文章简介

出版社:Eur Spine J.

作   者:Quraishi NA, Rampersaud YR

编   号:10.1007/s00586-012-2623-2

年   份:2013    点击量:621

文章摘要 全文翻译

Purpose

Minimally invasive or ‘‘minimal access surgery’’ (MAS) is being utilized with increasing frequency to reduce approach-related morbidity in the lumbar spine. This paper describes our minimal access technique for posterior bilateral transforaminal lumbar interbody fusion  (TLIF) and spinal instrumentation in a patient with high- grade spondylolisthesis grade (Myerding Grade III) with 5-year follow-up.

目的

现在越来越频繁地使用微创或“微损伤”(MAS)来减少腰椎手术切口相关并发症。本文采用微创技术进行后路双侧经椎间孔腰椎椎体间融合(TLIF)和脊柱内固定治疗一例重度脊椎滑脱患者(Myerding  III级),并随访5年。

 

Methods

A 24-year-old lady presented with mechanical back pain and left leg L5 radiculopathy. On examination, she was a thin lady with an obvious step deformity in the lower lumbar spine and otherwise, a normal neurological examination. Imaging showed a grade III isthmic L5–S1 spondylolisthesis with foraminal stenosis and focal kyphotic alignment of 20°[slip angle (SA) = 70°]. Conservative measures had failed, and a decision was made to proceed with a MAS-TLIF approach.

方法

一名24岁女性,背部疼痛,左侧L5神经根病。查体见患者偏瘦,下腰椎存在明显“台阶样”畸形,但神经系统检查正常。影像学显示L5-S1脊椎III级滑脱,伴有椎间孔狭窄和滑脱处后凸成角20°(SA角70°)。保守治疗失败,决定采取MAS-TLIF手术。

 

Results

The estimated blood loss was less than 100 ml, operating time 150 min, and post-operative hospital stay was 4 days. Post-operatively the patient had significant improvement of back and radicular pain. Improvement in ODI was substantial and sustained at 5 years. A solid fusion was achieved at 8 months. The slip percentage improved from 68 % (pre-op) to 28 % (post-op) and the focal alignment to 20° lordosis (SA = 110°).

结果

估计失血量少于100ml,手术时间为150分钟,术后住院4天。术后患者背痛和神经根痛得到显著改善。术后5年随访,ODI获得持续、明显改善。8个月时实现了坚固融合。滑脱率从术前68%降低到术后28%,病变部位恢复20度前凸(SA角为110°)。

 

Conclusions

A MAS approach for selected patients with a mobile high-grade spondylolisthesis is feasible, safe and clinically effective, with the added benefit of reduced soft- tissue disruption. Our result of this technique suggests that the ability to correct focal deformity, and achieve excellent radiographic and clinical outcome is similar to the open procedure.

结论

采用微创手术治疗重度脊椎滑脱患者具有可行性、安全性和临床疗效,并减少软组织破坏。结果显示这项技术在矫正病变局部畸形和实现良好的影像学和临床结果方面,与开放性手术具有一样的效果。