After transforaminal lumbar interbody fusion for lumbar degenerative instability of the clinical ana.docx

After transforaminal lumbar interbody fusion for lumbar degenerative instability of the clinical ana.docx

《After transforaminal lumbar interbody fusion for lumbar degenerative instability of the clinical ana.docx》由会员分享，可在线阅读，更多相关《After transforaminal lumbar interbody fusion for lumbar degenerative instability of the clinical ana.docx（4页珍藏版）》请在冰豆网上搜索。

Aftertransforaminallumbarinterbodyfusionforlumbardegenerativeinstabilityoftheclinicalana

Aftertransforaminallumbarinterbodyfusionforlumbardegenerativeinstabilityoftheclinicalanalysis

Author:

WangShuhaipayGuoquanJifuLiZhaoYanjunWangHuGangShiJiaoYanGuofei

[Abstract]ObjectiveToevaluatethetransforaminallumbarfusion（TLIFlumbardegenerativeinstabilityoftheclinicalefficacyandtheadvantagesanddisadvantages.MethodsAretrospectiveanalysisfromJanuary2005toOctober2009andwasadmittedtomorethan1.5yearsfollow-upisnotdegenerativestabilityof47patients,allpatientsunderwentcombinedposteriorTLIFPLIFsurgery,including28malesand19females,aged45-69years,mean58.3years,durationof2months-15years,segmentalinstability,singlesegmentof33cases,L4/L5/S1doublesegment9cases,L2/L3/L4/L5,L3/L4/L5/S1threesegmentsin2cases,L1/L2/L3/L4/L5foursegments1cases.tohavethespinalcanalandnerverootcanalstenosisofthelinesegmentPLIFsurgery,spinalstenosisofthesegmentisnotretainedonthespine,interspinousligamentandthelaminaoftheintegrityofthelineTLIFsurgery,thisgroupofpatientsinclinicalefficacyofinterbodyfusionratesandcorrectionofdegenerativescoliosisevaluationresultsall47patientswerefollowedupfor1-4years,anaverageof18monthsinaccordancewith29pointsJOAlowbackpainwereassessedstandards（includingsymptoms,signsdailylifesuchasthedirectionofmovementandbladderfunctionassessmentofclinicalefficacy,themeanpreoperative（11.7+-6.5assignedtothelastfollow-up（mean22.7+-11.6points,includingexcellentin32cases,goodin13cases,2cases,goodrateof95.7%oftheconclusionsinthetreatmentofdegenerativelumbarinstability,lumbarfusionaftertransforaminalapproachforclinicalefficacy,interbodyfusionrate,isaworthyapproach.

[Keywords:

]foraminalinterbodyfusionapproachforclinicalstudiesofdegenerativelumbarinstabilityDegenerativelumbarspinediseaseisacommondiseaseintheelderly,associatedwithdiscdegeneration（prominentandspinalstenosis,aseriousimpactonpatientqualityoflife,increasinglyinrecentyears,increasingagingpopulationtrend,sothatthediseasehasincreasedeveryyear.Itscharacteristicsare:

standingandwalkingandlegpaincausedbybackpain,lumbarhyperextensionsuchsymptoms.[1]Suchpatientsareassociatedwithlumbarinstability,posteriordecompressionaloneoftencannotachievethedesiredresults.ourdepartmentsince2005JanuarytoJune2009adoptedbythetransforaminalapproachlumbarfusion（transforminallumbarinterbodyfusionTLIFtreatmentofdegenerativelumbarinstabilityin47cases,bythefollow-upobservation,resultsweresatisfactory,areasfollows.

Clinicaldata1.1GeneralInformationAtotalof47casesofthisgroupofpatients,including28malesand19females,aged45-69years,mean58.3years,durationof2monthsto15years,allpatientswerepreoperativeMRIexaminationrevealedalumbardischerniationand（or）lumbarspinalcanalstenosis,andbyCT,lumbarside,doubleoblique,hyperextension,flexionX-rayconfirmedthatnocrackisthmusandⅡdegreesofspondylolisthesis,inlinewiththediagnosisoflumbardegenerativeinstabilityrangeofpatientsarelowbackpain,intermittentclaudication（claudicationsymptomsoccur-800metersfrom50meterswithunilateralorbilaterallowerextremitypain,sensorylossandthecorrespondingcontrolsegment,asmallnumberofpatientswithcaudaequinasyndrome.segmentalinstabilitywhichsinglesegmentL5/S114例,L4/L518例,L3/L41case,multi-segmentL4/L5/S19例,L2/L3/L4/L52例,L3/L4/L4/L5/S12cases,L1/L2/L3/L4/L5L1cases.

1.2ProceduresAreusedendotrachealintubation,thepatientstoopoutsidespinesurgeryinthebracket,C-armtohelplocate,towanttorevealthecenterofthesegmentaftertheincision,fromthespinousprocess,laminasubperiostealdissectiontothebilateralfacetAutomaticretractorretractor,designedfromthepreoperativelumbarsegmentsofbilateral‘herringboneridge’nailsintothevertex,alongthedirectionofthepedicleintotheguidepin.C-armradiographicseethelocationofthesatisfactionofthearchtoselecttheappropriatemodelnailroot（SuzhouYiXieYanWingBoltoffersandpedicleandvertebralbody.tohavespinalstenosisandnerverootcanalstenosisofthesegmentdoesnotkeepthespineligament,posteriorlaminectomy,toInadditiontothecorrespondingsegmentofthespinousprocessandlamina,bilateralfacetjointtoretaintheintegrityofthespinalcanaltoopenalargereleasetolooseduralsacandnerverootcanal.Fornon-segmentalspinalstenosis,keepthespine,betweentheligamentandthelaminaintegrity.lineTLIFsurgeryMethods:

