Mafi qarancin ɓarna na ɓarna na lumbar da aikin haɗin gwiwa

1) Karamin invasive lumbar hemilaminectomy

Ɗaya daga cikin mahimman ka'idoji na ƙananan ɓarna na ɓarna na lumbar shine don adana wurin shigar da ƙwayar tsoka na multifidus akan tsarin spinous. A cikin jimlar laminectomy na al'ada, an cire tsarin kashin baya kuma ana jan tsokar multifidus zuwa ɓangarorin biyu. Lokacin rufe raunin, ba za a iya gyara wurin farawa na ƙwayar multifidus zuwa tsarin spinous ba. Duk da haka, ta yin amfani da fasaha na semi laminectomy, za a iya yin cikakken ƙaddamar da ƙwayar ƙwayar ƙwayar ƙwayar cuta a gefe ɗaya ta hanyar tashar aiki. Karɓar tashar aikin zuwa baya yana bayyana ƙananan ɓangaren tsari na kashin baya da farantin kashin baya. A hankali a latsa jakar dural don cire flavum na ligamentum da babban aikin articular da ya saba wa juna, don haka kammala tsarin da ya dace na bai-daya don ragewa tsakanin bangarorin biyu. Tsarin jiki na kashin lumbar na sama ya bambanta da na ƙananan lumbar. A L3 da matakan sama, farantin vertebral tsakanin tsarin spinous da tsarin articular yana da kunkuntar sosai. Idan an yi amfani da hanyar haɗin kai, don ƙaddamar da raguwa na ipsilateral, ƙarin ƙaddamar da tsarin ipsilateral na sama ya zama dole. Wani zabin kuma shine a yi amfani da dabarar dabarar da ta shafi bangarorin biyu, wacce ta hada da rage hutun gefen dama ta hanyar hemilaminectomy na hagu, da kuma akasin haka. Wani bincike ya yi amfani da wannan dabarar bibiyu don rage sassa 7 na marasa lafiya 4, tare da jimlar lokacin tiyata na mintuna 32 a kowane sashi, matsakaicin asarar jini na 75ml, da matsakaicin zaman asibiti na kwanaki 1.2. Duk marasa lafiya tare da preoperative neurogenic claudication sun ɓace ba tare da wata matsala ba.

Yawancin karatu sun kimanta aminci da tasiri na ƙananan ƙwayar cuta na baya na lumbar. Hanyar koyon aikin tiyatar kashin baya kadan ta sami kulawa, kuma a farkon matakan wasu binciken, yawan rikicewar sa yana da yawa. Ikuta ya ba da rahoton kwarewar su na yin amfani da hanyar da ba ta dace ba don ƙaddamar da ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar cuta, tare da 38 daga cikin 44 marasa lafiya suna nuna tasiri mai kyau na gajeren lokaci. Makidin makin JOA ya inganta da matsakaita na 72%. Matsalolin da suka biyo baya sun ragu, kuma idan aka kwatanta da bude tiyata, an rage yawan asarar jini a cikin ciki. Bukatar magungunan kashe zafi bayan tiyata yana raguwa sosai, kuma an rage zaman asibiti sosai. Akwai 25% rikitarwa kudi, ciki har da 4 lokuta na dural hawaye, 3 lokuta na ƙananan articular tsarin karaya a kan m m gefe, 1 hali na cauda equina ciwo da bukatar sake yin aiki bayan tiyata, da kuma 1 hali na epidural hematoma na bukatar sake aiki.

