Posterior lumbar interbody fusion (PLIF) is a common surgical procedure and widely used in the treatment of lumbar degenerative disc disorders. Traditionally, posterior lumbar interbody fusion is done by using the tra...Posterior lumbar interbody fusion (PLIF) is a common surgical procedure and widely used in the treatment of lumbar degenerative disc disorders. Traditionally, posterior lumbar interbody fusion is done by using the traditional pedicle screw (PS) which offers great advantages, but at the same time it has some disadvantages which include the risk of superior facet joint violation and muscle damage. Recently, an alternative method of screw insertion via cortical bone trajectory (CBT) has been invented which has less invasive process and can be placed without the drawbacks associated with the traditional pedicle screw. However, it has to remain an interest whether CBT will provide similar or greater clinical outcomes compared to PS in PLIF. So the main aim of this review is to compare the clinical outcomes of cortical bone trajectory and traditional pedicle screw fixation in posterior lumbar interbody fusion based on the articles published on this topic. Compared to the traditional pedicle screw fixation, PLIF with CBT has similar clinical outcome based on pain intensity, ODI status and JOA score, as well as similar fusion rate and radiological evaluated complication such as loosening of screw. In addition PLIF with CBT has advantages of less facet joint violation, less blood loss, less intraoperative muscle damage and perioperative pain. On the basis of this study, we can suggest that PLIF with CBT can be considered as a reasonable alternative to PS in PLIF.展开更多
Objective: To evaluate the surgical results of posterior lumber interbody fusion with transpedicular fixation with rod screw system in management of spondylolisthesis. Study Design: Retrospective study reviewed all pa...Objective: To evaluate the surgical results of posterior lumber interbody fusion with transpedicular fixation with rod screw system in management of spondylolisthesis. Study Design: Retrospective study reviewed all patient treated by lumber interbody fusion with transpedicular fixation with rod screw system. Patients and Methods: They were 40 patients operated for lumber and lumbosacral spondylolisthesis from Feb 2014 to April 2017 in Al-Azhar university hospital. These patients followed postoperatively clinically for improved neural function and for fusion stability and hardware fixation by radiological investigation. Data about pain intensity (by Visual Analogue Scale) was collected pre- and postoperatively;and outcome was assessed by Oswetry disability index (ODI). Outcome was graded as excellent, good, fair, or poor. Pre- and Post-operative data were statistically compared. Results: The mean age was 45 years (range between 30 - 60 years) with female sex predominance (male:female = 1:3). They had lytic (n = 30) or degenerative (n = 10) spondylolisthesis;and all underwent PLIF (posterior lumbar interbody fusion). In lytic group, the level was L4/L5 in 19 patients and L5/S1 in 11 patients, while in degenerative group the level was L4/L5 in 4 patients, L5/S1 in 3 patients, L2/L3 in 2 and L3/L4 in one patient. The spondylolisthesis grade was grade I among 25 subjects, grade two among 11 subjects and retrolisthesis among 4 subjects. Sensory deficits reported in 22 subjects (19 had lytic and 3 had degenerative spondylolisthesis);while motor deficits reported among 10 subjects and reduced reflexes among 8 subjects. The outcome was excellent, good, and fair among 30, 7, and 3 subjects respectively. The return to previous levels of activity was reported among 32 patients. VAS was 3.5 ± 2.94 at the end of follow up, while ODI was 28% and 36.0% and 3 and 6 months respectively. Conclusion: PLIF associated with transpedicular rod screw fixation system for management of spondylolisthesis is considered a safe and effective surgical intervention in both lytic and degenerative types.展开更多
目的评估在骨质疏松条件下,行L5/S1节段斜外侧椎间融合术(oblique lateral interbody fusion at L5/S1,OLIF51)及其联合双侧皮质骨轨迹螺钉(cortical bone trajectory screw,CBT)和双侧椎弓根螺钉(bilateral pedicle screw,BPS)的生物...目的评估在骨质疏松条件下,行L5/S1节段斜外侧椎间融合术(oblique lateral interbody fusion at L5/S1,OLIF51)及其联合双侧皮质骨轨迹螺钉(cortical bone trajectory screw,CBT)和双侧椎弓根螺钉(bilateral pedicle screw,BPS)的生物力学性能。方法招募1名健康青年男性作为志愿者,获得其腰骶椎三维CT数据,在有限元分析软件中完成L4~S1三维模型,采用前路钛板(titanium plate,TP)固定的OLIF51手术模型、OLIF51+CBT和OLIF51+BPS手术模型的构建,分别命名为A、B、C、D模型。通过赋值、设定条件、施加载荷,分析不同条件下的生物力学特性。结果顺利完成4种有限元模型的构建。4种模型在所有运动中的平均活动度(range of motion,ROM)变化趋势为A模型>B模型>C模型>D模型;其中,与A模型相比,B模型降幅为84.21%~94.42%,C模型降幅为88.12%~96.40%,D模型降幅为90.07%~96.49%(P均<0.05);与B模型相比,C模型降幅为7.41%~52.38%,D模型降幅为27.78%~58.33%(P均<0.05)。3种手术模型在所有运动中的融合器(Cage)平均最大应力变化趋势为B模型>C模型>D模型;其中,与B模型相比,C模型降幅为12.89%~57.62%,D模型降幅为36.43%~73.11%;D模型和C模型相比,除左侧弯外差异均有统计学意义(P均<0.05);D模型降幅为21.83%~37.67%。3种手术模型在所有运动中的内固定平均最大应力变化趋势为B模型>C模型>D模型;与B模型相比,C模型降幅为3.55%~65.47%,D模型降幅为18.58%~84.41%;CBT应力大于BPS应力(P<0.05)。结论在OLIF51手术中,补充后路内固定可以增强融合节段的稳定性并减轻TP上的应力。不建议对骨质疏松症患者单独进行OLIF51手术,使用BPS辅助固定可达到最佳生物力学特性。接受CBT辅助内固定的患者术后需要佩戴支具,并尽量避免融合部位的右侧弯曲运动。展开更多
文摘Posterior lumbar interbody fusion (PLIF) is a common surgical procedure and widely used in the treatment of lumbar degenerative disc disorders. Traditionally, posterior lumbar interbody fusion is done by using the traditional pedicle screw (PS) which offers great advantages, but at the same time it has some disadvantages which include the risk of superior facet joint violation and muscle damage. Recently, an alternative method of screw insertion via cortical bone trajectory (CBT) has been invented which has less invasive process and can be placed without the drawbacks associated with the traditional pedicle screw. However, it has to remain an interest whether CBT will provide similar or greater clinical outcomes compared to PS in PLIF. So the main aim of this review is to compare the clinical outcomes of cortical bone trajectory and traditional pedicle screw fixation in posterior lumbar interbody fusion based on the articles published on this topic. Compared to the traditional pedicle screw fixation, PLIF with CBT has similar clinical outcome based on pain intensity, ODI status and JOA score, as well as similar fusion rate and radiological evaluated complication such as loosening of screw. In addition PLIF with CBT has advantages of less facet joint violation, less blood loss, less intraoperative muscle damage and perioperative pain. On the basis of this study, we can suggest that PLIF with CBT can be considered as a reasonable alternative to PS in PLIF.
