SURGICAL TREATMENT OF DISCOGENIC LOW BACK PAIN BY MINIMALLY INVASIVE TRANSFORAMINAL LUMBAR INTERBODY FUSION COMBINED WITH UNILATERAL PEDICLE SCREW FIXATION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIANG Bowei ¹ , ZHAO Jinmin ² , LI Ningning ¹ , HU Zhaohui ¹ , SUN Hongzhi ¹

1Department of Spine Surgery, the Fifth Affiliated Hospital of Guangxi Medical University/Liuzhou People’s Hospital, Liuzhou Guangxi, 545006, P.R.China;;
2Department of Hand Surgery, the First Affiliated Hospital of Guangxi Medical University.;

Corresponding author：

Keywords：

Discogenic low back pain; Transforaminal lumbar interbody fusion; Unilateral pedicle screw fixation

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【Abstract】 Objective To investigate the effectiveness of surgical treatment for discogenic low back pain (DLBP) by minimally invasive transforaminal lumbar interbody fusion (TLIF) combined with unilateral pedicle screw fixation (UPSF). Methods Between March 2006 and July 2009, 57 patients with single-level DLBP were treated by minimally invasive TLIF combined with UPSF, including 27 males and 30 females with an average age of 45.6 years (range, 38-61 years) and a disease duration of 3.8 years (range, 9 months to 11 years). The involved segments included L2，3 in 2 cases, L3，4 in 5 cases, L4，5 in 29 cases, and L5, S1 in 21 cases. The operative time, incision length, intraoperative blood loss, postoperative drainage volume, hospitalization times, fusion rate, and complications were observed. The effectiveness were evaluated through Oswestry disability index (ODI) and visual analogue score (VAS), and the operative outcomes were compared in different groups classified according to various pressures of the contrast medium and sensitivities to discoblock after inducing consistent pain. Results The operation time, incision length, blood loss, postoperative drainage volume, and hospitalization times were (84.6 ± 37.4) minutes, (3.4 ± 0.6) cm, (132.5 ± 23.2) mL, (58.7 ± 21.4) mL, and (6.5 ± 0.8) days, respectively. All patients were followed up 2 years and 2 months to 5 years and 4 months (mean, 3.2 years). At last follow-up, ODI and VAS scores were significantly improved when compared with preoperative scores (P lt; 0.05). The effectiveness according to ODI were excellent in 27 cases, good in 22 cases, fair in 6 cases, and poor in 2 cases, with an excellent and good rate of 86.0%. All patients acquired b interbody fusion. At last follow-up according to ODI and VAS scores, better results were found in patients of low-pressure sensitive group and high-sensitive discoblock group (P lt; 0.05). Conclusion Minimally invasive TLIF combined with UPSF is reliable for DLBP with minimal surgical trauma, less paravertebral tissue injury, and fewer complications, but the indications for operation must be strictly followed. Patients being sensitive to low-pressure or high-sensitive to discoblock can achieve better surgical results.

Citation： LIANG Bowei,ZHAO Jinmin,LI Ningning,HU Zhaohui,SUN Hongzhi. SURGICAL TREATMENT OF DISCOGENIC LOW BACK PAIN BY MINIMALLY INVASIVE TRANSFORAMINAL LUMBAR INTERBODY FUSION COMBINED WITH UNILATERAL PEDICLE SCREW FIXATION. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(3): 272-276. doi: Copy

1.	腰椎疾患所致腰痛的临床观察. 中国脊柱脊髓杂志, 2010, 20(3): 224-227.
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7.	李兵, 胡朝晖, 卓祥龙. 经椎间孔椎体间融合治疗退行性腰椎间盘病. 中国修复重建外科杂志, 2008, 22(8): 914-917.
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12.	Kallewaard JW, Terheggen MA, Groen GJ, et al. Discogenic low back pain. Pain Pract, 2010, 10(6): 560-579.
13.	Kotil K, Tunckale T, Tatar Z, et al. Serum creatine phosphokinase activity and histological changes in the multifidus muscle: a prospective randomized controlled comparative study of discectomy with or without retraction. J Neurosurg Spine, 2007, 6(2): 121-125.
14.	Kim CW. Scientific basis of minimally invasive spine surgery: prevention of multifidus muscle injury during posterior lumbar surgery. Spine (Phila Pa 1976), 2010, 35(26 Suppl): S281-286.
15.	Shunwu F, Xing Z, Fengdong Z, et al. Minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases. Spine (Phila Pa 1976), 2010, 35(17): 1615-1620.
16.	Fan S, Hu Z, Zhao F, et al. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. Eur Spine J, 2010, 19(2): 316-324.
17.	Park P, Garton HJ, Gala VC, et al. Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine (Phila Pa 1976), 2004, 29(17): 1938-1944.
18.	董健文, 邱奕雁, 赵卫东, 等. 单侧椎弓根钉棒固定单节段腰椎及其邻近节段生物力学研究. 中国临床解剖学杂志, 2010, 28(1): 85-89.
19.	Kepler CK, Sharma AK, Huang RC. Lateral transpsoas interbody fusion (LTIF) with plate fixation and unilateral pedicle screws: a preliminary report. J Spinal Disord Tech, 2011, 24(6): 363-367.
20.	刘涛, 李长青, 周跃, 等. 微创单侧椎弓根螺钉固定、椎体间融合治疗.
21.	王建华, 夏虹, 李树林, 等. 微创经椎间孔腰椎椎间融合术的应用解.

