed at decompressing and/or stabilizing the lumbar spine. Advances in technology andsurgical instrumentation have led to minimally invasive surgical techniques being developed and increasingly used in the treatment of lumbar degenerative disease. Compared to the traditional open spine surgery, minimally invasive techniques require smaller incisions and decrease approach-related morbidity by avoiding muscle crush injury by self-retaining retractors, preventing the disruption of tendon attachment sites of important muscles at the spinous processes, using known anatomic neurovascular and muscle planes, and minimizing collateral soft-tissue injury by limiting the width of the surgical corridor. The theoretical benefits of minimally invasive surgery over traditional open surgery include reduced blood loss, decreased postoperative pain and narcotics use, shorter hospital length of stay, faster recover and quicker return to work and normal activity. This paper describes the different minimally invasive techniques that are currently available for the treatment of degenerative disease of the lumbar spine.

Radiological and clinical outcomes of midline lumbar fusion on sagittal lumbar-pelvic parameters for degenerative lumbar diseases

BACKGROUND Improving the sagittal lumbar-pelvic parameters after fusion surgery is important for improving clinical outcomes.The impact of midline lumbar fusion(MIDLF)on sagittal lumbar-pelvic alignment for the management of degenerative lumbar diseases is still unknown.AIM To analyze the effects of short-segment MIDLF and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)on sagittal lumbar-pelvic parameters.METHODS We retrospectively analyzed 63 patients with degenerative lumbar diseases who underwent single-segment MIDLF or MIS-TLIF.The imaging data of patients were collected before surgery and at the final follow-up.The radiological sagittal parameters included the lumbar lordosis(LL),lower LL,L4 slope(L4S),L5 slope(L5S),L5 incidence(L5I),L1 axis and S1 distance(LASD),pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),and PI-LL mismatch(PI-LL).Additionally,the clinical outcomes,including lower back and leg pain visual analog scale(VAS)and Oswestry disability index(ODI)scores,were also analyzed.RESULTS In both groups,LL and Lower LL significantly increased,while L5I and LASD significantly decreased at the final follow-up compared to that recorded prior to operation(P<0.05).In the MIDLF group,L4S significantly decreased compared to that recorded prior to operation(P<0.05),while the mean SS significantly increased and the PT significantly decreased compared to that recorded prior to operation(P<0.05).In the MIS-TLIF group,SS slightly increased and the mean PT value decreased compared to that recorded prior to operation,but without a statistically significant difference(P>0.05).However,the PI-LL in both groups was significantly reduced compared to that recorded prior to operation(P<0.05).There was no significant difference in the sagittal lumbar-pelvic parameters between the two groups prior to operation and at the final follow-up(P>0.05).In addition,the change in sagittal lumbar-pelvic parameters did not differ significantly,except forΔLASD within the two groups(P>0.05).The mean lower back and leg pain VAS and ODI scores in both groups were significantly improved three months after surgery and at the final follow-up.Though the mean ODI score in the MIDLF group three months after surgery was slightly higher than that in the MIS-TLIF group,there was no significant difference between the two groups at the final follow-up.CONCLUSION Short-segment MIDLF and MIS-TLIF can equally improve sagittal lumbar parameters such as LL,Lower LL,L5I,and LASD in the treatment of lumbar degenerative diseases.However,MIDLF had a larger impact on pelvic parameters than MIS-TLIF.

机器人导航内镜下经椎间孔入路椎间融合术治疗腰椎间盘突出症

目的探讨应用机器人导航内镜下经椎间孔入路椎间融合术治疗腰椎间盘突出症的临床疗效。方法将98例腰椎间盘突出症患者根据治疗方法不同分为观察组(32例,采用机器人导航内镜下经椎间孔入路椎间融合术治疗)与对照组(66例,采用后路腰椎椎间融合术治疗)。记录手术时间、术中出血量、术后引流量、住院时间及并发症发生情况,采用疼痛VAS评分评价疼痛改善情况,采用ODI评分评价脊柱功能。结果患者均获得随访,时间12~22个月。手术时间观察组长于对照组(P<0.01)。术中出血量、术后引流量及住院时间观察组均少(短)于对照组(P<0.01)。两组并发症发生率比较差异无统计学意义(P>0.05)。两组术后1周及1、3、6、12个月疼痛VAS评分、ODI均较术前降低(P<0.05);观察组均低于对照组(P<0.01)。结论采用机器人导航内镜下经椎间孔入路椎间融合术治疗腰椎间盘突出症创伤小,疼痛改善情况好,脊柱功能恢复快。

