Treatment of degenerative lumbar spondylolisthesis by using minimally invasive transforaminal lumbar interbody fusion and percutaneous pedicle screw fixation

Chinese Journal of Contemporary Neurology and Neurosurgery

Feng-zeng JIAN¹  Hao WU¹  Can ZHANG¹  Qu WANG¹  Yan-da LIN¹ 

[1] Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China;

关键词: Spondylolysis;    Lumbar vertebrae;    Spinal fusion;    Internal fixation (not in MeSH);    Surgical procedures, minimally invasive;   

DOI  :  

来源: DOAJ

【 摘 要 】

Objective To discuss clinical therapeutic effects ofminimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) combinedwith percutaneous pedicle screw fixation for degenerative lumbarspondylolisthesis (DLS).  Methods A total of 32 DLS patientstreated by MIS-TLIF and percutaneous pedicle screw fixation from January 2013 toSeptember 2015 in Xuanwu Hospital, Capital Medical University wereretrospectively reviewed. Visual Analogue Scale (VAS), Oswestry Disability Index(ODI) and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) scoreswere assessed and compared between preoperation and one week, 3 months afteroperation and in the last follow-up. Lumbar lordosis angle, coronal Cobb angle,coronal and sagittal body shifting, complication, the degreeof spondylolisthesis (Meyerding classification) and the rate ofspondylolisthesis were measured according to preoperative and postoperativespinal X-ray examination. Fusion rate was evaluated according to X-rays or CT inthe last follow-up, and MRI was used to assess the degree of decompression. Results Thirty-two patients were under test with meanoperation time 160 min, intraoperative blood loss 120 ml, postoperative hospitalstay 7.22 d and follow-up 10.83 months. Decompression and fusion levels rangedfrom L2-S1 and interbody fusion was performed in 32 patients and 41 levels werefused. Compared with preoperation, the VAS and ODI scores were significantlyincreased at one week, 3 months after operation and in the last follow-up(P = 0.000, for all), while SF-36 score (P = 0.002, 0.000,0.000), lumbar lordotic angle (P = 0.000, for all), coronal Cobb angle(P = 0.000, for all) and slippage rate (P = 0.000, for all)were significantly decreased. The fusion rate was 92.22%, and the improvementrate of ODI was (80.51 ± 6.02)% in the last follow-up. There were 3 casesappeared complications, including one case of infection and 2 cases ofcerebrospinal fluid (CSF) fistula, and were cured after treatment. Neurologicaldefects, internal fixation failure, breakage of pedicle screw or titanium rod,or Cage displacement were not found in 32 cases. There was no death. Conclusions MIS-TLIF combined with percutaneous pedicle screwfixation is an effective technique for treatment of DLS patients, with lessinjury, less intraoperative blood loss, low complication incidence rate, goodscoliosis correction and definite therapeutic effects, even this method needsmore operation time, longer learning curve and more radiation.

 

DOI: 10.3969/j.issn.1672-6731.2016.03.003

【 授权许可】

Unknown