PDF(Pubmed)
Abstract：
Objectives Expandable transforaminal interbody fusion (TLIF) devices have been developed to introduce more segmental lordosis through a narrow operative corridor, but there are concerns about the degree of achievable correction with a small graft footprint. In this report, we describe the technical nuances associated with placing bilateral expandable cages for correction of iatrogenic deformity. Materials and Methods A 60-year-old female with symptomatic global sagittal malalignment and a severe lumbar kyphotic deformity after five prior lumbar surgeries presented to our institution. We performed multilevel posterior column osteotomies, a L3-4 intradiscal osteotomy, and placed bilateral lordotic expandable TLIF cages at the level of maximum segmental kyphosis. Results We achieve a 21-degree correction of the patient\'s focal kyphotic deformity and restoration of the patient global sagittal alignment. Conclusion This case demonstrates both the feasibility and utility of placing bilateral expandable TLIF cages at a single disc space in the setting of severe focal sagittal malalignment. This technique expands the implant footprint and, when coupled with an intradiscal osteotomy, allows for a significant restoration of segmental lordosis.
摘要：
目的开发了可扩展的经椎间孔椎间融合术（TLIF）装置，以通过狭窄的手术走廊引入更多的节段前凸，但是，人们担心移植物足迹较小的情况下可实现的校正程度。在这份报告中,我们描述了与放置双侧可扩张笼以矫正医源性畸形相关的技术细微差别。材料与方法一名60岁女性，在向我们的机构进行了五次腰椎手术后，有症状的整体矢状位错位和严重的腰椎后凸畸形。我们做了多级后柱截骨术,L3-4椎间盘截骨术，并将双侧前凸可膨胀TLIF笼置于最大节段后凸水平。结果我们实现了患者局灶性后凸畸形的21度矫正和患者整体矢状位的恢复。结论该病例证明了在严重局灶性矢状位错位的情况下，将双侧可扩张的TLIF笼放置在单个椎间盘间隙的可行性和实用性。这项技术扩大了植入物的足迹，加上椎间盘内截骨术，允许节段前凸的显着恢复。