A cikin binciken da Yagi mai yiwuwa ya yi, marasa lafiya 41 da lumbar spinal stenosis an raba su da kasu kashi biyu: rukuni ɗaya (20 lokuta) sun sami raguwar ƙarancin ƙwayar cuta, kuma ɗayan rukuni (21 lokuta) sun sami raunin laminectomy na gargajiya, tare da matsakaicin bin- har zuwa wata 18. Idan aka kwatanta da ƙungiyar tiyata na laminectomy na al'ada, ƙungiyar masu lalata aikin tiyata mafi ƙanƙanta tana da matsakaicin matsakaicin zaman asibiti, ƙarancin asarar jini, ƙananan matakan isoenzyme na creatine kinase a cikin jini, ƙarancin VAS don ƙananan ciwon baya shekara ɗaya bayan tiyata, da kuma saurin farfadowa. 90% na marasa lafiya a cikin wannan rukuni sun sami gamsuwa na rashin jin daɗi da kuma alamun taimako. Babu wasu lokuta na rashin kwanciyar hankali na baya bayan tiyata. Castro ya yi amfani da bututun aiki na 18mm don yin aikin tiyata na kashin baya na endoscopic na kashin baya akan marasa lafiya 55 da ke da kashin baya na lumbar. Ta hanyar matsakaita na shekaru 4 na biyo baya, 72% na marasa lafiya sun sami sakamako mai kyau ko kyakkyawan sakamako, kuma 68% na marasa lafiya suna da gamsuwa na zahiri kamar yadda yake da kyau. Sakamakon ODI ya ragu a matsakaici, kuma ma'auni na VAS don ciwon ƙafa ya ragu da 6.02 a matsakaici.

Asgarzadie da Khoo sun ba da rahoton lokuta 48 na ƙwanƙwasa na lumbar da aka bi da su tare da ƙananan ƙwayar cuta na lumbar. Daga cikin su, marasa lafiya 28 sun sami raguwar kashi-kashi ɗaya, yayin da sauran 20 suka sami raguwar matakai biyu. Idan aka kwatanta da ƙungiyar kulawa, wacce aka yi ta buɗe laminectomy na gargajiya, ƙungiyar mafi ƙanƙanta tana da matsakaicin matsakaicin zubar jini na ciki (25 vs 193ml) da ɗan gajeren zaman asibiti (36 vs 94 hours). An bi 32 daga cikin marasa lafiya 48 na tsawon shekaru 4 bayan tiyata. Watanni shida bayan tiyata, haƙurin tafiya na duk marasa lafiya ya inganta, kuma 80% na marasa lafiya sun kiyaye shi har zuwa matsakaicin watanni 38 bayan tiyata. A lokacin lokacin biyo baya, haɓakar ƙimar ODI da maki SF-36 ana kiyaye su akai-akai. A cikin wannan rukuni na lokuta, babu rikitarwa na lalacewar jijiya da ya faru. Ga lokuta na degenerative lumbar spondylolisthesis, ƙananan ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar cuta ba tare da haɗuwa ba kuma hanya ce mai tasiri. Pao kawai ya yi ƙarancin ɓarna na ɓarna na lumbar a kan lokuta 13 na ƙashin ƙugu na lumbar da aka haɗa tare da Ⅰ ° lumbar spondylolisthesis. Duk lokuta bayan tiyata sun nuna sakamako mai kyau na asibiti kuma babu wani mummunan zamewa. Sasai ya bi da 23 lokuta na degenerative lumbar spondylolisthesis da 25 lokuta na degenerative lumbar spinal stenosis ta yin amfani da fasaha na rashin daidaituwa da haɗin kai. Bayan shekaru biyu na biyo baya, ko da yake ma'aunin claudication neurogenic intermittent claudication da ODI score na degenerative lumbar spondylolisthesis kungiyar sun kasance dan kadan mafi muni, gaba ɗaya, ƙananan ƙungiyoyi biyu sun kasance daidai. Daga cikin 23 lokuta na degenerative lumbar spondylolisthesis, 3 marasa lafiya sun sami karuwa na ≥ 5% a cikin zamewar bayan aiki. Kleeman ya yi amfani da fasahohin ƙaddamarwa wanda ya adana tsari mai laushi da haɗin gwiwa don bi da marasa lafiya na 15 tare da ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar cuta ta 6.7mm. Bayan matsakaita na shekaru 4 na biyo baya, marasa lafiya 2 sun sami rauni na zamewa da bayyanar cututtuka, kuma marasa lafiya 12 sun sami sakamako mai kyau ko kyakkyawan sakamako na asibiti.