显微镜辅助微创经椎间孔腰椎椎间融合术治疗单节段腰椎滑脱症

目的探讨显微镜辅助经Quadrant通道结合经皮椎弓根钉固定行微创小切口经椎间孔腰椎椎间融合术(MIS-TLIF)治疗单节段腰椎退行性滑脱症的疗效。方法回顾性分析2018年4月至2021年3月行椎体间融合术治疗单节段腰椎退行性滑脱症患者的临床资料,其中采用开放经椎间孔腰椎椎间融合术(TLIF)治疗患者41例(开放组),经Wiltse入路Quadrant通道直视下TLIF治疗患者25例(微创组),显微镜下减压并采用经皮椎弓根钉TLIF治疗患者38例(显微组)。记录3组患者手术时间、术中出血量、X线透视次数、引流量、术后2天和7天切口周围疼痛视觉模拟评分(VAS)、并发症情况,术后CT检查评估椎弓根钉置钉准确率,记录术前及术后6个月、24个月日本骨科协会(JOA)评分和Oswestry功能障碍指数(ODI),末次随访时采用改良MacNab标准评价临床疗效。结果所有手术均顺利完成。显微组术中出血量、引流量、术后2天和7天切口周围疼痛VAS评分均小于微创组和开放组(P<0.05),椎弓根钉置钉准确率高于微创组和开放组(P<0.05),但术中X线透视次数高于微创组和开放组(P<0.05)。开放组发生术后切口浅表软组织感染1例,疑似感染1例,脑脊液漏1例;微创组出现术后短暂性神经症状2例。3组术后6个月、24个月JOA评分和ODI评分均较术前明显改善(P<0.05),3组间比较无统计学差异(P>0.05)。术后6个月和24个月融合率3组间比较无统计学差异(P>0.05)。按改良MacNab标准,3组患者疗效优良率无统计学差异(P>0.05)。结论显微镜辅助通道下MIS-TLIF治疗单节段腰椎退行性滑脱症,术中出血少、切口疼痛感小、并发症少,采用经皮椎弓根钉置钉准确率高,融合率、疗效优良率与开放手术一致,临床疗效好。

内镜、微创和开放式经椎间孔椎体间融合术治疗腰椎退行性疾病的效果比较

目的比较经椎间孔内镜腰椎椎间融合术(Endo-LIF)、微创腰椎椎间融合术(MIS-TLIF)和开放腰椎椎间融合术(PLIF)治疗腰椎退行性疾病(LDD)的临床疗效和安全性。方法回顾性分析2013年1月至2023年1月在百色市人民医院因LDD接受经椎间孔腰椎椎间融合术就诊的150例患者临床资料,按手术方式分为Endo-LIF组、MIS-TLIF组、PLIF组三组,每组各50例。比较患者手术时间、透视次数、术中失血量、住院时间、并发症以及术前和术后3个月的视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)评分、椎间隙高度指数、病变节段活动度(ROM)。结果PLIF组的手术时间长于Endo-LIF组和MIS-TLIF组,术中透视次数少于Endo-LIF组和MIS-TLIF组,差异有统计学意义(P<0.05)。Endo-LIF组和MIS-TLIF组的手术时间、术中透视次数比较,差异无统计学意义(P>0.05)。患者术中出血量Endo-LIF组少于MIS-TLIF组及PLIF组,MIS-TLIF组少于PLIF组,差异有统计学意义(P<0.05);患者术后卧床时间和住院时间Endo-LIF组短于MIS-TLIF组及PLIF组,MIS-TLIF组短于PLIF组,差异有统计学意义(P<0.05)。三组患者满意度比较,差异有统计学意义(P<0.05)。Endo-LIF组满意度高于PLIF组,差异有统计学意义(P<0.017)。三组患者术后3个月VAS及ODI评分低于手术前,差异有统计学意义(P<0.01)。三组患者并发症发生率、椎间隙高度指数、ROM比较,差异无统计学意义(P>0.05)。结论Endo-LIF、MIS-TLI、PLIF三种手术方法术后3个月的预后结果相似,PLIF术中透视次数最少,Endo-LIF创伤较小,在降低术中出血,缩短术后卧床时间和住院时间方面优势明显,术后恢复速度较快,适合临床推广。

