目的:我们介绍了成人特发性脊柱侧凸(AS)的周向微创脊柱手术(CMIS)与腰椎外侧椎间融合术(LLIF)和经皮椎弓根螺钉应用的手术方法和短期(术后2年)结果。
方法:我们招募了8名接受CMIS(2018-2020)的AS患者,并检查了融合水平的数量,上器械椎骨,下部器械椎骨,LLIF处理段的数量,术前椎间融合的数量,术中失血,手术时间,各种脊髓骨盆参数,Oswestry残疾指数,腰痛,视觉模拟量表(VAS),腿VAS,骨融合率,围手术期并发症。
结果:两例上器械椎骨为T4,T7,T8和T9,而在所有情况下,较低的器械椎骨是骨盆。接受LLIF的固定椎骨和节段的平均数量分别为13.3±2.0和4.6±0.7。手术后所有脊柱骨盆参数均显着改善(胸椎后凸:P<0.05,腰椎前凸,cobb角,骨盆倾斜,骨盆发病率-腰椎前凸,矢状垂直轴:P<0.001),并实现了良好的对准。Oswestry残疾指数和VAS评分显著改善(P<0.001)。腰骶部和胸椎的骨融合率分别为100%和88%,分别。只有1例患者出现术后冠状失衡。
结论:CMIS术后2年效果良好,在没有植骨的情况下,在胸椎中证实了自发性骨融合。在这个过程中,通过LLIF和经皮椎弓根螺钉装置平移技术充分的椎间释放可以实现充分的整体对准矫正。因此,纠正冠状面和矢状面的整体失衡比纠正脊柱侧凸更重要。
We present the surgical approaches and short-term (2 years postoperative) results pertaining to circumferential minimally invasive spine surgery (CMIS) with lateral lumbar interbody fusion (LLIF) and percutaneous pedicle screw application for adult idiopathic scoliosis (AS).
We enrolled eight patients with AS who underwent CMIS (2018-2020) and examined the number of fused levels, upper instrumented vertebra, lower instrumented vertebra, number of LLIF-treated segments, number of preoperative intervertebral fusions, intraoperative blood loss, operative time, various spinopelvic parameters, Oswestry Disability Index, low back pain, visual analog scale (VAS), leg VAS, bone fusion rate, and perioperative complications.
The upper instrumented vertebra was T4, T7, T8, and T9 in two cases, whereas lower instrumented vertebra was the pelvis in all the cases. The average numbers of fixed vertebrae and segments that underwent LLIF were 13.3 ± 2.0 and 4.6 ± 0.7, respectively. All spinopelvic parameters improved significantly after surgery (thoracic kyphosis: P < 0.05, lumbar lordosis, cobb angle, pelvic tilt, pelvic incidence-lumbar lordosis, sagittal vertical axis: P < 0.001), and good alignment was achieved. The Oswestry Disability Index and VAS scores improved significantly (P < 0.001). The bone fusion rates achieved in the lumbosacral and thoracic spine were 100% and 88%, respectively. Only 1 patient showed postoperative coronal imbalance.
The 2-year postoperative results of CMIS for AS were good, and spontaneous bone fusion was confirmed in the thoracic spine without bone grafting. In this procedure, sufficient intervertebral release with LLIF and a percutaneous pedicle screw device translation technique enabled adequate global alignment correction. Therefore, correcting the global imbalance of the coronal and sagittal planes is more crucial than correcting scoliosis.