文摘Objective: To evaluate the surgical results of posterior lumber interbody fusion with transpedicular fixation with rod screw system in management of spondylolisthesis. Study Design: Retrospective study reviewed all patient treated by lumber interbody fusion with transpedicular fixation with rod screw system. Patients and Methods: They were 40 patients operated for lumber and lumbosacral spondylolisthesis from Feb 2014 to April 2017 in Al-Azhar university hospital. These patients followed postoperatively clinically for improved neural function and for fusion stability and hardware fixation by radiological investigation. Data about pain intensity (by Visual Analogue Scale) was collected pre- and postoperatively;and outcome was assessed by Oswetry disability index (ODI). Outcome was graded as excellent, good, fair, or poor. Pre- and Post-operative data were statistically compared. Results: The mean age was 45 years (range between 30 - 60 years) with female sex predominance (male:female = 1:3). They had lytic (n = 30) or degenerative (n = 10) spondylolisthesis;and all underwent PLIF (posterior lumbar interbody fusion). In lytic group, the level was L4/L5 in 19 patients and L5/S1 in 11 patients, while in degenerative group the level was L4/L5 in 4 patients, L5/S1 in 3 patients, L2/L3 in 2 and L3/L4 in one patient. The spondylolisthesis grade was grade I among 25 subjects, grade two among 11 subjects and retrolisthesis among 4 subjects. Sensory deficits reported in 22 subjects (19 had lytic and 3 had degenerative spondylolisthesis);while motor deficits reported among 10 subjects and reduced reflexes among 8 subjects. The outcome was excellent, good, and fair among 30, 7, and 3 subjects respectively. The return to previous levels of activity was reported among 32 patients. VAS was 3.5 ± 2.94 at the end of follow up, while ODI was 28% and 36.0% and 3 and 6 months respectively. Conclusion: PLIF associated with transpedicular rod screw fixation system for management of spondylolisthesis is considered a safe and effective surgical intervention in both lytic and degenerative types.
文摘目的评估在骨质疏松条件下,行L5/S1节段斜外侧椎间融合术(oblique lateral interbody fusion at L5/S1,OLIF51)及其联合双侧皮质骨轨迹螺钉(cortical bone trajectory screw,CBT)和双侧椎弓根螺钉(bilateral pedicle screw,BPS)的生物力学性能。方法招募1名健康青年男性作为志愿者,获得其腰骶椎三维CT数据,在有限元分析软件中完成L4~S1三维模型,采用前路钛板(titanium plate,TP)固定的OLIF51手术模型、OLIF51+CBT和OLIF51+BPS手术模型的构建,分别命名为A、B、C、D模型。通过赋值、设定条件、施加载荷,分析不同条件下的生物力学特性。结果顺利完成4种有限元模型的构建。4种模型在所有运动中的平均活动度(range of motion,ROM)变化趋势为A模型>B模型>C模型>D模型;其中,与A模型相比,B模型降幅为84.21%~94.42%,C模型降幅为88.12%~96.40%,D模型降幅为90.07%~96.49%(P均<0.05);与B模型相比,C模型降幅为7.41%~52.38%,D模型降幅为27.78%~58.33%(P均<0.05)。3种手术模型在所有运动中的融合器(Cage)平均最大应力变化趋势为B模型>C模型>D模型;其中,与B模型相比,C模型降幅为12.89%~57.62%,D模型降幅为36.43%~73.11%;D模型和C模型相比,除左侧弯外差异均有统计学意义(P均<0.05);D模型降幅为21.83%~37.67%。3种手术模型在所有运动中的内固定平均最大应力变化趋势为B模型>C模型>D模型;与B模型相比,C模型降幅为3.55%~65.47%,D模型降幅为18.58%~84.41%;CBT应力大于BPS应力(P<0.05)。结论在OLIF51手术中,补充后路内固定可以增强融合节段的稳定性并减轻TP上的应力。不建议对骨质疏松症患者单独进行OLIF51手术,使用BPS辅助固定可达到最佳生物力学特性。接受CBT辅助内固定的患者术后需要佩戴支具,并尽量避免融合部位的右侧弯曲运动。