全内镜与微创经椎间孔腰椎椎间融合术治疗腰椎退行性疾病的临床效果对比

目的:比较全内镜经椎间孔腰椎椎间融合术(FE-TLIF)和微创经椎间孔腰椎椎间融合术(MI-TLIF)治疗腰椎退行性疾病(LDD)的临床效果和安全性。方法:前瞻性将2020年1月—2022年10月在百色市人民医院因LDD接受TLIF治疗的患者60例,按随机数字表法分为FE-TLIF组(接受FE-TLIF治疗)和MI-TLIF组(接受MI-TLIF治疗),每组30例。比较两组的围手术期指标、术前和术后3个月疼痛视觉模拟评分法(VAS)评分与Oswestry功能障碍指数(ODI)评分、术后6个月及1年椎体间融合情况。结果:两组手术时间比较,差异无统计学意义(P>0.05)。FE-TLIF组术中透视次数多于MI-TLIF组,差异有统计学意义(P<0.05)。FE-TLIF组术中出血量少于MI-TLIF组,术后卧床时间、住院时间均短于MI-TLIF组,差异均有统计学意义(P<0.05)。两组患者术后VAS评分及ODI评分与术前比较均明显降低,差异均有统计学意义(P<0.05)。术后6个月及1年两组椎体间融合情况比较,差异均无统计学意义(P>0.05)。两组术后并发症发生率比较,差异无统计学意义(P>0.05)。结论:FE-TLIF与MI-TLIF在术后疼痛缓解、功能恢复、融合率方面显示出了相似的结果,但FE-TLIF在降低术中出血量,缩短术后卧床时间、住院时间上有更大优势。

单侧双通道内镜下(UBE-TLIF)与微创经椎间孔腰椎融合术(MIS-TLIF)治疗退变性腰椎椎管狭窄症的疗效比较

目的 比较单侧双通道内镜下经椎间孔腰椎椎间融合术(unilateral biportal endoscopic transforaminal lumbar interbodyfusion,UBE-TLIF)与微创经椎间孔入路腰椎椎间融合术(minimal invasive transforaminal lumbar interbody fusion, MIS-TLIF)治疗单节段退行性腰椎椎管狭窄症的疗效。方法 回顾性分析2021年1月至2021年12月成都中医药大学附属医院符合纳入标准的68例单节段退行性腰椎椎管狭窄症患者的临床资料,按手术方式分为UBE-TLIF组(27例)与MIS-TLIF组(41例)。对比两组患者的手术相关指标(手术时间、术中出血量、术后引流量、术后住院天数、并发症发生率等);实验室检查结果[全血C反应蛋白(C-reactive protein, CRP)、血清磷酸肌酸激酶(creatine kinase, CK)]及临床疗效评价[腰痛及下肢疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index, ODI)、改良MacNab标准评价优良率、Brantigan标准评价椎间融合率]等。结果 68例患者均获得随访,随访时间12~20个月。与MIS-TLIF组相比,UBE-TLIF组患者的手术时间、住院时间更长,但术中出血量、术后引流量更短(P<0.05)。实验室检查方面:术前两组实验室检查差异无统计学意义(P>0.05);术后3 d UBE-TLIF组全血C反应蛋白含量较MIS-TLIF组低(P<0.05);术后1、3 dUBE-TLIF组血清磷酸肌酸激酶水平均低于MIS-TLIF组(P<0.05)。临床疗效评价:术前两组间患者腰痛及下肢疼痛视觉模拟评分及Oswestry功能障碍指数比较,差异无统计学意义(P>0.05),术后各时间点上述评分均较术前显著下降(P<0.05);组间比较发现各组术后3 d、1个月、6个月、12个月的腰痛及下肢疼痛视觉模拟评分,术后3、12个月Oswestry功能障碍指数,末次随访优良率,椎间融合率比较,差异无统计学意义(P>0.05)。并发症方面:UBE-TLIF组无并发症发生,MIS-TLIF组发生并发症2例,包括术后切口感染1例及术后下肢麻木1例,两组间并发症发生率比较,差异无统计学意义(P>0.05)。结论 UBE-TLIF手术方式可达到与MIS-TLIF手术方式相似的术后腰痛疼痛评分、腿疼痛评分、功能障碍指数,且较MIS-TLIF肌肉损伤释放的CK更少、组织出血量更少、术后恢复更快。

