退行性脊柱侧弯椎管狭窄单侧双通道内镜减压椎间融合术△

Unilateral biportal endoscopic lumbar interbody fusion for degenerative scoliosis complicate with spinal stenosis

摘要:

[目的]介绍单侧双通道内镜减压椎间融合术（unilateral biportal endoscopic lumbar interbody fusion, UBE-LIF）治疗退行性脊柱侧弯合并椎管狭窄症的手术技术和初步临床效果。[方法] 对 1 例退行性脊柱侧弯合并椎管狭窄症的患者行上述治疗。根据术前临床表现和影像资料，确定手术节段，C 形臂 X 线机透视确定手术入路及解剖标志体表投影。透视下行椎弓根穿刺并置入导丝，上下两个通道分别置入内镜和手术器械，显露并去除上位椎体椎板下缘及下关节突、下位椎体上关节突尖部及内缘，切除肥厚的黄韧带，显露出口根和行走根，分离粘连组织，切除椎间盘并处理椎间隙，椎间植骨，置入融合器。同法处理其他节段。所有节段处理完毕后，沿导丝拧入椎弓根螺钉，固定连接棒。[结果] 本例患者顺利完成手术，手术时间约 280 min，术中出血量约 180 mL。切口一期愈合。术后 3 d 下床活动。随访时间 6 个月，VAS 评分术前腰部 5 分、下肢 6 分， 末次随访时均为 1 分；ODI 指数术前 51.1%，末次随访时 13.3%；JOA 评分术前 13 分，末次随访时 23 分。末次随访无症状复发。[结论]UBE-LIF 微创技术可以明显改善退行性脊柱侧弯合并椎管狭窄症患者的临床症状，矫正脊柱侧弯，恢复脊柱稳定性，促进术后快速恢复。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical outcome of unilateral biportal endoscopic lumbar interbody fusion (UBE LIF) in the treatment of degenerative scoliosis complicated with spinal stenosis. [Methods] A patient received abovesaid surgical treatment for degenerative scoliosis complicated with spinal stenosis. According to the preoperative clinical menifestation and imaging data, the surgicall segments was determined. The surgical approach and body surface anatomical marks was identified by C-arm fluoroscopy, guide pins were placed under fluoroscopy. Working portals were made over the guide pins, and endoscope and surgical instruments were placed through the upper and lower channels, respectively, to expose and remove the lower edge of the upper vertebral lamina, the tip of upper facet and inner edge of the facet of the lower vertebra. Subsequently, the hypertrophic ligamentum flavum was removed, the outlet root and walking root were exposed, the adhesive tissue was separated, the intervertebral disc was removed. After the intervertebral space was treated, and fusion cage with bone autograft was placed into the space. The other segments were treated in the same manner. After all segments were treated, pedicle screws were inserted along the guide wire, and then fixed with the connecting rods. [Results] The patient successfully completed the operation with operation time of 280 min, the intraoperative blood loss of 180 mL. The patient had incision healed well, got out of bed 3 days after surgery, and followed up for 6 months. The VAS score significantly improved from 5 (low back pain) and 6 (leg pain) preoperatively to 1 at the last follow-up, additionally, the ODI improved from 51.1 to 13.3, and JOA score was from 13 to 23 correspondingly. The patient had no symptoms recurred until the last follow-up. [Conclusion] The UBE-LIF is a minimally invasive technique, and does significantly improve the clinical symptoms of degenerative scoliosis complicated with spinal stenosis, correct scoliosis, restore spinal stability, and promote rapid recovery after surgery