2) Transforaminal lumbar interbody fusion tiyata

Blume da Rojas ne suka fara ba da shawara na Transforaminal lumbar interbody fusion (TLIF), kuma Harms da Jeszensky suka haɓaka. Wannan fasaha ta samo asali ne daga shirin farko na Cloward na haɗin gwiwa na lumbar na baya (PLIF). Yin tiyata na PLIF yana buƙatar raguwa mai yawa na kashin baya da kuma tushen jijiya na biyu don fallasa sararin samaniya na lumbar, yayin da aikin TLIF ya fallasa sararin samaniya na lumbar daga gefe guda ta hanyar haɗin gwiwar intervertebral. Sabili da haka, idan aka kwatanta da aikin tiyata na PLIF wanda ke buƙatar kammalawa na biyu, TLIF tiyata yana buƙatar ƙananan raguwa akan tsarin jijiyoyi. Wani babban fa'idar aikin tiyata na TLIF shine yana ba da damar rage raunin kashin baya na lumbar lokaci guda da haɗin kai na gaba ta hanyar incision na baya.

Peng et al. idan aka kwatanta sakamakon asibiti da na hoto na aikin tiyatar TLIF kaɗan mai cutarwa tare da buɗewar TLIF na gargajiya. Sakamakon biyo baya na shekaru biyu sun kasance iri ɗaya, amma ƙungiyar da ta fi dacewa da farko ba ta da zafi bayan tiyata, saurin farfadowa, taƙaitaccen asibiti, da ƙananan matsaloli. Dhal et al. A baya-bayan nan idan aka kwatanta majiyyata 21 da ke yin aikin tiyatar TLIF kaɗan da kuma marasa lafiya 21 da ke yin tiyatar buɗe ido na gargajiya. Bayan shekaru biyu na bin diddigin, an gano cewa babu bambanci a cikin sakamakon asibiti tsakanin ƙungiyoyin biyu. Duk da haka, ƙungiyar da aka bude ta nuna karuwa mai yawa a cikin yawan jini da kuma tsawon lokaci a asibiti. Selznick et al. yi imani cewa ɗan ƙaranci tiyatar TLIF don shari'o'in bita abu ne mai yuwuwa a zahiri kuma baya ƙara haɓakar ƙarar jini da rikice-rikicen jijiya. Duk da haka, abin da ya faru na hawaye na dual a cikin shari'o'in bita yana da girma sosai, don haka mafi ƙarancin tiyata na TLIF don shari'o'in bita yana da ƙalubale kuma ya kamata a yi ta ta hanyar ƙwararrun likitocin masu cutarwa.

Binciken da Kasis et al. an gano cewa ƙaramin ƙwanƙwasa PLIF tiyata tare da iyakancewar ɗaukar hoto na iya samun ingantacciyar sakamako na asibiti da ɗan gajeren zaman asibiti idan aka kwatanta da aikin buɗe ido na gargajiya. Ya yi imani da maki 5 masu zuwa: (1) adana tsarin baya na kashin baya; (2) Guji bawon waje daga tsarin karkatacce; (3) Cikakken gyare-gyare na hanyoyin haɗin gwiwa da haɗin gwiwa; (4) Ƙananan rikitarwa na lalacewar ƙwayoyin cuta; (5) Gujewa yin amfani da ƙashi na iliac autologous yana da alaƙa da haɓakar sakamako na asibiti.