Minimally invasive lumbar interbody fusion via MAST Quadrant retractor versus open surgery： a prospective randomized clinical trial

In recent years, a variety of minimally invasive lumbar surgery techniques have achieved desirable efficacy, but some dispute remains regarding the advantages over open surgery. This study aimed to compare minimally invasive lumbar interbody fusion via MAST Quadrant retractor with open surgery in terms of perioperative factors, postoperative back muscle function, and 24-month postoperative follow-up results. Methods From September 2006 to June 2008, patients with single-level degenerative lumbar spine disease who were not responsive to conservative treatment were enrolled in this study. Patients were randomized to undergo either minimally invasive surgery （MIS, transforaminal lumbar interbody fusion via MAST Quadrant retractor, 41 cases） or open surgery （improved transforaminal lumbar interbody fusion, 38 cases）. Results The MIS group had longer intraoperative fluoroscopy time than the open surgery group, and the open surgery group had significantly increased postoperative drainage volume and significantly prolonged postoperative recovery time compared with the MIS group （P 〈0.05 for all）. MRI scanning showed that the T2 relaxation time in the multifidus muscle was significantly shorter in the MIS group than in the open surgery group at 3 months after surgery （P 〈0.01）. Surface electromyography of the sacrospinalis muscle showed that the average discharge amplitude and frequency were significantly higher in the MIS group than in the open surgery group （P 〈0.01）. The Oswestry disability index and visual analog scale scores were better at 3, 6, 12 and 24 months postoperatively than preoperatively in both groups. Both groups of patients met the imaging convergence criteria at the last follow-up. Conclusions MIS can effectively reduce sacrospinalis muscle injury compared with open surgery, which is conducive to early functional recovery. In the short term, MIS is superior to open surgery, but in the long term there is no significant difference between the two procedures.

Comparison between Minimally Invasive Transforaminal Lumbar Interbody Fusion and Conventional Open Transforaminal Lumbar Interbody Fusion： An Updated Meta-analysis

Background： The previous studies agree that minimally invasive transforaminal lumbar interbody fusion （MIS-TLIF） has better function outcomes, less blood loss, and shorter hospital stay, when compared to open-TLIF. However, there are no significance differences on operative time, complication, and reoperation rate between the two procedures. This could be from less relative literatures and lower grade evidence. The further meta-analysis is needed with more and higher grade evidences to compare the above two TLIF procedures. Methods： Prospective and retrospective studies that compared open-TLIF and MIS-TLIF were identified by searching the Medline, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, and VIP database （the literature search comprised Medical Subject Heading terms and key words or Emtree term）. The retrieval time ranged from the date when the database was founded to January 2015. Pooled risk ratios （RRs） and weighted mean differences （WMDs） with 95% confidence intervals were calculated for the clinical outcomes and perioperative data. Results： Twenty-four studies （n =1967 patients） were included in this review （n =951, open-TLIF, n 1016, MIS-TLIF）. MIS-TLIF was associated with a significant decrease in the visual analog score （VAS）-back pain score （WMD 0.44; P= 0.001）, Oswestry Disabilities Index （WMD 1.57; P =0.005）, early ambulation （WMD = -1.77; P = 0.0001）, less blood loss （WMD = -265.59; P 〈 0.00001）, and a shorter hospital stay （WMD =-1.89; P 〈 0.0001）. However, there were no significant differences in the fusion rate （RR =0.99; P = 0.34）, VAS-leg pain （WMD = -0.10; P = 0.26）, complication rate （RR = 0.84; P = 0.35）, operation time （WMD = 5.23; P = 0.82）, or reoperation rate （RR = 0.73; P = 0.32）. Conclusions： MIS-TLIF resulted in a similar fusion rate with better functional outcome, less blood loss, shorter ambulation, and hospital stay; furthermore, it did not increase the complication or reoperation rate based on the existing evidence.

