ABSTRACT
Objective To examine the feasibility and early effects of unilateral pedicle screw fixation in combination with contralateral translaminar facet screw fixation plus interbody fusion through the channel-assisted muscle-splitting approach for the treatment of degenerative lumbar spine diseases in elderly patients.Methods A total of 82 elderly patients with degenerative lumbar spine diseases received treatment between January 2015 and June 2016.Of these patients,25 had lumbar spinal stenosis,42 had degenerative lumbar instability,13 had giant lumbar disc herniation,and two had recurrent lumbar disc herniation;There were 69 cases of single segment and 13 cases of double segment lesions.Perioperative evaluation,imaging evaluation,and clinical evaluation were performed,and surgical complications were analyzed.Results The average length of incision was (2.6 ± 0.4) cm in cases of single segment lesions and (4.4±0.5) cm in cases of two segment lesions.The mean operation time was (98.3±19.6) minutes and peri-operation blood loss was (232.2±25.8) ml.The post-operation height of the intervertebral disc space significantly increased at the last follow-up(P ＜ 0.05);the height of the intervertebral disc space was restored and well maintained with internal fixation showing no loosening,breakage or Cage shift.The post-operation lumbar coronal Cobb angle decreased(P＜0.05)while the sagittal Cobb angle increased(P＜0.05)at the last follow-up.There was no significant difference in the area and grade of the multifidus muscle on MRI 12 months after operation.Seventy-two patients were followed up for 12-18 months (mean =16.8 months),and there were 67 cases of intervertebral fusion (93.1％).The last follow-up showed a Japanese Orthopaedic Association(JOA) score of (25.8 ± 1.7),which was significantly higher than the pre-operation score (10.6±1.3),with an excellence rate of 88.9 ％.The Oswestry Disability Index score was significantly reduced,from (50.9±21.6) at pre-operation to (9.6± 4.8) at the last follow-up.There were 78 patients with primary wound healing,three cases of superficial wound necrosis,one case of dural tear,and one case of nerve root injury.No cardiovascular or cerebrovascular incident was observed during or after operation.Conclusions Combined pedicle/facet screw fixation plus interbody fusion through the channel-assisted muscle-splitting approach shows satisfactory short-term effects when used for the treatment of degenerative lumbar spine diseases in the elderly and possesses advantages such as minimal invasiveness,limited bleeding,quick recovery,high fusion rates and significantly improved clinical outcomes.However,further clinical studies are required to assess its medium-and long-term efficacy.
ABSTRACT
Objective To estimate the effect of pedicle screw fixation of thoracolumbar fractures via paraspinal approach and compare it with the conventional posterior midline approach.Methods Forty-two cases of thoracolumbar monosegmental fractures subjected to single posterior pedicle screw fixation and reduction from December 2008 to May 2010 were included in the study.Among the patients,19 cases were operated through paraspinal muscular-sparing approach (paraspinal approach group) and 23 cases through posterior midline surgical approach (conventional approach group).Surgical incision length,operation time,intraoperative blood loss,postoperative drainage volume,postoperative hospital stay,pre-and post-operative VAS and other perioperative indices as well as fracture reduction outcome were compared between the two groups.Oswestry disability index (ODI) was assessed after operation.Results There were no statistical differences between the two groups in aspects of surgical incision length,operation time,postoperative hospital stay,height restoration of fractured vertebra (P ＞ 0.05),but intraoperative blood loss (148.5 ± 26.5) ml,postoperative draining loss (72.9 ± 17.3) ml,postoperative VAS (1.1 ± 0.3) points and ODI (13.4 ± 2.7) points in paraspinal approach group showed statistical differences from those in conventional approach group (P ＜ 0.05).Conclusion Paraspinal muscle-sparing approach is characterized by minor trauma,less bleeding,slight pain and quick recovery as compared with conventional posterior midline approach and hence may be the preferred choice for the treatment of thoracolumbar fracture without spinal canal decompression.