degenerativescoliosisconcavesideofthetransversesegmentbetweentheentry,withaboneknifechiseledupperpartofthevertebralbodyandtheinferiorarticularprocessonthelowerpartofvertebraljointssuddenly,thecorrespondingintervertebralforamentoprotectthepediclefromtheloweredgeoftheuppervertebralbodytogowiththelinesegmentofthenerveroots,intervertebralforamenapproachforresectionoftheannulusfromthenucleuspulposusandthecartilageoftheupperandlowervertebralend-platetotheboneoftheendplate.pre-bentrodconnectingbothsideswereevenonbothsideshavesetagoodpediclenailed.degenerativescoliosisconcavesideofthedistraction,convexsideofthevertebralbodytoapplypressureandrotationtechniques,correctiondegenerativescoliosis,recoveryⅡdegreepositionwithinthevertebralslippageSelecttheappropriateangleandsizeoftheCage,willcutintothebonefragmentsoftheautologousspinousprocessandlaminaintothecorrespondingpressureinsidetheCage,andthecorrespondingvertebralimplantclearance,theappropriatepressurehasbeenplacedCageinsegments,sothattheupperandlowervertebralboneCageandpressuretightendboards.C-armX-raymachine,confirmthatlumbarsequencewassatisfactory.decompressionofthelinesegmenthasbeenre-explorationconfirmthattherewasnoduralbilateralnerverootcompression.thoroughlywashed,tostopbleeding.osteotomechiselasmallarticularsurfaceoftheconvexside,fillinthesmalljointsofautologousbonefusion.duraexposedpartofthesprayoffaprotectedbiologicalprotein.setwithsideholesaventriculardrainagetubedrainage,suturethemuscletoclosethedeadspace.suturedeepfascia,subcutaneousandskin.surgery.

1.3aftertreatmentRoutineuseofantibiotics7-10days,24-48hours,asthedrainageoffluidsituationextubation.After2-4daysundertheprotectionofgettingoutofbedinthewaist.

2resultsTheoperativemeanoperativetime3.5hours,meanbloodloss900ml.Intraoperativesevereadhesionoccurstogive5casesofduralrupturerepair.1patientpostoperativecerebrospinalfluidleakage.GiveTrendelenburg,fluidandotherrecoveredaftertreatment.All47casespatientswerestageⅠhealing.norecentwoundinfectioncomplications.all47patientswerefollowedupfor1-4years,anaverageof18monthsandlatelaterallumbarspine（lumbarspineafter1yearhadheldoutflexionfilmsshowedvertebralsequenceintact.pediclescrew-rodsystemingoodposition,nopseudoarthrosis.

Evaluation:

lumbardiscdiseasetreatmentbyJOAscoretodeterminethebaseline（198,629dividedbysymptomsⅠ,Ⅱphysicalexamination,Ⅲdailylife,Ⅳbladderfunction,Ⅴsatisfaction,Ⅵmentalstateevaluationofreference6parts.Evaluationofhospital,thedischargeandfollow-uptotimeswhenthescore.

Table1Clinicalfollow-upresultsafter

Tab.1Clincalfollow-upresultsaftersurgery

Lastadmission,discharge,follow-upJOAscorewas11.7+-6.515.2+-3.722.7+-11.6

admissionandlastfollow-up,P<0.05

Atypicalcase:

Figure1-7forthesamepatient:

Figure1:

MRIshoweddegenerativelumbarinstability,L1/L2,L2/L3,L4/L5areunstable,L4/L5segmentsⅡospondylolisthesis,duralsacwascompressed.

Figure2:

ThehorizontalpositionMRIfilmshowedL4/L5segmentalstenosis.

Figure3:

CRlumbarspinefilmsshoweddegenerativelumbarscoliosis.

Figures4and5:

lumbarhyperextension,flexionrayconfirmedL1/L2,L2/L3,L4/L5areunstable.

Figure6,7:

lineTLIFlumbarsequencebacktonormalaftersurgery,anteroposteriorfilmsshowed:

L1/L2,L2/L3spinousprocessandlaminaintact,confirmedtheTLIFsurgerydoesnotinterferewiththerearstructure.

3Discussion3.1Thetransforaminalapproachforlumbarinterbodyfusion,revisionsurgeryinthelumbarspinehasbeenwidelyused,themainadvantageisnottointerferewiththerearoftheboneligamentstructureofthespine,reducingoperationtimeandsurgicaltrauma-inducedbleeding,mainlyusedinrevisionsurgerywhenthelumbartoreducetheduramateroftheharassment,preventruptureoftheduramater,toreducethecaudaequinaandnerverootinjuryoccurred,weapplythistechniquetolumbardegenerativesmoothcases,experiencehasthefollowingadvantages:

3.1.1hadheldoutforlumbarflexioninstabilityandX-raythereisalowbackpainduetoinstabilitycausedbythepatient,ifthereisnoinstabilityintherearsegmentoftheligamentumflavumthickeningistheapplicationofthissurgicalindication.

3.1.2ApplicationTLIFmethoddoesnotinterferewiththerearofthelamina,yellowligament,completedecompressionofthenerveroot,mildtrauma,lessbleeding,shorteroperativetime,rapidpostoperativerecovery.

3.1.3nodamagetothestructurebehindthelumbarspine,thelumbarspinefixedandbetterstabilityaftercageinsertion,fusionrate.Tor