Quadrant通道下单侧后路腰椎椎体间融合术与传统开放术治疗退行性腰椎疾病的疗效比较

目的 探讨Quadrant通道下单侧后路腰椎椎体间融合术与传统开放术治疗退行性腰椎疾病的价值。方法 选取2019年1月至2023年6月我院外科治疗的退行性腰椎疾病患者100例,通过随机数字表法分为两组。观察组(50例)实施Quadrant通道下单侧后路腰椎椎体间融合术进行治疗,对照组(50例)实施常规开放手术治疗,比较两组治疗效果。结果 相比较对照组,观察组手术时间长、切口长度短、术中出血量小、术后引流量小、术后下地时间短、术后住院时间短(P <0.05),术后1、2、3d的疼痛评分低(P <0.05),术后2、4、6周的Oswestry功能障碍指数低(P <0.05),末次随访MacNab分级的优良率高(P <0.05)。结论 Quadrant通道下单侧后路腰椎椎体间融合术治疗退行性腰椎疾病效果十分显著,术后疼痛少,恢复快,术后功能障碍改善良好,具有较好的应用价值。

Mast Quadrant-assisted Minimally Invasive Modified Transforaminal Lumbar Interbody Fusion： Single Incision Versus Double Incision

Background： The concept of minimally invasive techniques is to make every effort to reduce tissue damage. Certainly, reducing skin incision is an important part of these techniques. This study aimed to investigate the clinical feasibility of Mast Quadrant-assisted modified transforaminal lumbar interbody fusion （TLIF） with a small single posterior median incision. Methods： During the period of March 2011 to March 2012, 34 patients with single-segment degenerative lumbar disease underwent the minimally invasive modified TLIF assisted by Mast Quadrant with a small single posterior median incision （single incision group）. The cases in this group were compared to 37 patients with single-segment degenerative lumbar disease in the double incision group. The perioperative conditions of patients in these two groups were statistically analyzed and compared. The Oswestry Disability Index （ODI） scores, Visual Analog Scale （VAS） scores, and sacrospinalis muscle damage evaluation indicators before operation and 3, 12 months postoperation were compared. Results： A total of 31 and 35 cases in the single incision and double incision groups, respectively, completed at least 12 months of systemic follow-up. The differences in perioperative conditions between the two groups were not statistically significant. The incision length of the single incision group was significantly shorter than that of the double incision group （P 〈 0.01）. The ODI and VAS scores of patients in both groups improved significantly at 3 and 12 months postoperation. However, these two indicators at 3 and 12 months postoperation and the sacrospinalis muscle damage evaluation indicators at 3 months postoperation did not differ significantly between the two groups （P _〉 0.05）. Conclusions： Mast Quadrant-assisted modified TLIF with a small single posterior median incision has excellent clinical feasibility compared to minimally invasive TLIF with a double paramedian incision.

Comparing minimally invasive and open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease： a meta-analysis

Background Transforaminal lumbar interbody fusion （TLIF） through a minimally invasive approach （mTLIF） was introduced to reduce soft tissue injury and speed recovery. Studies with small numbers of patients have been carried out, comparing mTLIF with traditional open TLIF （oTLIF）, but inconsistent outcomes were reported.

Biomechanical evaluation of two fusion techniques based on finite element analysis:Percutaneous endoscopic and minimally invasive transforaminal lumbar interbody fusion

As a novel minimally invasive technique,percutaneous endoscopic transforaminal lumbar interbody fusion(PETLIF)has been widely used in the treatment of lumbar degenerative diseases.The purpose of this study was to analyze these two operation types’biomechanical performances of PE-TLIF and traditional minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)using the finite element(FE)method.The intact FE models of L4-L5 were established and validated based on the CT images.On this basis,the FE models of MIS-TLIF and PETLIF were established and analyzed.It is demonstrated that for lumbar interbody fusion with the oblique asymmetrically implanted cage under bilateral pedicle screws and rods fixation,such as MIS-TLIF and PE-TLIF,different degrees of articular process resection have no significant effect on the cage subsidence,and the surgical segment can achieve similar stability.In addition,the maximum stress of the L4 inferior endplate of MIS-TLIF and PE-TLIF is greater than that of the L5 superior endplate,which indicates that MIS-TLIF and PE-TLIF can cause cage subsidence in the L4 inferior endplate.

