RESUMO
Objective To explore the effect of transforamen lumbar interbody fusion in treatment of lumbar intervertebral disk herniation with unilateral pedicle screw fixation. Methods Retrospectivly studied the clinical data of 36 patients with lumbar intervertebral disk herniation who were treated through transforamen lumbar interbody fusion with unilateral pedicle screw from January 2011 to October 2012. There were 22 male and 14 female patients, aged form 44 to 68 years old with mean age of 56. The lesion positions included 8 patients in L3/4, 17 patients in L4/5, and 11 patients in L5/S1. The data of operation time, intraoperative bleeding volume, and postoperative drainage volume were collected. Therapeutic effect were evaluated by visual analogue score (VAS), lumbar vertebral score of Japanese Orthopedic Association (JOA) score, and Oswestry dysfunction index (ODI). Results Operation time was 65-100 min with mean time of 85 min. Intraoperative bleeding volume was 100-250 ml with mean volume of 135 ml. Postoperative drainage volume was 100-200 ml with mean volume of 150 ml. Followed up for 12-36 months with mean time of 20 months. No loosening, breakage of screws or displacement of interbody fusion cages were found in the follow up period. The rate of anastomosis was 100%(36/36). The VAS was (7.9 ± 1.2) scores before operation and (1.1±0.3) scores at the end of follow up period, there was significant difference( P<0.05). The JOA score was (10.2±2.6) scores before operation and (23.2±4.3) scores at the end of follow up period, there was significant difference (P<0.05). The ODI was (43.3±6.2) scores before operation and (15.2±4.3) scores at the end of follow up period, there was significant difference ( P<0.05). Conclusion The effect of transforamen lumbar interbody fusion with unilateral pedicle screw fixation is proper for the patients who are suffering from lumbar intervertebral disk herniation, which has advantages of less invasion, less bleeding, better stability, better effect, quicker recovery and less complication.
RESUMO
Objective To compare the curative effect of transforaminal lumbar interbody fusion by Wihse approach and posterior median approach in treatment of lumbar spinal canal stenosis.Methods Ninety-six patients with lumbar spinal canal stenosis were treated with transforaminal lumbar interbody fusion by Wihse approach (42 cases,Wihse group) and posterior median approach (54 cases,control group).The operation time,exposure time,exposure bleeding volume,length of incision,intraoperative bleeding volume,visual analog score (VAS) of nick at the third day after surgery,and VAS of lumbar and leg,Japanese orthopedic association (JOA) score and Roland-Morris disability questionnaire (RDQ) score at 1 year after surgery were compared between the 2 groups.Results The length of incision,exposure time,operation time,exposure bleeding volume,intraoperative bleeding volume,VAS of nick at the third day after surgery and VAS of lumbar at 1 year after surgery in Wiltse group were (5.0 ± 1.2) cm,(20.0 ± 7.6) min,(150.0 ± 8.4) min,(10.6 ±5.4) ml,(125.5 ± 10.6) ml,(4.5 ±0.6) scores and (1.0 ±0.5) scores,and in control group were (8.0 ± 1.6) cm,(35.2 ±6.8) min,(162.0 ±5.6) min,(84.5 ±7.8) ml,(186.4 ± 15.4) ml,(6.8 ± 0.5) scores and (2.5 ± 0.8) scores],there were statistical differences between the 2 groups (P ＜ 0.01).But there were no statistical differences in the VAS of leg,JOA score and RDQ score at 1 year after surgery between the 2 groups (P ＞ 0.05).Conclusion Two kinds of approach transforaminal lumbar interbody fusions all have good therapeutic effect on lumbar spinal canal stenosis,but the Wiltse approach has advantages of small incision,less intraoperative dissection,less bleeding and low incidence of postoperative lumbodynia.