EFFECTIVENESS OF COMBINED TREATMENT OF LUMBAR SPONDYLOLISTHESIS WITH MED, Quadrant, AND Sextant-R SYSTEMS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

KANG Hui , CAI Xianhua , XU Feng , HUANG Yong.

Department of Orthopaedics, Wuhan General Hospital of Guangzhou Command of Chinese PLA, Wuhan Hubei, 430070, P.R.China. Corresponding author: KANG Hui, E-mail: kanghuicss@163.com;

Corresponding author：

Keywords：

Lumbar spondylolisthesis; MED system; Quadrant system; Sextant-R system; Minimal invasive surgery

DOI：

10.7507/1002-1892.20130094

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Objective To analyze the effectiveness of combined treatment of lumbar spondylolisthesis with MED, Quadrant, and Sextant-R systems. Methods Between August 2006 and June 2011, 35 patients with lumbar spondylolisthesis were treated, including 11 cases of isthmic spondylolisthesis and 24 cases of degenerative spondylolisthesis. There were 25 males and 10 females, with a mean age of 55 years (range, 33-71 years). The mean disease duration was 37 months (range, 8-75 months). Spondylolisthesis occurred at L4, 5 level in 21 patients and at L5, S1 level in 14 patients. According to Meyerding classification, 35 cases were rated as dergee I. The minimally invasive surgeries were performed by paraspinal muscle approach; Quadrant system was used for decompression and fusion at severe side, MED system for windowing of lamina at mild side, and Sextant-R system for fixation and reduction. Visual analogue scale (VAS) score was used to evaluate pain, Oswestry disability index (ODI) to evaluate clinical outcomes, spondylolishesis ratio and intervertebral height to evaluate spondylolisthesis reduction. Results Lumbar continuous thin layer CT at postoperation showed that no pedicle screw invaded spinal canal and intervertebral fusion device was at good position. Incisions healed by first intention. All patients were followed up 18-38 months (mean, 26 months). All patients got bone fusion and had no internal fixation failure by radiologic examination at 1 year after operation. Low back pain was relieved, lumbar function improved obviously, and satisfactory reduction of spondylolisthesis was obtained. At 2 weeks and 1 year after operation, the VAS score, ODI score, spondylolisthesis ratio, and intervertebral height were significantly improved when compared with preoperative ones (P lt; 0.05). VAS score and ODI score showed significant differences (P lt; 0.05) between at 2 weeks and 1 year after operation. Spondylolisthesis ratio and intervertebral height showed no significant difference (P gt; 0.05) between at 2 weeks and at 1 year after operation. Conclusion Minimally invasive surgical management for lumbar spondylolisthesis via MED, Quadrant, and Sextant-R systems is a safe and effective surgical technique. However, its indications should be well considered.

Citation： KANG Hui,CAI Xianhua,XU Feng,HUANG Yong.. EFFECTIVENESS OF COMBINED TREATMENT OF LUMBAR SPONDYLOLISTHESIS WITH MED, Quadrant, AND Sextant-R SYSTEMS. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(4): 399-403. doi: 10.7507/1002-1892.20130094 Copy

1.	Gille O, Jolivet E, Dousset V, et al. Erector spinae muscle changes on magnetic resonance imaging following lumbar surgery through a posterior approach. Spine (Phila Pa 1976), 2007, 32(11): 1236-1241.
2.	Motosuneya T, Asazuma T, Tsuji T, et al. Postoperative change of the cross- sectional area of back musculature after 5 surgical procedures as assessed by magnetic resonance imaging. J Spinal Discord Tech, 2006, 19(5): 318-322.
3.	黎庆初, 尹刚辉, 张忠民, 等. 微创Wihse入路与传统后正中入路手术治疗双节段腰椎管狭窄症的疗效比较. 中国脊柱脊髓杂志, 2012, 22(9): 812-817.
4.	Wang J, Zhou Y, Zhang ZF, et al. Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2. Eur Spine J, 2010, 19(10): 1780-1784.
5.	Hyun SJ, Kim YB, Kim YS, et al. Postoperative changes in paraspinal muscle volume: comparison between paramedian interfascial and midline approaches for lumbar fusion. KoreanMed Sci, 2007, 22(4): 646-651.
6.	Levin DA, Hale JJ, Bendo JA. Adjacent segment degeneration following spinal fusion for degenerative disc disease. Bull NYU Hosp Jt Dis, 2007, 65(1): 29-36.
7.	范顺武, 胡志军, 方向前. 腰椎后路手术中脊旁肌保护的相关思考. 中华骨科杂志, 2011, 31(4): 400-407.
8.	Kim KT, Lee SH, Suk KS, et al. The quantitative analysis of tissue injury markers after mini-open lumbar fusion. Spine (Phila Pa 1976), 2006, 31(6): 712-716.
9.	黎庆初, 胡辉林, 刘宝戈, 等. 多裂肌间隙入路微创手术治疗腰椎滑脱症. 中国脊柱脊髓杂志, 2011, 21(4): 303-307.
10.	王建, 周跃, 张正丰, 等. 微创经椎间孔腰椎体间融合术治疗腰椎滑脱症的临床研究. 中华外科杂志, 2011, 49(12): 1076-1080.
11.	滕海军, 王亮, 郭志良, 等. Quadrant通道下治疗退变性腰椎滑脱的临床疗效. 临床骨科杂志, 2012, 15(5): 498-500.
12.	Foley KT, Gupta SK. 802 percutaneous pedicle screw-rod fixation of the lumbar spine. Neurosurg, 2001, 49(2): 536-537.
13.	王建, 周跃, 初同伟, 等. 改良内窥镜下行后路腰椎间融合和经皮椎弓根螺钉固定治疗腰椎退变性疾患. 中国脊柱脊髓杂志, 2007, 17(2): 908-912, F0003.
14.	刘涛, 李长青, 周跃, 等. 微创手术治疗Ⅰ、Ⅱ度腰椎滑脱症的疗效观察. 中国脊柱脊髓杂志, 2009, 19(5): 354-359.
15.	李立钧, 周炜, 陆晴友, 等. 微创经椎间孔腰椎间融合术治疗下腰椎疾患的初步报告. 中国修复重建外科杂志, 2008, 22(4): 501-503.
16.	孟志斌, 李俊, 李洪潮, 等. X-TUBE内镜下椎弓根钉内固定治疗退行性腰椎管狭窄伴腰椎滑脱的近期临床观察. 颈腰痛杂志, 2008, 29(2): 124-127.
17.	滕海军, 王亮, 郭志良, 等. Quadrant通道下单切口治疗腰椎滑脱近期疗效观察. 中国修复重建外科杂志, 2010, 24(5): 517-520.
18.	林海滨, 吴献伟, 李荣议, 等. Metrx Quadrant可扩张通道管微创系统在腰椎滑脱手术中的初步应用. 中华医学杂志, 2010, 90(25): 1756-1759．.
19.	周跃, 王建, 李长青, 等. 成人腰椎峡部裂型滑脱症的微创治疗. 中华骨科杂志, 2009, 29(7): 609-614.
20.	康辉, 徐峰, 蔡贤华, 等. 经Quadrant系统微创治疗峡部裂型腰椎滑脱症的临床研究. 中国矫形外科杂志, 2012, 20(15): 1345-1349.
21.	张海龙, 顾昕, 贺石生, 等. 微创经椎间孔椎体间融合术与开放性手术治疗腰椎滑脱症的疗效比较. 中华骨科杂志, 2011, 31(10): 1088-1092.

1. Gille O, Jolivet E, Dousset V, et al. Erector spinae muscle changes on magnetic resonance imaging following lumbar surgery through a posterior approach. Spine (Phila Pa 1976), 2007, 32(11): 1236-1241.
2. Motosuneya T, Asazuma T, Tsuji T, et al. Postoperative change of the cross- sectional area of back musculature after 5 surgical procedures as assessed by magnetic resonance imaging. J Spinal Discord Tech, 2006, 19(5): 318-322.
3. 黎庆初, 尹刚辉, 张忠民, 等. 微创Wihse入路与传统后正中入路手术治疗双节段腰椎管狭窄症的疗效比较. 中国脊柱脊髓杂志, 2012, 22(9): 812-817.
4. Wang J, Zhou Y, Zhang ZF, et al. Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2. Eur Spine J, 2010, 19(10): 1780-1784.
5. Hyun SJ, Kim YB, Kim YS, et al. Postoperative changes in paraspinal muscle volume: comparison between paramedian interfascial and midline approaches for lumbar fusion. KoreanMed Sci, 2007, 22(4): 646-651.
6. Levin DA, Hale JJ, Bendo JA. Adjacent segment degeneration following spinal fusion for degenerative disc disease. Bull NYU Hosp Jt Dis, 2007, 65(1): 29-36.
7. 范顺武, 胡志军, 方向前. 腰椎后路手术中脊旁肌保护的相关思考. 中华骨科杂志, 2011, 31(4): 400-407.
8. Kim KT, Lee SH, Suk KS, et al. The quantitative analysis of tissue injury markers after mini-open lumbar fusion. Spine (Phila Pa 1976), 2006, 31(6): 712-716.
9. 黎庆初, 胡辉林, 刘宝戈, 等. 多裂肌间隙入路微创手术治疗腰椎滑脱症. 中国脊柱脊髓杂志, 2011, 21(4): 303-307.
10. 王建, 周跃, 张正丰, 等. 微创经椎间孔腰椎体间融合术治疗腰椎滑脱症的临床研究. 中华外科杂志, 2011, 49(12): 1076-1080.
11. 滕海军, 王亮, 郭志良, 等. Quadrant通道下治疗退变性腰椎滑脱的临床疗效. 临床骨科杂志, 2012, 15(5): 498-500.
12. Foley KT, Gupta SK. 802 percutaneous pedicle screw-rod fixation of the lumbar spine. Neurosurg, 2001, 49(2): 536-537.
13. 王建, 周跃, 初同伟, 等. 改良内窥镜下行后路腰椎间融合和经皮椎弓根螺钉固定治疗腰椎退变性疾患. 中国脊柱脊髓杂志, 2007, 17(2): 908-912, F0003.
14. 刘涛, 李长青, 周跃, 等. 微创手术治疗Ⅰ、Ⅱ度腰椎滑脱症的疗效观察. 中国脊柱脊髓杂志, 2009, 19(5): 354-359.
15. 李立钧, 周炜, 陆晴友, 等. 微创经椎间孔腰椎间融合术治疗下腰椎疾患的初步报告. 中国修复重建外科杂志, 2008, 22(4): 501-503.
16. 孟志斌, 李俊, 李洪潮, 等. X-TUBE内镜下椎弓根钉内固定治疗退行性腰椎管狭窄伴腰椎滑脱的近期临床观察. 颈腰痛杂志, 2008, 29(2): 124-127.
17. 滕海军, 王亮, 郭志良, 等. Quadrant通道下单切口治疗腰椎滑脱近期疗效观察. 中国修复重建外科杂志, 2010, 24(5): 517-520.
18. 林海滨, 吴献伟, 李荣议, 等. Metrx Quadrant可扩张通道管微创系统在腰椎滑脱手术中的初步应用. 中华医学杂志, 2010, 90(25): 1756-1759．.
19. 周跃, 王建, 李长青, 等. 成人腰椎峡部裂型滑脱症的微创治疗. 中华骨科杂志, 2009, 29(7): 609-614.
20. 康辉, 徐峰, 蔡贤华, 等. 经Quadrant系统微创治疗峡部裂型腰椎滑脱症的临床研究. 中国矫形外科杂志, 2012, 20(15): 1345-1349.
21. 张海龙, 顾昕, 贺石生, 等. 微创经椎间孔椎体间融合术与开放性手术治疗腰椎滑脱症的疗效比较. 中华骨科杂志, 2011, 31(10): 1088-1092.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF COMBINED TREATMENT OF LUMBAR SPONDYLOLISTHESIS WITH MED, Quadrant, AND Sextant-R SYSTEMS

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