Ana sa ran maye gurbin diski na endoscopic na baya zai maye gurbin aikin tiyata na juzu'i a nan gaba. A halin yanzu akwai kayan maye gurbin diski na intervertebral an tsara su don maye gurbin gabaɗaya, amma saboda girman girman su, ba za a iya shigar da su ta hanyar tiyatar endoscopic na baya ba. Ray et al. ɓullo da ƙwayar ƙwayar cuta ta tsakiya wanda ke aiki kamar matashi don kula da tsayin diski na intervertebral. A halin yanzu, ana samun dasa shuki na tsakiya na kasuwanci. Raymedia et al. gudanar da wani bincike na asibiti a kan nucleus pulposus implants a Jamus a cikin 1996, sannan wani binciken a Amurka a 1998. Raymedia et al. An ruwaito a cikin 1999 cewa marasa lafiya 101 sun sami ƙwayar ƙwayar cuta ta tsakiya. Kodayake Raymedia et al. ya ruwaito cewa 17 daga cikin marasa lafiya na 101 sun sami rarrabuwar kawuna ko ƙaura, yawancin marasa lafiya har yanzu sun sami babban taimako na jin zafi. Don rage haɓakawa ko ƙaurawar ƙwayoyin pulposus na tsakiya da haɓaka haɓakar fasahar maye gurbin faya-fayan ƙarancin ɓarna, Advanced Biosurfaces (kamfanin) ya ɓullo da tsarin dabarun da ke amfani da polymers, balloons ɗin jigilar kaya, catheters na balloon, da bindigogin allura na polymer. Wannan polymer shine polyurethane, wanda za'a iya yin polymerized a wurin kuma yana da kaddarorin inji mai ƙarfi idan aka kwatanta da samfuran likitanci na masana'antu. Balloon ya ƙunshi abu na roba, wanda zai iya faɗaɗa sosai lokacin da aka yi wa polymer allurar a cikin cika, amma har yanzu balloon yana da ƙarfi sosai. Likitoci na iya yaɗuwa cikin sararin intervertebral a ƙarƙashin matsin lamba. Kamfanin ya gudanar da gwaje-gwaje masu yawa a cikin vivo da in vitro don tabbatar da daidaituwar kwayoyin halitta na polymer a cikin aikin haɗin gwiwa na gwiwa. Waɗannan binciken sun ba da shawarar cewa akwai ƙananan abubuwan da za a iya cire su na monomeric. A cikin nazarin nazarin halittu na samfurin cadaveric intervertebral disc, an nuna cewa wannan abu zai iya kula da tsayi na al'ada da kuma kayan aikin kwayoyin halitta na diski na intervertebral. A halin yanzu, ana iya shigar da abubuwan da ake sakawa a cikin diski na tsakiya ta tsakiya ta hanyar budewa ta baya ko hanyar laparoscopic na gaba. Ordway et al. Hakanan ya haɓaka wurin maye gurbin diski, wanda ake kira "hydrogel disc nucleus pulposus", wanda za'a iya sanya shi ƙarƙashin endoscope. Kwanan nan, SaluMedica da sauransu sun ɓullo da wani nau'in prosthesis intervertebral diski mai suna Salubria, wanda shine mai karfi da kuma roba hydrogel. A cewar rahotanni na yanzu, zai iya rage herniation na diski na intervertebral da ke hade da raunin jijiya da ƙananan ciwon baya. An kiyasta cewa maye gurbin diski na Salubria na roba zai zama babban ci gaba a cikin aikin tiyata na yanzu, yana samar da prosthesis ga kashin baya wanda ya fi dacewa da halaye na biomechanical da aikin motsi na lumbar na halitta.

3) Karamin cin zarafi na gaba sacral kusanci axial intervertebral fusion tiyata

Daga hangen nesa na biomechanical, yana yiwuwa a sanya kayan aikin haɗin gwiwa kusa da axis na jujjuyawar kashin baya yayin aiwatar da matsawa na tsayin daka na jikin kashin baya. Duk da haka, ci gabansa yana da iyaka saboda rashin kayan aiki da kayan aiki. Kwanan nan, bisa ga jerin nazarin cadaveric da na asibiti, an samu damar shiga tsakani daga sararin samaniya na gaba zuwa yankin lumbosacral don kauce wa bayyanar da baya, na baya, da kuma sassan layi na kashin baya, ba tare da lalata tsokoki na baya ba, ligaments, da kuma abubuwan da ke bayan kashin baya, ko kuma buqatar shiga cikin kogon ciki ko jan jini da gabobin ciki. Aikace-aikacen fasahar fluoroscopy X-ray biplane yana ba da garanti mai inganci don rage rikice-rikice na ciki.