Instrumentation-related complications of lumbar degenerative disc diseases treated by minimally invasive transforaminal lumbar interbody fusion

Objective:To analyze the instrumentation-related complications of patients with lumbar degenerative disc diseases(LDD)who underwent minimally invasive transforaminal lumbar interbody fusion(MISTLIF)and to discuss the potential strategy for the control of these complications.Methods:A total of 87 patients with LDD were treated with the MIS-TLIF procedure.Complications,including malposition or breakage of guide pin,percutaneous pedicle screw(PPS)or cages,neurological deficit,and superior-level facet joint violations,were determined during and after the surgery.Computed tomography(CT)was used to evaluate the PPS accuracy and the superior-level facet joint violations.Results:A total of 386 PPSs were used.During the surgery,3(0.8%)guide pin and 1(0.3%)PPS perforated the anterior wall of the vertebral body,respectively.One(0.3%)PPS was pulled out during the reduction of slip.Malposition of the cages occurred in 6(1.6%)PPSs.These were all adjusted accordingly during the surgery.All the patients received>2 years of follow-up.No loosening or breakage of PPS and cage was observed,but CT showed 27(7.0%)PPSs misplaced.No neurological deficit related to misplaced PPS was observed.The total facet joint violation(FJV)rate was 36.2%,with grade 2 and grade 3 violations is 21(12.1%)and 6(3.4%),respectively.Conclusion:MIS-TLIF has similar instrumentation-related complications with open TLIF.Accurate preoperative evaluation and improved surgical techniques can effectively reduce these instrumentation-related complications.

大通道脊柱内镜辅助下腰椎椎间融合术治疗腰椎退行性疾病3年以上随访的疗效观察

目的分析大通道脊柱内镜辅助下腰椎椎间融合术(镜下融合)治疗腰椎退行性疾病3年以上的随访结果。方法2018年6月至2020年6月中山大学附属第三医院脊柱外科接受镜下融合手术腰椎退行性疾病患者共28例;女20例,男8例;年龄40~80(58.9±10.6)岁。病程为1~240(44.0±53.3)个月。诊断为单纯腰椎椎管狭窄5例、单纯腰椎不稳3例、腰椎椎管狭窄合并不稳5例、腰椎退行滑脱12例、复发型腰椎间盘突出症3例;其中26例为单节段,2例为双节段;12例经椎间孔入路,16例经关节突入路;11例(68.8%)行单侧入路双侧减压。术前、术后及末次随访使用腰椎Oswestry功能障碍指数(ODI)、腰痛及腿痛的视觉模拟评分(VAS)、日本骨科协会评分(JOA)评价疗效。对随访腰椎CT影像按照Bridwell标准判断椎间融合情况。结果所有患者均顺利完成镜下融合手术;手术时间为239~630(399.8±104.4)min。所有病例随访时间为37~61(44.7±6.2)个月。术后及末次随访ODI评分、腰痛及腿痛VAS评分、JOA评分均较术前明显改善(P<0.05)。术后椎间隙高度较术前增加[(12.2±2.1)mm比(8.3±2.8)mm,P<0.05]。术中、术后及随访时均无严重并发症发生,1例患者术后椎管内骨块残留压迫行走根。随访期间14例复查腰椎CT;其中13例(92.9%)达到骨性融合。结论大通道脊柱内镜辅助下腰椎椎间融合术3年以上随访临床疗效令人满意,是治疗腰椎退行性疾病的一种微创、安全、有效的术式选择。

