ABSTRACT
Adjacent segment degeneration (ASDeg) is a common complication occurring in patients after lumbar fusion, mainly manifested as adjacent disc herniation, adjacent vertebral fracture or spondylolisthesis, adjacent segment scoliosis, adjacent segment spinal canal stenosis or facet joint degeneration, etc. When patients with imaging manifestations of ASDeg present with clinical symptoms such as lumbosacral pain, root lower limb pain or intermittent claudication, it is called adjacent segment disease (ASDis), and reoperation is often required at this time. At present, open surgery has been widely used in the treatment of symptomatic ASDis, including fusion via posterior approach and transforaminal approach, etc. The traditional surgery is effective, but it always has many disadvantages, such as large surgical trauma, large intraoperative blood loss, long operation time and hospital stay, and slow postoperative recovery. Therefore, surgeons are actively trying to apply various minimally invasive procedures to the treatment for symptomatic ASDis. Anterior lumbar interbody fusion (ALIF) has better recovery effect on intervertebral space height and lumbar lordosis, but it also has higher risk of vascular, urinary system and abdominal organ injury. Minimally invasive transforaminallumbar interbody fusion (MIS-TLIF) has a significant effect on the protection of muscles (such as multifidus muscle) and ligaments. However, compared with open surgery, MIS-TLIF has a limited effect on the correction of coronal and sagittal malformations, and has a higher incidence of superior facet joint violation. lateral lumbar interbody fusion (LLIF) has significant correction effect on coronal and sagittal malformations, complete treatment of intervertebral space, high intervertebral fusion rate, and good intervertebral space height recovery. However, due to the influence of the iliac crest, the surgical segment of LLIF is limited, and there is a risk of injury to the lumbar plexus and iliac vessels at the lower lumbar spine. Extreme lateral lumbar interbody fusion (XLIF) has a low risk of iliac vascular injury, little impact on the original internal fixation, and good interbody fusion effect. However, XLIF is not suitable for patients with a history of retroperitoneal surgery, retroperitoneal abscess, or vascular anatomical abnormalities, and neurological monitoring is often needed during surgery. Compared with open surgery, oblique lumbar interbody fusion (OLIF) has the advantages of less surgical trauma and low risk of common complications (such as dural injury). However, due to the need to pull the sympathetic nerve during operation, OLIF may lead to postoperative limb cold and heat disorders, thus affecting the judgment of surgical decompression effect. Percutaneous endoscopic lumbar discectomy (PELD) can fully decompress the nerve and dural sac while causing less damage to the posterior spinal structure. However, it is not suitable for patients with ASDis complicated with severe spinal stenosis, lumbar spondylolisthesis or cauda equina syndrome. At the same time, PELD has a steeper learning curve than other procedures. Percutaneous endoscopic lumbar interbody fusion (PELIF) also has the disadvantages of steep learning curve and easy to damage outlet nerve, but it has the advantages of less blood loss, shorter hospital stay, faster recovery, and fewer complications (such as deep vein thrombosis and pulmonary embolism) compared with open surgery. This paper reviews the advantages and disadvantages of different minimally invasive procedures in the treatment of symptomatic ASDis and the indications of different minimally invasive procedures through literature retrieval, in order to provide reference for the future minimally invasive methods in the treatment of symptomatic ASDis.
ABSTRACT
BACKGROUND:Percutaneous kyphoplasty with bone cement injection for repair of multi-segmental thoracolumbar vertebral osteoporotic fractures can restore the compressed vertebral height, correct deformity and reduce complications. OBJECTIVE: To explore the therapeutic effects of percutaneous kyphoplasty with bone cement in patients with multi-segmental thoracolumbar vertebral osteoporotic fractures. METHODS:Eighty patients with multi-segmental thoracolumbar vertebral osteoporotic fractures were enroled, 29 males and 51 females, aged 61-78 year, including 52 case of two-segmental vertebral fractures, 22 cases of three-segmental vertebral fractures, 6 cases of four-segmental vertebral fractures. Al the patients were divided into experimental group and control group randomly. Patients in the control group were given active basic treatment and anti-osteoporosis treatment and stayed in bed. Patients in the experimental group were given percutaneous kyphoplasty with bone cement injection on the above basis. Al the patients were folowed-up 12 months after treatment. Then the Oswesty dysfunction index, Barthel index, visual analog scale score, and theanterior vertebral height and midline height, Cobb angle were compared between the two groups. RESULTS AND CONCLUSION: In the experimental group, the Oswesty dysfunction index, Barthel index, visual analog scale score, and the anterior vertebral height and midline height, Cobb angle were al significantly improved at 3 days, 3 months and 12 months after treatment than before (P < 0.05). In the control group, the Oswesty dysfunction index, Barthel index and visual analog scale score were improved significantly at 3 and 12 months after treatment (P < 0.05), while the anterior vertebral height and midline height were improve dramaticaly at 12 months after treatment (P < 0.05). Compared with the control group, the experimental group showed better the Oswesty dysfunction index and Cobb angle than the control group at 12 months after treatment (P < 0.05), but there were no difference in the other indicators between the two groups. No adverse reactions associated with bone cement material occurred in the experimental group. Taken together, the percutaneous kyphoplasty with bone cement injection can rapidly relieve pain in patients with multi-segmental thoracolumbar vertebral osteoporotic fractures, which can correct kyphosis and improve patient's quality of life.