Cragg et al. na farko an bayar da rahoton percutaneous anterior sacral approach (AxiaLIF) don L5/S1 intervertebral fusion: ① Yi ɗan ƙaramin yanki na kusan 4mm kusa da incision coccyx, saka allurar jagora a ƙarƙashin kewayawar fluoroscopy na X-ray, sannan hawa tare da gaban gaban sacrum. don isa ga sacral 1 vertebral jiki, kafa tashar aiki; ② Cire L5/S1 faifan intervertebral kuma a goge ƙarshen guringuntsin guringuntsi, da dasa ƙashi a cikin sararin intervertebral; ③ Yin amfani da na'urar da aka kera ta musamman na 3D titanium alloy don dasawa da dawo da tsayin diski na intervertebral, cimma raguwa ta atomatik na tushen jijiya; ④ Percutaneous gyarawa daga baya: Yana ba da kai tsaye 360 ​​° gyarawa don L5-S1. Binciken na asibiti ya gano cewa marasa lafiya da L5 slippage da L5 / S1 discogenic ƙananan ciwon baya da aka bi da su tare da AxiaLIF sun nuna ci gaba mai mahimmanci a cikin VAS da ODI idan aka kwatanta da magani na farko. An sallame su a cikin sa'o'i 24 kuma sun koma bakin aiki a cikin kwanaki 15. Babu rarrabuwa, sako-sako, ko nakasar sacral bayan dasawa, kuma adadin haduwar wata 12 ya kasance 88%. Marotta et al. gudanar da ƙarin nazarin asibiti, kuma sakamakon yana ƙarfafawa. AxiaLIF hanya ce mai aminci da inganci. AxiaLIF yana buƙatar fasaha na musamman da ilimin ilimin halittar jiki na hanyoyin da ba a saba da su ba, kuma likitoci ba za su iya isa canal na kashin baya ba ko yin discectomy kai tsaye a ƙarƙashin hangen nesa, wanda shine kalubale ga likitocin tiyata.

4) Yin tiyatar haɗin gwiwa na gefe na lumbar

Haɗin haɗin gwiwa na Lumbar wata fasaha ce ta gama gari wacce ke da fa'idodi guda uku: (1) cire ƙwayar diski na intervertebral azaman tushen jin zafi; (2) Matsakaicin girman fusion; (3) Mayar da tsayin sararin samaniya na lumbar intervertebral da lumbar lordosis. Haɗin haɗin gwiwa na Lumbar ya haɗa da haɗin haɗin jiki na gaba, haɗin haɗin gwiwa na baya, haɗin haɗin haɗin gwiwa na intervertebral ko endoscopic interbody fusion ta hanyar extraperitoneal. An sami rahotannin wallafe-wallafe game da ɗan ƙaramin ɓarna na retroperitoneal na gefen haɗin gwiwa ta hanyar hanyar tsoka na lumbar. Ana yin wannan dabarar ta hanyar babban ƙwayar tsoka na retroperitoneum na lumbar a ƙarƙashin kulawar neurophysiological da jagorar fluoroscopy, wanda aka sani da DLIF ko XLIF ɗan ƙaramin aikin tiyata na lumbar.