1. 腰椎疾患所致腰痛的临床观察. 中国脊柱脊髓杂志, 2010, 20(3): 224-227.
2. 剖学研究. 中国脊柱脊髓杂志, 2009, 19(10): 765-768.
3. Zhang YG, Guo TM, Guo X, et al. Clinical diagnosis for discogenic low back pain. Int J Biol Sci, 2009, 5(7): 647-658. 2 Park WM, Mc Call IW, O’Brien JP, et al. Fissuring of the posterior annulus fibrosus in the lumbar spine. Br J Radiol, 1979, 52(617): 382-387.
4. Errico TJ. Lumbar disc arthroplasty. Clin Orthop Relat Res, 2005, (435): 106-117.
5. 王建, 周跃, 李长青, 等. 经皮内镜椎间盘切除术治疗慢性椎间盘源性腰痛的初步研究. 中国修复重建外科杂志, 2009, 23(4): 400-403.
6. Modic MT, Masaryk TJ, Ross JS, et al. Imaging of degenerative disk disease. Radiology, 1988, 168(1): 177-186.
7. 李兵, 胡朝晖, 卓祥龙. 经椎间孔椎体间融合治疗退行性腰椎间盘病. 中国修复重建外科杂志, 2008, 22(8): 914-917.
8. Schulte TL, Leistra F, Bullmann V, et al. Disc height reduction in adjacent segments and clinical outcome 10 years after lumbar 360 degrees fusion. Eur Spine, 2007, 16(2): 2152-2158.
9. Resnick DK, Choudhri TF, Dailey AT, et al. Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 12: pedicle screw xation as an adjunct to posterolateral fusion for low-back pain. J Neurosurg Spine, 2005, 2(6): 700-706.
10. Ohtori S, Koshi T, Yamashita M, et al. Surgical versus nonsurgical treatment of selected patients with discogenic low back pain: a small-sized randomized trial. Spine (Phila Pa 1976), 2011, 36(5): 347-354.
11. O’Neill C, Kurgansky M. Subgroups of positive discs on discography. Spine (Phila Pa 1976), 2004, 29(19): 2134-2139.
12. Kallewaard JW, Terheggen MA, Groen GJ, et al. Discogenic low back pain. Pain Pract, 2010, 10(6): 560-579.
13. Kotil K, Tunckale T, Tatar Z, et al. Serum creatine phosphokinase activity and histological changes in the multifidus muscle: a prospective randomized controlled comparative study of discectomy with or without retraction. J Neurosurg Spine, 2007, 6(2): 121-125.
14. Kim CW. Scientific basis of minimally invasive spine surgery: prevention of multifidus muscle injury during posterior lumbar surgery. Spine (Phila Pa 1976), 2010, 35(26 Suppl): S281-286.
15. Shunwu F, Xing Z, Fengdong Z, et al. Minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases. Spine (Phila Pa 1976), 2010, 35(17): 1615-1620.
16. Fan S, Hu Z, Zhao F, et al. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. Eur Spine J, 2010, 19(2): 316-324.
17. Park P, Garton HJ, Gala VC, et al. Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine (Phila Pa 1976), 2004, 29(17): 1938-1944.
18. 董健文, 邱奕雁, 赵卫东, 等. 单侧椎弓根钉棒固定单节段腰椎及其邻近节段生物力学研究. 中国临床解剖学杂志, 2010, 28(1): 85-89.
19. Kepler CK, Sharma AK, Huang RC. Lateral transpsoas interbody fusion (LTIF) with plate fixation and unilateral pedicle screws: a preliminary report. J Spinal Disord Tech, 2011, 24(6): 363-367.
20. 刘涛, 李长青, 周跃, 等. 微创单侧椎弓根螺钉固定、椎体间融合治疗.
21. 王建华, 夏虹, 李树林, 等. 微创经椎间孔腰椎椎间融合术的应用解.

Chinese Journal of Reparative and Reconstructive Surgery

SURGICAL TREATMENT OF DISCOGENIC LOW BACK PAIN BY MINIMALLY INVASIVE TRANSFORAMINAL LUMBAR INTERBODY FUSION COMBINED WITH UNILATERAL PEDICLE SCREW FIXATION

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