[Case control study on two different surgical approaches combined fixation with lumbar interbody fusion for the treatment of single segmental lumbar vertebra diseases].

Disc Degeneration

[Case control study on two different surgical approaches combined fixation with lumbar interbody fusion for the treatment of single segmental lumbar vertebra diseases].

Zhongguo Gu Shang. 2017 Could 25;30(5):417-425

Authors: Zeng ZY, Yan WF, Tune YX, Mao KY, Ji JF, Zhang JQ, Wu P, Pei F, Tune GH, Han JF, Yu W

Summary
OBJECTIVE: To debate the benefits and drawbacks of two completely different surgical approaches mixed fixation with lumbar interbody fusion in treating single segmental lumbar vertebra illnesses.
METHODS: The medical information of 86 sufferers with single segmental lumbar vertebra illnesses handled from June 2011 to June 2013 was retrospectively analyzed. There have been 33 males and 53 females, aged from 28 to 76 years previous with a mean of 53.zero years. Amongst them, there have been 39 instances of lumbar disc degeneration, 22 instances of lumbar disc herniation sophisticated with spinal canal stenosis, 9 instances of giant lumbar disc herniation and 16 instances of lumbar degenerative spondylolisthesis (Meyerding diploma I ). Lesion websites contained L3, four in 5 instances, L4, 5 in 70 instances and L5S1 in 11 instances. All of the sufferers had been handled with inside fixation and lumbar interbody fusion with 45 instances by midline incision method (median incision group) and the opposite 41 instances by channel-assisted by muscle-splitting method(channel group). Incision size, operation time, intraoperative bleeding and postoperative drainage had been recorded in two teams. Visible analogue scale(VAS) was used to evaluate lumbar incision ache 72 h after operation. Trusted imaging outcomes to match the adjustments of the disc house peak in lesion in preoperative, postoperative and remaining follow-up, the coronal and sagittal Cobb angle in preoperative and remaining follow-up, the realm of multifidus and the diploma of multifidus fats deposition earlier than and after operation between two teams. Loosening or fragmentation of inside fixation, displacement of intervertebral cage and interbody fusion had been noticed in every group. Japanese Orthopedic Affiliation (JOA) scoring system was used to judge the perform earlier than operation and on the remaining follow-up.
RESULTS: The channel group was superior to the median incision group in incision size and postoperative drainage whereas the median incision group was lower than the channel group within the operation time and intraoperative bleeding. The common VAS rating of lumbar incision 72 h after operation was 1.50 factors in median incision group and zero.97 factors in channel group, and there was vital distinction between two teams(P<zero.05). No incision an infection was discovered, however there have been four instances of incisional epidermal necrosis, 1 case of incision healed badness, and three instances of nerve harm in channel group. The incidence of cacothesis of pedicle screw had been 5.zero% and three.6% in median incision group and channel group respectively, and there was no vital distinction between two teams(P>zero.05). The incidence of cacothesis of translaminar aspect screw had been 6.6% and 12.2% in median incision group and channel group respectively, and there was vital distinction between two teams(P<zero.05). All of the sufferers had been adopted up for 12 to 36 months with a imply of 22.Eight months. The adjustments of disc house peak had statistical distinction between preoperative and postoperative(P<zero.05) in all sufferers, however there was no vital distinction between postoperative and remaining follow-up(P>zero.05), nevertheless, there was no vital distinction three days after operation and remaining follow-up between two teams(P>zero.05). At remaining follow-up, coronal and sagittal Cobb angle had been clearly improved in all sufferers(P<zero.05), however there was no vital distinction between two teams(P>zero.05). One 12 months after operation, the realm of multifidus in median incision group was (789.00±143.15) mm² lower than preoperative(1 066.00±173.55) mm² (P<zero.05), and in channel group, was(992.00±156.75) mm² at 1 12 months after operation and(1 063.00±172.13) mm² preoperatively, there was no vital distinction between them(P>zero.05), nevertheless, there was vital distinction one 12 months after operation between two teams (P<zero.05) . Concerning the diploma of multifidus fats deposition, there was vital distinction between one 12 months after operation and preoperation in median incision group (P<zero.05), however there was no vital distinction between one 12 months after operation and preoperation in channel group (P>zero.05), and there was vital distinction at one 12 months after operation between two teams(P<zero.05). In the course of the follow-up interval, neither pedicle screw and/or translaminar aspect screw loosening, displacement or fragmentation nor displacement of intervertebral cage had been discovered. The lumbar interbody fusion price was 95.6% in median incision group and was 95.1% in channel group, and there was no vital distinction between two teams(P>zero.05). No apparent adjoining segmental degeneration was noticed in mounted place. JOA rating in median incision group was considerably elevated from Eight-16 factors (common: 12.77±2.56) preoperative to 21-29 factors (common: 25.20±2.43) at remaining follow-up(P<zero.05); and in channel group was considerably elevated from Eight-16 factors (common: 12.64±2.37) preoperative to 23-29 factors(common: 26.7±1.82) at remaining follow-up(P<zero.05); there was additionally vital distinction between two teams at remaining follow-up.
CONCLUSIONS: In comparison with the median incision method, unilateral pedicle screw mixed with contralateral translaminar aspect screw fixation utilizing channel-assisted by muscle-splitting method has benefits of small incision, much less trauma, quick restoration and so forth. Nevertheless, it additionally has shortages similar to excessive surgical problems incidence, particularly in instances that.

PMID: 29417772 [PubMed – in process]

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Case control study on two different surgical approaches combined fixation with lumbar interbody fusion for the treatment of single segmental lumbar vertebra diseases | Manubrium pain