Saboda gaskiyar cewa plexus na lumbar yana samuwa a cikin rabi na baya na psoas manyan tsoka, ƙayyadaddun rarrabawar 1/3 na gaba zuwa gaba na 1/2 na babban tsoka na psoas zai iya rage hadarin lalacewar jijiya. Bugu da kari, yin amfani da intraoperative saka idanu electromyography kuma iya rage hadarin lalacewa jijiya. Lokacin da ake hulɗa da sararin samaniya na lumbar da kuma shigar da na'urorin haɗin gwiwar intervertebral, yana da mahimmanci don kauce wa lalata kasusuwan kasusuwa da kuma ƙayyade jagorancin na'urar fusion ta hanyar anteroposterior da na gefe fluoroscopy. Fusion na intervertebral zai iya cimma raguwa a kaikaice na gobarar intervertebral ta hanyar maido da tsayin jijiyoyi na jijiyoyi da daidaitawa na kashin baya. Ƙayyade ko haɗin baya da ɓacin rai har yanzu sun zama dole bisa yanayin kowane mutum. Knight et al. An ba da rahoton rikice-rikice na farko a cikin mata marasa lafiya na 43 da marasa lafiya maza na 15 waɗanda suka yi aikin tiyata na wucin gadi na lumbar: 6 lokuta sun sami jin zafi na cinya na baya bayan tiyata, kuma lokuta 2 sun sami rauni na tushen jijiya na lumbar L4.

Ozgur et al. an ba da rahoton lokuta 13 na tiyata guda ɗaya ko ɓangarori da yawa na gefen lumbar interbody fusion tiyata. Duk marasa lafiya sun sami taimako mai mahimmanci a cikin ciwo na baya-bayan nan, ingantaccen aikin aiki, kuma babu wani abin da ya faru na rikitarwa. Anand et al. an ruwaito lokuta 12 na gefe guda ɗaya da L5/S1 sacral interbody fusion. A matsakaita, an haɗa sassan 3.6, kuma an gyara kusurwar Cobb daga 18.9 ° kafin a fara aiki zuwa 6.2 ° bayan tiyata. Pimenta et al. An bi da marasa lafiya 39 tare da fasahar fusion na gefe, tare da matsakaicin matsakaicin matakin fusion na 2. Matsakaicin kusurwa na gefe ya inganta daga matsakaicin 18 ° kafin tiyata zuwa matsakaicin 8 ° bayan tiyata, kuma kusurwar lumbar lordosis ya karu daga matsakaicin 34 °. kafin tiyata zuwa matsakaita na 41 ° bayan tiyata. Duk lokuta na iya tafiya a ƙasa kuma su ci abinci na yau da kullum a ranar tiyata. Matsakaicin asarar jini bai wuce 100ml ba, matsakaicin lokacin tiyata shine mintuna 200, matsakaicin zaman asibiti shine kwanaki 2.2. Sakamakon ciwo da aikin aiki duka sun inganta bayan tiyata. Wright et al. ya ruwaito marasa lafiya 145 daga cibiyoyin bincike da yawa waɗanda suka yi aikin tiyata na haɗin gwiwa na lumbar na gefe don cutar cututtukan lumbar. Abubuwan da aka haɗa su sun bambanta daga 1 zuwa 4 (72% kasancewa guda ɗaya, 22% kasancewa kashi biyu, 5% kasancewa sassa uku, kuma 1% kasancewa sassa huɗu). An yi amfani da goyon bayan intervertebral (86% PEEK abu, 8% allograft, da 6% intervertebral fusion cage) a hade tare da furotin morphogenetic kashi (52%), demineralized kashi matrix (39%), da autologous kashi (9%), bi da bi. Kashi 20% na tiyata suna amfani da haɗin gwiwar intervertebral kadai, 23% suna amfani da tsarin dunƙule na gefe don gyarawa, kuma 58% suna amfani da tsarin dunƙule pedicle na baya don taimakon gyarawa. Matsakaicin lokacin tiyata shine mintuna 74 kuma matsakaicin asarar jini shine 88ml. Wasu lokuta guda biyu sun sami lahani na wucin gadi ga jijiya na mata na haihuwa, kuma lokuta biyar sun sami raguwa na wucin gadi a ƙarfin jujjuyawar hip. Yawancin marasa lafiya suna tafiya a ƙasa a ranar bayan tiyata kuma an sallame su a ranar farko bayan tiyata.

