腰椎后路椎间融合术后融合器脱出的处理策略
|
摘要
背景:腰椎后路椎间融合术后融合器(cage)脱出发生率低,国内外相关文献较少,其发生原因和治疗策略尚缺乏足够的临床证据报道。目的:探讨腰椎后路椎间融合术后cage脱出的处理策略。方法:回顾性分析2012年1月至2018年6月诊治的18例行腰椎后路椎间融合术后cage向后脱出病例的资料,分析临床及影像学指标,探讨cage脱出的临床处理策略。结果:男11例,女7例,初次手术时患者年龄35～76岁,平均53.7岁。腰椎滑脱症8例,腰椎管狭窄症6例,腰椎间盘突出症4例。手术方式包括后路腰椎椎体间植骨融合术(PLIF) 13例,经椎间孔腰椎椎体间植骨融合术(TLIF)5例;单节段融合12例,双节段融合6例;椎弓根钉棒系统稳定性良好者13例,不良者5例;15例行翻修手术,术中探查发现cage型号偏小7例,cage类型选择不当5例,骨性终板损伤4例,椎间盘及软骨终板处理不彻底3例,椎弓根钉螺母松动2例,椎弓根螺钉松动2例;3例给予保守治疗。结论:腰椎后路椎间融合术后cage脱出与多种因素相关,应根据是否导致腰腿痛症状、椎间植骨融合情况以及椎管内占位情况决定治疗方案,大多数病例需行翻修手术。
Background: The incidence of cage retropulsion after lumbar posterior interbody fusion is low. The causes and treatment strategies of the disease are not yet well documented. Objective: To investigate the treatment strategies of cage retropulsion after lumbar posterior interbody fusion. Methods: The data of 18 patients with cage retropulsion after posterior lumbar interbody fusion treated between January 2012 and June 2018 were retrospectively analyzed. Clinical and imaging indicators were observed, and the risk factors and clinical treatment strategies of cage retropulsion were discussed. Results: There were11 males and 7 females with an average age of 53.7 years(range, 35-76 years) at the time of initial surgery. There were 8 cases of lumbar spondylolisthesis, 6 cases of lumbar spinal stenosis and 4 cases of lumbar disc herniation, which were treated by posterior lumbar interbody fusion(PLIF) in 13 cases and by transforaminal lumbar interbody fusion(TLIF) in 5 cases. Single segmental fusion was performed in 12 cases and double segmental fusion in 6 cases. The stability of pedicle screw system was good in 13 cases and bad in 5 cases. Fifteen patients underwent revision surgery. Intraoperative investigation revealed that cage type was relatively small in 7 cases, cage type was improperly selected in 5 cases, bone endplate injury in 4 cases, incomplete management of intervertebral disc and cartilage endplate in 3 cases, nut loosening in 2 cases, and pedicle screw loosening in 2 cases. The remaining 3 patients were treated conservatively. Conclusions: Cage retropulsion after lumbar posterior interbody fusion is associated with a number of factors. Treatment strategy should be determined on the basis of symptoms, intervertebral fusion, and intraspinal space occupation. Revision surgery are required in most cases.
Background: The incidence of cage retropulsion after lumbar posterior interbody fusion is low. The causes and treatment strategies of the disease are not yet well documented. Objective: To investigate the treatment strategies of cage retropulsion after lumbar posterior interbody fusion. Methods: The data of 18 patients with cage retropulsion after posterior lumbar interbody fusion treated between January 2012 and June 2018 were retrospectively analyzed. Clinical and imaging indicators were observed, and the risk factors and clinical treatment strategies of cage retropulsion were discussed. Results: There were11 males and 7 females with an average age of 53.7 years(range, 35-76 years) at the time of initial surgery. There were 8 cases of lumbar spondylolisthesis, 6 cases of lumbar spinal stenosis and 4 cases of lumbar disc herniation, which were treated by posterior lumbar interbody fusion(PLIF) in 13 cases and by transforaminal lumbar interbody fusion(TLIF) in 5 cases. Single segmental fusion was performed in 12 cases and double segmental fusion in 6 cases. The stability of pedicle screw system was good in 13 cases and bad in 5 cases. Fifteen patients underwent revision surgery. Intraoperative investigation revealed that cage type was relatively small in 7 cases, cage type was improperly selected in 5 cases, bone endplate injury in 4 cases, incomplete management of intervertebral disc and cartilage endplate in 3 cases, nut loosening in 2 cases, and pedicle screw loosening in 2 cases. The remaining 3 patients were treated conservatively. Conclusions: Cage retropulsion after lumbar posterior interbody fusion is associated with a number of factors. Treatment strategy should be determined on the basis of symptoms, intervertebral fusion, and intraspinal space occupation. Revision surgery are required in most cases.
引文
[1] Kuslich SD, Ulstrom CL, Griffith SL, et al. The Bagby and Kuslich method of lumbar interbody fusion. History, techniques, and 2-year follow-up results of a United States prospective, multicenter trial. Spine(Phila Pa 1976), 1998, 23(11):1267-1278.