UBE-LIF与后路病灶清除植骨融合内固定术治疗腰椎布氏杆菌性脊柱炎的临床疗效比较

目的对比UBE-LIF(unilateral biportal endoscopic technique with transforaminal lumbar interbody fusion)技术行病灶清除联合经皮椎弓根螺钉内固定术与经典后路病灶清除植骨融合内固定术治疗腰椎布氏杆菌性脊柱炎(LBS)的安全性及临床疗效。方法回顾性分析甘肃省中医院脊柱骨科2020年1月至2022年1月收治的32例LBS患者的临床资料,按术式分为UBE-LIF组(n=15)和开放组(n=17)。记录并分析两组的一般资料、手术相关指标及术后病理HE染色;根据术前、术后1周及术后1、3、6个月和1年的红细胞沉降率(ESR)和C反应蛋白(CRP)变化,腰痛疼痛视觉模拟评分(VAS)、日本骨科协会评分(JOA)、Oswestry功能障碍指数(ODI)评估患者临床恢复情况;影像学方法测量术前及末次随访时腰椎前凸角(LL)和椎间隙高度(DH),并采用Suk分级标准评估椎间植骨融合情况。结果两组患者均顺利完成手术,且均未发生严重术后并发症。两组患者的性别、年龄、手术节段、手术时间、术前ESR和CRP水平、术前VAS、JOA评分及ODI指数、术前LL和DH等资料比较差异均无统计学意义(P>0.05);UBE-LIF组术中出血量、术后引流量、术后下床时间、术后住院时间明显少于开放组(P<0.001);术中取病变组织行病理学检查,均符合布氏杆菌病改变。两组患者均获随访,随访时间12~18个月,平均14.8个月。两组患者的术后各时间点VAS、JOA评分和ODI指数均较术前明显改善(P<0.05);其中两组在术后1周差异较为明显:UBE-LIF组VAS评分低于开放组(P<0.01),两组CRP均较术前升高且UBE-LIF组升高水平明显低于开放组(P<0.001),两组ESR较术前无明显差异(P>0.05);术后其余各时间点两组间VAS、JOA评分和ODI指数、CRP及ESR比较差异无统计学意义(P>0.05)。末次随访时影像学检查示,UBE-LIF组椎间植骨总体融合率为93.3%,开放组为94.1%,差异无统计学意义(χ^(2)=0.246,P=0.884);两组LL和DH均较术前显著改善(P<0.01),两组手术前后差值比较差异无统计学意义(P>0.05)。结论两种术式治疗LBS均安全有效;与后路病灶清除植骨融合内固定术相比,UBE-LIF技术联合经皮椎弓根螺钉内固定术具有术中视野清晰、出血量少、术后早期恢复更快、术后住院时间更短等优势,是一种可行的微创治疗LBS的手术方式。

Q⁃TLIF技术的临床应用与展望

进入21世纪以来,腰椎微创技术在全球范围内应用广泛,腰椎融合技术层出不穷,包括前路腰椎椎间孔融合术、斜外侧腰椎椎间融合术、微创经椎间孔腰椎椎间融合术、极外侧椎体间融合术、脊柱内镜下经后路椎板间入路腰椎椎体间融合术(Endo⁃P/TLIF)、单边双通道内镜下腰椎椎间融合术(UBELIF)、V形双通道内镜下腰椎椎间融合术(VBELIF)等,其中Endo⁃P/TLIF、UBELIF、VBELIF是近年来较为热门的后外侧入路微创腰椎椎间融合术式。然而,目前所有术式均无法实现在椎间盘内直接进行椎间盘处理、植骨床准备和融合器植入,因此无法避免这些操作所致的神经根损伤风险。本研究团队研发一套经皮腰椎融合器械,可实现直接Kambin三角撑开、直接椎间隙撑开、直接椎间盘切除、直接植骨床处理、直接植骨及植入融合器这些关键手术步骤。基于经皮腰椎融合器械的5个“直接”优势,提出一个创新术式——快速经椎间孔入路腰椎椎间融合术。

V形双通道脊柱内镜系统辅助下腰椎椎间融合术治疗单节段腰椎疾病的疗效分析

目的:探讨V形双通道脊柱内镜(VBE)系统辅助下经椎间孔入路腰椎椎间融合手术(VBE-TLIF)的初步临床应用效果。方法:回顾性分析2020年1月~2021年4月,因单节段腰椎疾病于我院接受VBE-TLIF手术治疗的20例患者的临床资料。其中男性13例,女性7例,年龄28~77岁,平均57.0±11.7岁。记录手术时间及并发症发生情况,于术前及术后3d、3个月、6个月、12个月、18个月时评估患者腰腿痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI),评估症状缓解情况。分析末次随访时改良MacNab评分、影像学资料等,评估手术优良率及融合率。结果:20例患者术后平均随访27.0±3.6个月(24~36个月),症状均得到明显改善。患者平均术前下肢痛VAS评分6.3±1.6分,腰痛VAS评分5.7±1.1分;术后3d下肢痛VAS评分1.9±0.9分,腰痛VAS评分2.3±0.8分;术后18个月下肢痛VAS评分0.7±0.6分,腰痛VAS评分0.9±0.7分,疼痛明显改善,差异有统计学意义(P<0.05)。术后18个月ODI为(15.0±5.8)%,较术前[(60.2±15.3)%]明显改善,差异有统计学意义(P<0.05)。术后出现屈髋乏力1例,经对症治疗1个月后改善;1例出现融合器移位伴神经根激惹症状,二次手术翻修,融合率为95%(19/20);无严重手术相关并发症出现,根据改良MacNab标准,优良率达95%。结论:VBE-TLIF是安全有效的腰椎微创融合技术方法,初步临床应用效果较为满意。