ANTERIOR LUMBAR INTERBODY FUSION WITH SELF-LOCKED CAGE FOR TREATMENT OF CENTRAL TYPE LUMBAR INTERVERTEBRAL DISC PROTRUSION AND RECESSIVE LUMBAR SEGMENTAL INSTABILITY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 LIUYiqiang , WEIGuoping , YANGWenbin , WANGChengri , HUANGRui

Department of Spine Surgery, the People's Hospital of Laibin, Laibin Guangxi, 546100, P. R. China;

Corresponding author：

LIUYiqiang, Email: liuyiqiang518@163.com

Keywords：

Anterior approach; Interbody fusion; Central type lumbar intervertebral disc protrusion; Recessive lumbar segmental instability

DOI：

10.7507/1002-1892.20140016

Video：

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Objective To evaluate the effectiveness of anterior lumbar interbody fusion (ALIF) with self-locked Cage in the treatment of central type lumbar intervertebral disc protrusion and recessive lumbar segmental instability. Methods Between March 2010 and February 2012, 31 patients with central type lumbar intervertebral disc protrusion and recessive lumbar segmental instability were treated with decompression and ALIF assisted by self-locked Cage through the mini-incision and retroperitoneal approach. There were 20 males and 11 females with the mean age of 46 years (range, 34-58 years). And the disease duration ranged from 5 to 32 months (mean, 16 months). The lesion located at the L_3,4 level in 2 cases, L_4,5 in 20 cases, and L₅, S₁ in 9 cases. The operation time, intraoperative blood loss, bedridden time, hospitalization time, and complications were recorded. The effectiveness was evaluated by Oswestry disability index (ODI) and visual analogue scale (VAS). Lumbar X-ray films and three-dimensional CT scan were taken to evaluate the fusion and the variation of the height and Cobb angle of intervertebral space. Results The mean operation time was 102 minutes; the mean intraoperative blood loss was 121 mL; the mean bedridden time was 5 days; and the mean hospitalization time was 11 days. Intraoperative peritoneum tear and ascending lumbar vein tear, postoperative cerebrospinal fluid leakage, pain at donor site, and asymmetric elevated skin temperature of the lower extremity occurred in 2 cases, 1 case, 1 case, 4 cases, and 2 cases respectively, which were relieved after symptomatic treatment. All cases were followed up 12-28 months (mean, 20 months). No infection, recurrence, deep venous thrombosis, or retrograde ejaculation was observed after operation. MRI showed complete decompression at 3 months after operation. At last follow-up, the scores of ODI, VAS of lumbars and lower limbs, the intervertebral height, and Cobb angle were significantly improved when compared with preoperative ones (P<0.05); CT scan showed bone fusion in all cases. Conclusion The clinical outcome of ALIF with self-locked Cage through mini-incision and retroperitoneal approach is satisfactory in treatment of central type lumbar intervertebral disc protrusion and recessive lumbar segmental instability. It can retain the posterior spinal construction and has the advantages of less trauma and bleeding, immediate stability, high bone fusion rate, and so on.

Citation： LIUYiqiang, WEIGuoping, YANGWenbin, WANGChengri, HUANGRui. ANTERIOR LUMBAR INTERBODY FUSION WITH SELF-LOCKED CAGE FOR TREATMENT OF CENTRAL TYPE LUMBAR INTERVERTEBRAL DISC PROTRUSION AND RECESSIVE LUMBAR SEGMENTAL INSTABILITY. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(1): 69-73. doi: 10.7507/1002-1892.20140016 Copy

1.	士清,王坤正,程斌,等.中央型腰椎间盘突出症合并隐性腰椎不稳的治疗.中国矫形外科杂志,2004,12(9):645-647.
2.	周永春,张朝跃,罗靖.腰椎间盘摘除加CAGE植骨椎间融合并联合椎弓根系统内固定术治疗中央型腰椎间盘突出症.中外医疗,2009,28(29):24-25.
3.	张伯勋.椎板切除术治疗腰椎疾患应注意的几个问题.中国脊柱脊髓杂志,2004,40(10):581-583.
4.	Beazel JR,Mullins M,Grindstaff TL.Lumbar instability:an evolving and challenging concept.J Man Manip Ther,2010,18(1):9-14.
5.	黄加强,夏虹.腰椎不稳的诊疗研究进展.医学临床研究,2012,29(8):1620-1622.
6.	贺宪,梁安靖,彭焰,等.腰椎终板Modic改变与腰椎间盘突出的相关性研究.中国矫形外科杂志,2012,20(9):774-777.
7.	刘伟,宋滇文,贾连顺.椎间盘源性腰痛的病理生理学机制.中国矫形外科杂志,2009,17(5):364-366.
8.	孟宪中,曹俊明,申勇,等.腰椎终板Modic退变对手术疗效影响的远期观察.中国矫形外科杂志,2008,16(9):660-662.
9.	Anderson DG,Sayadipour A,Shelby K,et al.Anterior interbody arthrodesis with percutaneous posterior pedicle fixation for degenerative conditions of the lumbar spine.Eur Spine J,2011,20(8):1323-1330.
10.	Lübbers T,Bentlage C,Sandvoss G.Anterior lumbar interbody fusion as a treatment for chronic refractory lower back pain in disc degeneration and spondylolisthesis using carbon cages-stand alone.Zentralbl Neurochir,2002,63(1):12-17.
11.	Duggal N,Mendiondo I,Pares HR,et al.Anterior lumbar interbody fusion for treatment of failed back surgery syndrome:an outcome analysis.Neurosurgery,2004,54(3):636-644.
12.	Tsantrizos A,Andreou A,Aebi M,et al.Biomechanical stability of five stand-alone anterior lumbar interbody fusion constructs.Eur Spine J,2000,9(1):14-22.
13.	苗军,夏群,张继东,等.单纯腰椎前路椎间融合器即刻与疲劳稳定性的研究.中华医学杂志,2008,88(7):457-460.
14.	夏群,苗军,张继东,等.单纯椎间融合器腰椎前路融合术治疗腰椎退变性疾病.中华骨科杂志,2011,31(10):1159-1164.
15.	Cho CB,Ryu KS,Park CK.Anterior lumbar interbody fusion with stand-alone interbody cage in treatment of lumbar intervertebral foraminal stenosis:comparative study of two different types of cages.J Korean Neurosurg Soc,2010,47(5):352-357.
16.	Videbaek TS,Bünger CE,Henriksen M,et al.Sagittal spinal balance after lumbar spinal fusion.Spine (Phila Pa 1976),2011,36(3):183-191.
17.	苗军,夏群,胡永成,等.微创腹膜外入路技术在腰椎前路手术中的应用.中华医学杂志,2009,89(23):1607-1610.
18.	吕国华.前路腰椎椎间融合术选择"锁孔"手术还是小切口手术? 中国脊柱脊髓杂志,2011,21(3):183.

