Lateral Single Cage Combined With Short Segmental Internal Fixation: Clinical Study

Objective: Lumbar degenerative disease is a common lumbar disease including lumbar intervertebral disc herniration,spondylolisthesis,stenosis ect.The destroy of annulus cartilaginous and facet of lumbar joint will cause lumbar vertebral unstability,compression of nerver roots,which will injury the nerver function and degrade the patients's living quality seriously . Since 1940s,posterior lumbar intervetebral fusion has become an usual surgical style.After decades of research and observation ,this style has been proved to enhance the stability of degenerative lumbar segments,increase capability of spinal channel,recover the nerve function. In many cases ,people use allo/auto-graft to accelerate the speed of fusion,reduce the time of lying in bed and improve the living quality.nowaday ,fusion cage are used widly to support the intervertebral space.In recent years ,many research has proved that cage implanting combined with the short segmental internal fixation could enhance the biomechanical stability。Traditional surgical style is to implant double cages in one segment which destroy posterior structure seriously,and double cage will occupy more space than single cage .This characters limit the total use of the graft bone and make more trouble in compliacations and fund. Oblique and single cage combined with short segmental internal fixation is a good way to avoid injurying double vertebral plates,reduce the destroy of posterior structure and increase the total use of graft-bone,And it has been proved in vitro test that singal cage combined with short segmental fixation can provid enough strength to mantein spinal stability.All of these finding gives theory support to treat lumbar degenerative disease with single cage combined with short segmental fixation. Main research direction: 1,To prove the availability of the oblique single cage combined with short segmengtal fixation in treatment of degenerative disease. 2,The complication in this kind of surgeon Methods: 1,To retrospectively analyze clinical curative effect of 98 case which have lumbar degenerative disease to compare our surgical style with double cages style in the field of curative effect ,complicatioons.To take X-ray film of AP direction and lateral position of each patient before and after operation,then in follow to measure index of lumbar spinal curvature,relative disc height,slip index,segmental lumbar lordosis,full lumbar lordosis; All the patients take low backleg pain evaluated with Japanese orthopaedic association(JOA) low backleg pain evaluated system before and after operation.and we use Greenough evaluation system to evaluate the successful rate of surgeon.all the results were compared with literature. 2,Complication in operatin was observed with naked eye and C-arm X-ray machine, including dural tear,nerve root injury etc.To take X-ray of each patient 3 days after operation to observe movement of cage,and to observe wether nerve root drag syndrome and nerve injury take place;In the 3 months ,6 months and 18 months ,to take X-ray film to observe movement of cage,pseudoarticulation,collapse of interbody space etc.,to analyze sympton and physical sign to find wether operation associated nerve symptom take place. 3,Choose radiographic index: relative disc height,slip index,and JOA,Greenough evaluation system to compare the clinical curative effect ,sort and quantity of two kind of cage to decide which kind of cage is more suitable for lateral single cage combined with short segmental internal fixation . Results: In the follow observation ,we found that in all the index ,the relative disc height,slip index and the JOA evaluation have significant improvement after operation.And Greenough also show that the operation have high successful rate.In our observation ,we also found some cage-associated and drag-associated complication ,but the whole complication rate is low. Conclusion: Using Oblique and single cage combined with short segmental internal fixation to treat lumbar degenerative disease can raise stability of degenerative segment,enhance the lumbarinterbody height,rectificate spondylolisthesis.It can be proved by the X-ray examination. Most of patients have significant improvement of syptom evaluated by JOA.Greenough also show that the operation have high successful rate.Some cage-associated and drag-associated complication are also observed, but the whole complication rate is low,we use PEEK-cage and BAK-cage in this research ,and compared with the complication and clinical observation ,PEEK-cage is more suitableee.To sum up ,this surgical style is safe and effective.