| Background：lumbar degenerative diseases are common and frequentdiseases in spinal surgery, the major clinical manifestations are lumbar and legpain. Some experts define lumbar degenerative diseases as a series of diseasesin general, including degenerative change of lumbar intervertebral disc, facetjoints, cartilage and ligaments, which due to lumbar and leg pain ofpatients(mechanical pain and pressure pain).Conservative therapy of lumbardegenerative diseases is important, but the majority of patients afterconservative therapy can not get the desired effect, under the circumstances,surgery is the only way for lumbar degenerative diseases. The key of thesurgery includes decompression, fusion and internal fixation. The surgery oflumbar degenerative diseases requires accurate decompression to ease thecompression of spinal cord and nerve root. But decompression damaged thenormal lumbar physiological stability, the reconstruction of spinal stability is ofgreat significance. The "gold standard" of lumbar degenerative diseases isfusion, it can rebuild the stability of the lumbar spine.Posterior lumbarinterbody fusion,(PLIF) is the most classic lumbar fusion surgery, it canrebuild the stability of three-column, provides a good environment within thebone graft healing. Interbody cage is a milestone in the surgery of interbodyfusion, it can withstand a higher load of the spine strength and improve thefusion rate, but the postoperative activity of vertebrae will loss completely.Previous surgeries for lumbar degenerative diseases with rigid internal fixationcan make the spine more stable and improve the fusion rate. But with thecontinuous advances in spinal surgery, experts have realized the poor long-termeffect in patients with internal fixation and fusion, some patients withrecurrence of symptoms need a reoperation. Lumbar non-fusion and internal fixation system is aimed at overcoming weakness of recurrence. Lumbarnon-fusion fixation in line with the spine biomechanical principles, it is a leapin spinal surgery.Objective：To investigate the efficacy and advantage of the K-rod systemin the treatment of lumbar degenerative disease by comparing the preoperative,postoperative and follow-up image of patients with lumbar degenerativediseases.Methods： From December2010, Spine and spinal cord surgerydepartment has completed a total of34cases of lumbar non-fusion surgeries(single segment non-fusion:22cases, multi-segments non-fusion: six cases,multi-segment hybrid: six cases; L2-3: one case, L3-4: four cases, L4-5:20cases, L5-S1:16cases, a total of41segments), there were15cases ofpostoperative patients which were follow-up over six months. Lumbar JOAscore of preoperation, postoperation and follow-up was used to calculatesymptom improvement rate, calculated as follows: improvement rate=(postoperative score-preoperative score)×100/(total score-preoperativescore). MRI of lumbar as a routine examination of all preoperative patients(onepatient is in the acute phase of lumbar disc herniation accepted examination ofCT of lumbar) and lateral lumbar spine films;3days postoperation made laterallumbar spine films;15cases of postoperative patients more than six monthsaccepted MRI of lumbar, lateral lumbar spine films and lumbar extend-flexfilms, then we measured lumbar activity. The imaging data would eventually becollected and compared.①the intervertebral height and intervertebral anglemeasurement of surgical segment and adjacent segments, measure methods: Allinpatients in this study used the same DR machine to make the lateral lumbarspine films in a relaxed supine, intervertebral height equal to the average heightof anterior and posterior edge of the gap; intervertebral angle was a anglebetween inferior and superior edges of the adjacent vertebrae.②In MRI imaging of preoperative and follow-up, we compared the changes of surgicalsegment endplate inflammation (modic changes) and signal of surgical adjacentsegment vertebral gap (black disc change).③After six months follow-up,checked lumbar extend-flex films, observed intervertebral stability of operativesegments. vertebral displacement>4mm or intervertebral angle change>10°.④We measured the activity of lumbar flexion, dorsiflexion, and lateralbending, and compared with spine normal activity.Results：Symptom improvement rate of patients was calculated by JOAscore had a significant improvement.3days postoperation X-ray showedfixation in good position, there was no pulling nails, broken nails, and othercomplications. Imaging data of preoperative, postoperative and follow-up wascompared and got the following results:①The intervertebral height andintervertebral angle of surgery segment were slightly restored, and interve-rtebral height and intervertebral angle of adjacent segments slightly decreases,but less than the degenerative standard, compared with the preoperative discspace height decreased>3mm, disc space angle change>5°. Visibleintervertebral degenerative changes②In some patients, the preoperative MRI(lumbar endplates modic change and adjacent segments with the "blackdisc")and reviewed MRI showed that intervertebral degeneration didn’taggravate, some patients with intervertebral degeneration improved.③Patientswith six months follow-up checked lumbar extend-flex films, it displayedlumbar non-fusion system could maintain the stability of operative sessions.④Lumbar activity compared to the normal lumbar spine displayed there wasno significant lumbar limited.Conclusions：Lumbar non-fusion and internal fixation symptoms (K-rod)improved efficacy of surgery; Compared with traditional lumbar simplediskectomy and lumbar diskectomy, fusion and internal fixation, the complications decreased; Follow-up displayed that spinal surgery segments andthe adjacent segments were stable, there was no aggravated disc degenerationin adjacent segments. Non-fusion system protected the surgical segment discand slowed the degeneration, even the discs and endplates could repairthemselves. |
PDF Full Text Request