[2] Frisch RF, Luna IY, Brooks DM, et al. Clinical and radiographic analysis of expandable versus static lateral lumbar interbody fusion devices with two-year follow-up. J Spine Surg,2018, 4(1):62-71.
[3] McGilvray KC, Easley J, Seim HB, et al. Bony ingrowth potential of 3D-printed porous titanium alloy:a direct comparison of interbody cage materials in an in vivo ovine lumbar fusion model. Spine(Phila Pa 1976), 2018, 18(7):1250-1260.
[4] Rickert M, Fleege C, Tarhan T, et al. Transforaminal lumbar interbody fusion using polyetheretherketone oblique cages with and without a titanium coating:a randomised clinical pilot study. Bone Joint J, 2017, 99-B(10):1366-1372.
[5]李明,种衍学,宋将,等.腰椎椎体间融合不同手术入路及并发症.中国矫形外科杂志,2017, 25(13):1210-1214.
[6] Kimura H, Shikata J, Odate S, et al. Risk factors for cage retropulsion after posterior lumbar interbody fusion:analysis of1070 cases. Spine(Phila Pa 1976), 2012,37(13):1164-1169.
[7] Park MK, Kim KT, Bang WS, et al. Risk factors for cage migration and cage retropulsion following transforaminal lumbar interbody fusion. Spine(Phila Pa 1976), 2019, 19(3):437-447.
[8] Abul-Kasim K, Ohlin A. Evaluation of implant loosening following segmental pedicle screw fixation in adolescent idiopathic scoliosis:a 2 year follow-up with low-dose CT. Scoliosis, 2014, 9:13.
[9] Aoki Y, Yamagata M, Nakajima F, et al. Examining risk factors for posterior migration of fusion cages following transforaminal lumbar interbody fusion:a possible limitation of unilateral pedicle screw fixation. J Neurosurg Spine, 2010, 13(3):381-387.
[10]张亚峰,杨惠林,唐天驷,等.后路椎体间融合术后融合器脱出的原因及其翻修术.中国脊柱脊髓杂志,2006, 16(12):909-912.
[11]王洪立,姜建元,吕飞舟,等.腰椎融合器后移的原因分析及处理对策.中华骨科杂志,2012, 32(10):916-921.
[12]张凯,张锋,赵长清,等.腰椎椎间融合术后融合器后移的原因分析及再手术策略.中华骨科杂志,2016, 36(17):1093-1098.
[13] Abbushi A, Cabraja M, Thomale UW, et al. The influence of cage positioning and cage type on cage migration and fusion rates in patients with monosegmental posterior lumbar interbody fusion and posterior fixation. Eur Spine J, 2009, 18(11):1621-1628.
[14] Smith AJ, Arginteanu M, Moore F, et al. Increased incidence of cage migration and nonunion in instrumented transforaminal lumbar interbody fusion with bioabsorbable cages. J Neurosurg Spine, 2010,13(3):388-393.
[15] Zhao FD, Yang W, Shan Z, et al. Cage migration after transforaminal lumbar interbody fusion and factors related to it. Orthop Surg, 2012, 4(4):227-232.
[16] Duncan JW, Bailey RA. An analysis of fusion cage migration in unilateral and bilateral fixation with transforaminal lumbar interbody fusion. Eur Spine J, 2013, 22(2):439-445.
[17] Dimar JR 2nd, Beck DJ, Glassman SD, et al. Posterior lumbar interbody cages do not augment segmental biomechanical stability. Am J Orthop(Belle Mead NJ), 2001, 30(8):636-639.
[18] Phan K, Leung V, Scherman DB, et al. Bilateral versus unilat-eral instrumentation in spinal surgery:Systematic review and trial sequential analysis of prospective studies. J Clin Neurosci, 2016, 30:15-23.
[19] Chen DJ, Yao C, Song Q, et al.Unilateral versus bilateral pedicle screw fixation combined with transforaminal lumbar interbody fusion for the treatment of low lumbar degenerative disc diseases:analysis of clinical and radiographic results.World Neurosurg, 2018, 115:e516-e522.
[20] Pan FM, Wang SJ, Yong ZY, et al. Risk factors for cage retropulsion after lumbar interbody fusion surgery:series of cases and literature review. Int J Surg, 2016, 30:56-62.
[21] Aoki Y, Yamagata M, Nakajima F, et al. Posterior migration of fusion cages in degenerative lumbar disease treated with transforaminal lumbar interbody fusion:a report of three patients. Spine(Phila Pa 1976), 2009, 34(1):E54-E58.
[22] Sakai Y, Yagi H, Shinjo R, et al. Reoperation within 2 years after lumbar interbody fusion:a multicenter study. Eur Spine J, 2018,27(8):1972-1980.
[23] Chang TS, Chang JH, Wang CS, et al. Evaluation of unilateral cage-instrumented fixation for lumbar spine. J Orthop Surg Res, 2010, 5:86.