Dangane da dabarun gyaran gyare-gyare na ƙananan ƙwayar cuta don tsofaffi na lumbar degenerative scoliosis, Akbarnia et al. An ba da rahoton marasa lafiya 13 waɗanda ke yin jiyya na juzu'i da yawa don lumbar scoliosis fiye da 30 °. An haɗa sassa uku a matsakaita, kuma duk shari'o'in sun kasance sun haɗa da haɗin baya da gyara lokaci guda. Bayan matsakaicin matsakaici na watanni 9, duka lumbar scoliosis da lordosis sun nuna ingantaccen ci gaba. Ɗaya daga cikin shari'ar yana buƙatar tiyatar bita saboda ƙaurawar da aka sanya ta intervertebral, yayin da wani yanayin ya sami incisional hernia a wurin da aka haɗa fuska ta gefe. A cikin watanni 6 bayan tiyata, duk lokuta sun sami cikakkiyar bacewar rauni a cikin tsokoki na lumbar ko kumbura a cikin cinyoyinsu. Idan aka kwatanta da kafin tiyata, makin VAS na ɗan gajeren lokaci, maki SRS-22, da maki ODI duk sun inganta. Anand et al. sun sami sakamako iri ɗaya a cikin binciken su na marasa lafiya 12, tare da sassan fusion jere daga 2 zuwa 8 (matsakaicin 3.64) da matsakaicin ƙarar jini na 163.89ml yayin gabatowar gaba da 93.33ml yayin gyaran pedicle na baya. Matsakaicin lokacin tiyata don tiyata na gaba shine awanni 4.01, kuma matsakaicin lokacin tiyata na baya shine awa 3.99. Matsakaicin kusurwar Cobb ya inganta daga matsakaicin kusurwar farko na 18.93 ° zuwa matsakaicin kusurwar bayan tiyata na 6.19 °.

Sauƙaƙan amfani da cages na haɗin gwiwar intervertebral don haɗuwa na gaba yana ƙaruwa da haɓakar haɗin gwiwa na ƙarya saboda rashin isasshen kwanciyar hankali na sashin haɗin gwiwa na farko. A cikin 'yan shekarun nan, an yi amfani da hanyoyin da aka taimaka wajen gyarawa na baya don inganta yawan ƙwayar intervertebral. Ƙwaƙwalwar ƙafar ƙafar ƙafa ta baya (Sextant) hanya ce mai tasiri, wanda ke da fa'idodin guje wa lalacewar tsoka yayin aikin tiyata na baya, rage asarar jini na ciki, saurin farfadowa bayan tiyata, da haɓaka ƙimar haɗin gwiwa. Koyaya, aikin yana da rikitarwa. Percutaneous facet screw fixation (PFSF) hanya ce mai inganci don taimakawa ALIF, tare da ƙarancin buƙatun fasaha da ƙarancin farashi, kuma cikin sauri ya sami shahara. Kandziora et al. idan aka kwatanta da halaye na biomechanical na PFSF, translaminar facet screw fixation, da pedicle screw fixation in vitro, kuma sun gano cewa kwanciyar hankali na biomechanical na lumbar facet screw fixation a farkon matakin ya yi kama da na translaminar screw fixation, amma dan kadan ya fi muni fiye da na pedicle. dunƙule gyarawa. Kang et al. an ruwaito cewa an yi gyaran gyare-gyaren translaminar articular screw (TFS) a ƙarƙashin kewayawar CT, kuma an dasa dukkan sukurori daidai ba tare da wata matsala ba. Sakamakon bin diddigin binciken da Jang et al. akan PFSF + ALIF da TFS + ALIF ba su nuna wani bambanci mai mahimmanci a cikin ƙididdiga na ODI da Macnab, sakamakon tiyata, da ƙimar haɗin gwiwa. Koyaya, na farko yana da haɗarin tiyata da aminci mafi girma. Percutaneous PFSF na iya zama ingantacciyar kari ga tiyatar gyaran kafa ta baya.