1. 士清,王坤正,程斌,等.中央型腰椎间盘突出症合并隐性腰椎不稳的治疗.中国矫形外科杂志,2004,12(9):645-647.
2. 周永春,张朝跃,罗靖.腰椎间盘摘除加CAGE植骨椎间融合并联合椎弓根系统内固定术治疗中央型腰椎间盘突出症.中外医疗,2009,28(29):24-25.
3. 张伯勋.椎板切除术治疗腰椎疾患应注意的几个问题.中国脊柱脊髓杂志,2004,40(10):581-583.
4. Beazel JR,Mullins M,Grindstaff TL.Lumbar instability:an evolving and challenging concept.J Man Manip Ther,2010,18(1):9-14.
5. 黄加强,夏虹.腰椎不稳的诊疗研究进展.医学临床研究,2012,29(8):1620-1622.
6. 贺宪,梁安靖,彭焰,等.腰椎终板Modic改变与腰椎间盘突出的相关性研究.中国矫形外科杂志,2012,20(9):774-777.
7. 刘伟,宋滇文,贾连顺.椎间盘源性腰痛的病理生理学机制.中国矫形外科杂志,2009,17(5):364-366.
8. 孟宪中,曹俊明,申勇,等.腰椎终板Modic退变对手术疗效影响的远期观察.中国矫形外科杂志,2008,16(9):660-662.
9. Anderson DG,Sayadipour A,Shelby K,et al.Anterior interbody arthrodesis with percutaneous posterior pedicle fixation for degenerative conditions of the lumbar spine.Eur Spine J,2011,20(8):1323-1330.
10. Lübbers T,Bentlage C,Sandvoss G.Anterior lumbar interbody fusion as a treatment for chronic refractory lower back pain in disc degeneration and spondylolisthesis using carbon cages-stand alone.Zentralbl Neurochir,2002,63(1):12-17.
11. Duggal N,Mendiondo I,Pares HR,et al.Anterior lumbar interbody fusion for treatment of failed back surgery syndrome:an outcome analysis.Neurosurgery,2004,54(3):636-644.
12. Tsantrizos A,Andreou A,Aebi M,et al.Biomechanical stability of five stand-alone anterior lumbar interbody fusion constructs.Eur Spine J,2000,9(1):14-22.
13. 苗军,夏群,张继东,等.单纯腰椎前路椎间融合器即刻与疲劳稳定性的研究.中华医学杂志,2008,88(7):457-460.
14. 夏群,苗军,张继东,等.单纯椎间融合器腰椎前路融合术治疗腰椎退变性疾病.中华骨科杂志,2011,31(10):1159-1164.
15. Cho CB,Ryu KS,Park CK.Anterior lumbar interbody fusion with stand-alone interbody cage in treatment of lumbar intervertebral foraminal stenosis:comparative study of two different types of cages.J Korean Neurosurg Soc,2010,47(5):352-357.
16. Videbaek TS,Bünger CE,Henriksen M,et al.Sagittal spinal balance after lumbar spinal fusion.Spine (Phila Pa 1976),2011,36(3):183-191.
17. 苗军,夏群,胡永成,等.微创腹膜外入路技术在腰椎前路手术中的应用.中华医学杂志,2009,89(23):1607-1610.
18. 吕国华.前路腰椎椎间融合术选择"锁孔"手术还是小切口手术? 中国脊柱脊髓杂志,2011,21(3):183.

Chinese Journal of Reparative and Reconstructive Surgery

ANTERIOR LUMBAR INTERBODY FUSION WITH SELF-LOCKED CAGE FOR TREATMENT OF CENTRAL TYPE LUMBAR INTERVERTEBRAL DISC PROTRUSION AND RECESSIVE LUMBAR SEGMENTAL INSTABILITY

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