[2] Frisch RF, Luna IY, Brooks DM, et al. Clinical and radiographic analysis of expandable versus static lateral lumbar interbody fusion devices with two-year follow-up. J Spine Surg,2018, 4(1):62-71.
[3] McGilvray KC, Easley J, Seim HB, et al. Bony ingrowth potential of 3D-printed porous titanium alloy:a direct comparison of interbody cage materials in an in vivo ovine lumbar fusion model. Spine(Phila Pa 1976), 2018, 18(7):1250-1260.
[4] Rickert M, Fleege C, Tarhan T, et al. Transforaminal lumbar interbody fusion using polyetheretherketone oblique cages with and without a titanium coating:a randomised clinical pilot study. Bone Joint J, 2017, 99-B(10):1366-1372.
[5]李明,种衍学,宋将,等.腰椎椎体间融合不同手术入路及并发症.中国矫形外科杂志,2017, 25(13):1210-1214.
[6] Kimura H, Shikata J, Odate S, et al. Risk factors for cage retropulsion after posterior lumbar interbody fusion:analysis of1070 cases. Spine(Phila Pa 1976), 2012,37(13):1164-1169.
[7] Park MK, Kim KT, Bang WS, et al. Risk factors for cage migration and cage retropulsion following transforaminal lumbar interbody fusion. Spine(Phila Pa 1976), 2019, 19(3):437-447.
[8] Abul-Kasim K, Ohlin A. Evaluation of implant loosening following segmental pedicle screw fixation in adolescent idiopathic scoliosis:a 2 year follow-up with low-dose CT. Scoliosis, 2014, 9:13.
[9] Aoki Y, Yamagata M, Nakajima F, et al. Examining risk factors for posterior migration of fusion cages following transforaminal lumbar interbody fusion:a possible limitation of unilateral pedicle screw fixation. J Neurosurg Spine, 2010, 13(3):381-387.
[10]张亚峰,杨惠林,唐天驷,等.后路椎体间融合术后融合器脱出的原因及其翻修术.中国脊柱脊髓杂志,2006, 16(12):909-912.
[11]王洪立,姜建元,吕飞舟,等.腰椎融合器后移的原因分析及处理对策.中华骨科杂志,2012, 32(10):916-921.
[12]张凯,张锋,赵长清,等.腰椎椎间融合术后融合器后移的原因分析及再手术策略.中华骨科杂志,2016, 36(17):1093-1098.
[13] Abbushi A, Cabraja M, Thomale UW, et al. The influence of cage positioning and cage type on cage migration and fusion rates in patients with monosegmental posterior lumbar interbody fusion and posterior fixation. Eur Spine J, 2009, 18(11):1621-1628.
[14] Smith AJ, Arginteanu M, Moore F, et al. Increased incidence of cage migration and nonunion in instrumented transforaminal lumbar interbody fusion with bioabsorbable cages. J Neurosurg Spine, 2010,13(3):388-393.
[15] Zhao FD, Yang W, Shan Z, et al. Cage migration after transforaminal lumbar interbody fusion and factors related to it. Orthop Surg, 2012, 4(4):227-232.
[16] Duncan JW, Bailey RA. An analysis of fusion cage migration in unilateral and bilateral fixation with transforaminal lumbar interbody fusion. Eur Spine J, 2013, 22(2):439-445.
[17] Dimar JR 2nd, Beck DJ, Glassman SD, et al. Posterior lumbar interbody cages do not augment segmental biomechanical stability. Am J Orthop(Belle Mead NJ), 2001, 30(8):636-639.
[18] Phan K, Leung V, Scherman DB, et al. Bilateral versus unilat-eral instrumentation in spinal surgery:Systematic review and trial sequential analysis of prospective studies. J Clin Neurosci, 2016, 30:15-23.
[19] Chen DJ, Yao C, Song Q, et al.Unilateral versus bilateral pedicle screw fixation combined with transforaminal lumbar interbody fusion for the treatment of low lumbar degenerative disc diseases:analysis of clinical and radiographic results.World Neurosurg, 2018, 115:e516-e522.
[20] Pan FM, Wang SJ, Yong ZY, et al. Risk factors for cage retropulsion after lumbar interbody fusion surgery:series of cases and literature review. Int J Surg, 2016, 30:56-62.
[21] Aoki Y, Yamagata M, Nakajima F, et al. Posterior migration of fusion cages in degenerative lumbar disease treated with transforaminal lumbar interbody fusion:a report of three patients. Spine(Phila Pa 1976), 2009, 34(1):E54-E58.
[22] Sakai Y, Yagi H, Shinjo R, et al. Reoperation within 2 years after lumbar interbody fusion:a multicenter study. Eur Spine J, 2018,27(8):1972-1980.
[23] Chang TS, Chang JH, Wang CS, et al. Evaluation of unilateral cage-instrumented fixation for lumbar spine. J Orthop Surg Res, 2010, 5:86.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |