Minimally invasive lumbar decompression uye fusion kuvhiyiwa

1) Minimally invasive lumbar hemilaminectomy

Imwe nheyo inokosha yeminimaly invasive lumbar decompression ndeyekuchengetedza tendinous kuisa pfungwa ye multifidus muscle pane spinous process. Mune yechinyakare yakazara laminectomy, iyo spinous process inobviswa uye multifidus tsandanyama inodhonzwa kumativi ese. Paunenge uchivhara ronda, nzvimbo yekutanga ye multifidus muscle haigoni kugadziriswa kune spinous process. Nekudaro, uchishandisa semi laminectomy tekinoroji, yakazara musana canal decompression inogona kuitwa kune rimwe divi kuburikidza nekushanda chiteshi. Kutenderedza chiteshi chebasa kumusana kunoburitsa chikamu chezasi che spinous process uye contralateral vertebral plate. Dzvanya zvinyoro nyoro pa dural sac kuti ubvise ligamentum flavum uye contralateral superior articular process, nokudaro uchizadzisa iyo classic unilateral approach yebilateral decompression. Iyo anatomical chimiro chepamusoro lumbar spine yakasiyana neyeyepasi lumbar spine. PaL3 uye pamusoro pemazinga, iyo vertebral plate pakati pe spinous process uye articular process yakanyanya kutetepa. Kana nzira yeunilateral ikashandiswa, kuitira kuti decompress iyo ipsilateral recess, kunyanya kubviswa kweipsilateral upper articular process inofanirwa. Imwe sarudzo ndeye kushandisa nzira mbiri, iyo inosanganisira decompression yekurudyi lateral recess kuburikidza nekuruboshwe hemilaminectomy, uye zvinopesana. Imwe ongororo yakashandisa nzira iyi yekudyidzana kuti decompress 7 zvikamu zvevarwere 4, neavhareji nguva yekuvhiya yemaminetsi makumi matatu nemaviri pachikamu, avhareji yekurasikirwa neropa ye75ml, uye avhareji yekugara muchipatara mushure memazuva 1.2. Vose varwere vane preoperative neurogenic claudication vakanyangarika pasina matambudziko.

Zvidzidzo zvakawanda zvakaongorora kuchengetedzeka uye kushanda kweashoma invasive posterior lumbar decompression. Nzira yekudzidza yekuvhiyiwa kwemuzongoza zvishoma yakagamuchira kutariswa, uye mumatanho ekutanga ezvimwe zvidzidzo, chiyero chayo chekunetseka chakanyanya. Ikuta yakarondedzera ruzivo rwavo rwekushandisa unilateral approach ye bilateral lumbar spinal decompression kurapa lumbar spinal stenosis, ne 38 kunze kwevarwere ve44 vanoratidza zvakanaka kwenguva pfupi kushanda. Iyo JOA scoring index yakavandudzwa neavhareji ye72%. Zvinetso zvepashure zvakaderera, uye zvichienzaniswa nekuvhiyiwa kwakazaruka, kurasikirwa kweropa kwemukati kunoderera zvakanyanya. Kudiwa kwemashure ekurwadziwa kwepainkiller kunoderedzwa zvakanyanya, uye kugara muchipatara kunopfupikiswa zvakanyanya. Pane 25% complication rate, kusanganisira 4 zviitiko zve dural misodzi, 3 zviitiko zvepasi articular process fractures padivi rekuvhiya nzira, 1 kesi ye cauda equina syndrome inoda reoperation mushure mekuvhiyiwa, uye 1 nyaya yeepidural hematoma inoda kuvhiyiwa zvakare.

Muchidzidzo chinotarisirwa naYagi, varwere ve41 vane lumbar spinal stenosis vakakamurwa zvisina kurongeka kuva mapoka maviri: boka rimwe (20 kesi) rakapinda zvishoma nezvishoma invasive endoscopic decompression, uye rimwe boka (21 kesi) rakapinda mutsika laminectomy decompression, neavhareji yekutevera- kusvika kumwedzi 18. Kuenzaniswa neyakajairwa laminectomy decompression kuvhiyiwa boka, iyo ishoma invasive yekuvhiya decompression boka ine ipfupi avhareji yekugara muchipatara, kurasikirwa kweropa kushoma, yakaderera tsandanyama isoenzyme mazinga e creatine kinase muropa, yakaderera VAS mamaki ekurwadziwa kwemusana gore rimwe mushure mekuvhiyiwa, uye kukurumidza kupora. 90% yevarwere vari muboka iri vakawana zvinogutsa neurological decompression uye zororo rechiratidzo. Hapana zviitiko zve postoperative spinal kusagadzikana zvakaitika. Castro akashandisa 18mm yekushanda chubhu kuita endoscopic spinal canal decompression kuvhiyiwa pavarwere ve55 vane lumbar spinal stenosis. Kuburikidza neavhareji yemakore mana ekutevera, 72% yevarwere vakawana zvakanakisa kana zvakanakisa mhedzisiro, uye 68% yevarwere vaive nekugutsikana kugutsikana sekwakanakisa. Nhamba yeODI yakaderera paavhareji, uye nhamba yeVAS yemarwadzo emakumbo yakaderera ne6.02 paavhareji.

Asgarzadie naKhoo vakashuma 48 zviitiko zve lumbar spinal stenosis yakarapwa neine minimally invasive lumbar spinal decompression. Pakati pavo, varwere ve28 vakave ne-single-segment decompression, nepo vamwe makumi maviri vakawana decompression yematanho maviri. Kuenzaniswa neboka rinodzora, iro rakapinda mutsika yakavhurika laminectomy, boka risinganyanyi kupindira raive neavhareji yeavhareji yekubuda ropa (25 vs 193ml) uye kupfupika muchipatara kugara (36 vs 94 maawa). 32 kunze kwevarwere ve48 vakateverwa kwemakore 4 mushure mekuvhiyiwa. Mwedzi mitanhatu mushure mekuvhiyiwa, kushivirira kwekufamba kwevarwere vose kwakavandudzwa, uye 80% yevarwere vakaichengeta kusvika paavhareji yemwedzi ye38 mushure mekuvhiyiwa. Munguva yekutevera nguva, kuvandudzwa kweODI mamakisi uye SF-36 mamakisi aigara akachengetedzwa. Muboka iri rezviitiko, hapana matambudziko ekukuvara kwetsinga kwakaitika. Kune zviitiko zvekuderera kwechiuno spondylolisthesis, minimally invasive lumbar spinal decompression pasina fusion zvakare inzira inoshanda. Pao aingoita zvishoma kuvharisa lumbar spinal decompression pa 13 kesi dze lumbar spinal stenosis dzakasanganiswa ne Ⅰ ° lumbar spondylolisthesis. Mhosva dzese dzepashure dzakaratidza mhedzisiro yakanaka yekiriniki uye hapana kuwedzera kwekutsvedza. Sasai akarapa 23 kesi dze degenerative lumbar spondylolisthesis uye 25 kesi dze degenerative lumbar spinal stenosis vachishandisa unilateral uye bilateral decompression techniques. Mushure memakore maviri ekutevera, kunyange zvazvo iyo neurogenic intermittent claudication score uye ODI chikamu che degenerative lumbar spondylolisthesis boka rakanga rakanyanya kuipa, zvakakwana, zvikamu zvemapoka maviri akafanana. Pakati pezviitiko zve23 zvekuora mwoyo lumbar spondylolisthesis, varwere ve3 vakawana kuwedzera kwe ≥ 5% mu postoperative slip. Kleeman akashandisa maitiro ekuderedza akachengetedza spinous process uye interspinous ligament kurapa varwere ve15 vane lumbar spinal stenosis yakaoma ne degenerative lumbar spondylolisthesis, ine avhareji inotsvedza ye6.7mm. Mushure meavhareji yemakore mana ekutevera, varwere ve2 vakaona kuwedzera kwekutsvedza uye zviratidzo, uye varwere ve12 vakawana zvakanaka kana zvakanakisa mhedzisiro yekiriniki.

2) Transforaminal lumbar interbody fusion kuvhiyiwa

Transforaminal lumbar interbody fusion (TLIF) yakatanga kukurudzirwa neBlume neRojas, uye yakasimudzirwa neHarms naJeszensky. Iyi tekinoroji yakabva kune yaCloward yekutanga chirevo che posterior lumbar interbody fusion (PLIF). Kuvhiyiwa kwePLIF kunoda kuderedzwa kwepelinha kwakakura uye mutsara wetsinga midzi traction kuti ibudise lumbar intervertebral space, asi TLIF inovhiya inobudisa nzvimbo yepakati pepakati kubva kune rumwe rutivi kuburikidza ne intervertebral foramen. Naizvozvo, kana ichienzaniswa nekuvhiya kwePLIF kunoda kupedzwa kweviri, kuvhiyiwa kweTLIF kunoda kudhonzwa kudiki pane neural chimiro. Imwe mukana mukuru wekuvhiyiwa kweTLIF ndeyekuti inobvumira kuti panguva imwe chete yemashure lumbar spinal decompression uye anterior intervertebral fusion kuburikidza neakasiyana posterior incision.

Peng et al. akaenzanisa mhedzisiro yekiriniki uye yekufungidzira yekuvhiya kushoma kweTLIF nekuvhiya kwechinyakare kwakavhurika TLIF. Migumisiro yemakore maviri ekutevera yakanga yakafanana, asi boka risinganyanyi kupindira pakutanga raiva nemarwadzo mashoma epashure, kukurumidza kupora, kugara muchipatara kwenguva pfupi, uye kuderera kwezvinetso. Dhall et al. tichienzanisazve varwere makumi maviri nemumwe vari kuvhiyiwa zvishoma neTLIF uye varwere makumi maviri nemumwe vari kuvhiyiwa yechinyakare yakavhurika yeTLIF. Mushure memakore maviri ekutevera, zvakaonekwa kuti pakanga pasina misiyano mumigumisiro yekliniki pakati pemapoka maviri. Zvisinei, boka rakazaruka rakaratidza kuwedzera kukuru kwekubuda ropa uye kugara kwenguva refu muchipatara. Selznick et al. tenda kuti kuvhiyiwa kweTLIF kusinganyanyi kukuvadza nyaya dzekudzokorora kunogoneka nehunyanzvi uye hakuwedzeri kuwedzera kwehuwandu hwekubuda ropa uye matambudziko etsinga. Nekudaro, chiitiko chedural misodzi mumakesi ekudzokorora chakanyanya, saka kuvhiyiwa kweTLIF kusinganyanyi kupindira kwenyaya dzekudzokorora kunonetsa uye kunofanirwa kuitwa nevavhiyi vane ruzivo vashoma.

Chidzidzo chinotarisirwa naKasis et al. vakawana kuti kuvhiyiwa kwePLIF kushoma nekusanyanya kuratidzwa kunogona kuita zvirinani mhedzisiro yekiriniki uye kugara muchipatara kwenguva pfupi zvichienzaniswa nekuvhiyiwa kwechinyakare. Anotenda mune zvinotevera 5 pfungwa: (1) kuchengetedzwa kwemashure maitiro emusana; (2) Dzivisa kusvuura kunze kubva kune inochinjika maitiro; (3) Kuzadza resection yebilateral articular process uye majoini; (4) Zvinetso zvishoma zvekukuvara kwetsinga; (5) Kudzivisa kushandiswa kwe autologous iliac bone grafting yakabatana zvikuru nekuvandudzwa kwemigumisiro yekliniki.

Posterior endoscopic disc replacement surgery inotarisirwa kunyatso kutsiva chikamu chekuvhiya fusion munguva pfupi iri kutevera. Iko ikozvino inowanikwa intervertebral disc replacement implants yakagadzirirwa kuchinjwa zvachose, asi nekuda kwehukuru hwayo, haigoni kuiswa kuburikidza nekuvhiyiwa kwemashure endoscopic. Ray et al. yakagadzira nucleus pulposus prosthesis inoita senge cushion kuchengetedza intervertebral disc kureba. Parizvino, zvekutengesa nucleus pulposus implants zviripo. Raymedia et al. akaita chidzidzo chekliniki pa nucleus pulposus implants muGermany muna 1996, yakateverwa neimwe dzidzo muUnited States muna 1998. Raymedia et al. yakashuma muna 1999 kuti varwere 101 vakawana nucleus pulposus implantation. Kunyangwe Raymedia et al. yakashuma kuti 17 kubva muvarwere ve101 vakawana kubviswa kwekudyara kana kutamiswa, vazhinji vevarwere vachiri kuwana rubatsiro rukuru rwekurwadziwa. Kuti kuderedze kuputika kana kutama kweiyo nucleus pulposus implants uye kukurudzira kuvandudzwa kweminiti invasive intervertebral disc replacement teknolojia, Advanced Biosurfaces (kambani) yakagadzira seti yemaitiro anoshandisa mapolymers, mabharuni ekutakura, catheter yebharuni, uye pfuti dzemajekiseni epolymer. Iyi polymer ndeye polyurethane, inogona kuve polymerized in situ uye ine yakasimba michina zvivakwa zvichienzaniswa nemaindasitiri epolymerized zvigadzirwa zvekurapa. Bharumu inoumbwa nezvinhu zvakanyunguduka, izvo zvinogona kuwedzera zvakanyanya kana polymer ikaiswa mukuzadza, asi bharumu richine simba. Vanachiremba vanogona kupararira munzvimbo ye intervertebral pasi pekumanikidzwa kunodzorwa. Iyo kambani yakaita zvakakura mu vivo uye in vitro kuyedza kusimbisa iyo biocompatibility yepolymer mukuvhiya kwemabvi akabatanidzwa. Zvidzidzo izvi zvinoratidza kuti kune mashoma mashoma anobvisika monomeric zvikamu. Muchidzidzo chebiomechanical che cadaveric intervertebral disc model, zvakanzi chinhu ichi chinogona kuchengetedza hurefu hwakakwana uye biomechanical zvinhu zve intervertebral disc. Parizvino, intervertebral disc nucleus pulposus implants inogona kuiswa kuburikidza ne posterior open approach kana anterior laparoscopic approach. Ordway et al. zvakare yakagadzira disc inotsiva nzvimbo, inonzi "hydrogel disc nucleus pulposus", inogona kuiswa pasi pe endoscope. Munguva pfupi yapfuura, SaluMedica nevamwe vakagadzira rudzi rwe intervertebral disc prosthesis inonzi Salubria, inova yakasimba uye elastic hydrogel. Maererano nemishumo yemazuva ano, inogona kuderedza herniation ye intervertebral disc inobatanidza nekukuvara kwetsinga uye kurwadziwa kwepashure. Inofungidzirwa kuti Salubria elastic disc replacement ichava kuvandudzwa kukuru mukuvhiya kwezvino fusion, kupa prosthesis yemuzongoza iyo inonyatsoenderana nemaitiro e-biomechanical uye zvakasikwa lumbar motion function.

3) Minimally invasive anterior sacral approach axial intervertebral fusion kuvhiyiwa

Kubva pane biomechanical maonero, zvinokwanisika kuisa fusion zviridzwa pedyo nepinal flexion axis paunenge uchiita longitudinal compression ye vertebral body. Nekudaro, kusimudzira kwayo kunogumira nekuda kwekushaikwa kwezviridzwa zviripo uye magraft. Munguva ichangopfuura, maererano nehuwandu hwezvidzidzo zvecadaveric uye zvekliniki, kuwanikwa kwepercutaneous kubva kune anterior sacral space kusvika kunharaunda ye lumbosacral yakaitwa kuti irege kuburitsa pachena, shure, uye lateral maitiro emusana, pasina kukuvadza mhasuru dzemashure, ligaments, uye. posterior vertebral components, kana kuda kupinda mudumbu remudumbu kana kudhonza kwemidziyo yeropa uye nhengo dzomukati. Iko kushandiswa kwebiplane X-ray fluoroscopy tekinoroji inopa vimbiso yakavimbika yekudzikisa intraoperative matambudziko.

Cragg et al. yakatanga kutaurwa percutaneous anterior sacral approach (AxiaLIF) yeL5/S1 intervertebral fusion: ① Ita diki diki diki inenge 4mm padyo necoccyx incision, isa giraidhi tsono pasi peX-ray fluoroscopy navigation, uye kwira uchienda nechemberi kwesacrum. kusvika kune sacral 1 vertebral body, kugadzira nzira yekushanda; ② Bvisa L5/S1 intervertebral disc uye bvisa iyo cartilage endplate, uye batanidza bhonzo munzvimbo ye intervertebral; ③ Kushandisa yakanyatsogadzirwa 3D titanium alloy mudziyo kudyara uye kudzoreredza intervertebral disc kureba, kuwana otomatiki decompression yetsinga midzi foramen; ④ Percutaneous kugadzirisa kubva kumashure: Inopa nekukurumidza 360 ° kugadzirisa kweL5-S1. Kuongororwa kwekliniki kwakawana kuti varwere vane L5 slippage uye L5 / S1 discogenic pasi kurwadziwa kwepashure vakabatwa neAxiaLIF vakaratidza kuvandudzwa kukuru muVAS uye ODI scores zvichienzaniswa nekutanga kurapwa. Vakaburitswa mumaawa makumi maviri nemana uye vakadzokera kubasa mukati memazuva gumi nemashanu. Pakanga pasina kutsemuka, kusunungura, kana kusakarakadza kwesacral mushure mekuisirwa, uye iyo 12 mwedzi yekusanganisa mwero yaive 88%. Marotta et al. vakaita zvimwe zvidzidzo zvekiriniki, uye mhedzisiro yacho inokurudzira. AxiaLIF inzira yakachengeteka uye inoshanda. AxiaLIF inoda hunyanzvi tekinoroji uye ruzivo rweanatomical yemaitiro asina kujairika, uye vanachiremba havagone kusvika kumusana wemusana kana kuita discectomy zvakananga pasi pekuona kwakananga, izvo zvinonetsa kune vanovhiya.

4) Lateral lumbar interbody fusion kuvhiyiwa

Lumbar interbody fusion inzira yakajairika ine zvibatsiro zvitatu: (1) kubvisa intervertebral disc tissue sechikonzero chekutambudzika; (2) Yakanyanya kukwirira fusion rate; (3) Dzorera kureba kwechiuno chepakati chepakati uye lumbar lordosis. Lumbar interbody fusion inosanganisira anterior interbody fusion, posterior interbody fusion, intervertebral foramen fusion kana endoscopic lateral interbody fusion kuburikidza ne extraperitoneal approach. Pakave nemishumo yemabhuku nezve minimally invasive retroperitoneal lateral interbody fusion kuburikidza ne lumbar tsandanyama nzira. Iyi nzira inoitwa kuburikidza ne lumbar hombe tsandanyama retroperitoneum pasi pekutariswa neurophysiological uye fluoroscopy kutungamira, inozivikanwa seDLIF kana XLIF zvishoma invasive lumbar fusion kuvhiyiwa.

Pamusana pekuti iyo lumbar plexus inowanikwa mumashure ehafu yepsoas guru muscle, zvishoma kuparadzaniswa kweanterior 1/3 kusvika kune anterior 1/2 nzvimbo yepsoas mikuru inogona kuderedza dambudziko rekukuvara kwetsinga. Uye zvakare, intraoperative kushandiswa kwe electromyography yekutarisa kunogona zvakare kuderedza njodzi yekukuvara kwetsinga. Paunenge uchitarisana ne lumbar intervertebral spaces uye kuisa intervertebral fusion zvishandiso, zvakakosha kudzivisa kukuvadza pfupa endplate uye kuona kutungamirirwa kwechigadzirwa chekubatanidza kuburikidza neanteroposterior uye lateral fluoroscopy. Intervertebral fusion inogona kuwana kukanganisa kusina kunanga kwe intervertebral foramen nekudzorera kukwirira kweneural foramen uye kurongeka kwepelinha dislocation. Tarisa kuti posterior fusion uye decompression ichiri kudikanwa zvichienderana nemamiriro emunhu wega. Knight et al. yakashuma matambudziko ekutanga muvarwere vechikadzi ve43 uye nevarwere vechirume ve15 avo vakawana zvishoma zvishoma lateral lumbar interbody fusion kuvhiyiwa: 6 zviitiko zvakanzwa kurwadziwa kwehudyu anterior mushure mekuvhiyiwa, uye 2 zviitiko zvakasangana lumbar L4 nerve midzi kukuvara.

Ozgur et al. yakashuma 13 zviitiko zveimwe kana yakawanda segment lateral lumbar interbody fusion kuvhiyiwa. Vese varwere vakawana zororo rakakura mukurwadziwa kwepashure, kuvandudzwa kwezvikoro, uye hapana kuitika kwematambudziko. Anand et al. yakashuma 12 zviitiko zvepamwe chete lateral uye L5 / S1 sacral interbody fusion. Paavhareji, zvikamu 3.6 zvakasanganiswa, uye kona yeCobb yakagadziriswa kubva preoperative 18.9 ° kusvika postoperative 6.2 °. Pimenta et al. vakarapa varwere 39 vane lateral fusion tekinoroji, ine avhareji yekusanganisa nhanho ye2. The lateral curvature angle yakavandudzwa kubva paavhareji ye18 ° vasati vavhiyiwa kusvika paavhareji ye8 ° mushure mekuvhiyiwa, uye lumbar lordosis angle yakawedzera kubva paavhareji ye34 °. vasati vavhiyiwa kusvika paavhareji ye41 ° mushure mekuvhiyiwa. Mhosva dzose dzinogona kufamba pasi uye kuva nekudya kwemazuva ose pazuva rekuvhiyiwa. Ivhareji yekurasikirwa kweropa iri pasi pe100ml, nguva yekuvhiya nguva ndeye 200 maminetsi, uye muvhareji wekugara muchipatara mazuva 2.2. Chiyero chemarwadzo uye chibodzwa chekushanda zvese zvakagadziridzwa mushure mekuvhiyiwa. Wright et al. yakashuma varwere ve145 kubva kumasangano akawanda ekutsvakurudza vakawana lateral lumbar interbody fusion kuvhiyiwa kwechirwere chechirwere chechirwere. Zvikamu zvakasanganiswa zvinotangira pa1 kusvika pa4 (72% ichive chidimbu chimwe chete, 22% ichive zvikamu zviviri, 5% ichive zvikamu zvitatu, uye 1% ichive zvikamu zvina). Intervertebral support (86% PEEK zvinhu, 8% allograft, uye 6% intervertebral fusion cage) yakashandiswa pamwe chete nefupa morphogenetic protein (52%), demineralized bone matrix (39%), uye autologous bone (9%), maererano. 20% yekuvhiya inoshandisa intervertebral fusion yoga, 23% inoshandisa lateral screw rod system yekubatsira kugadzirisa, uye 58% inoshandisa posterior percutaneous pedicle screw system yekubatsira kugadzirisa. Avhareji yekuvhiya nguva ndeye 74 maminetsi uye avhareji kurasikirwa kweropa ndeye 88ml. Mhosva mbiri dzakasangana nekukuvadzwa kwenguva pfupi kune yekubereka femoral nerve, uye zvishanu zviitiko zvakaona kuderedzwa kwechinguva muhudyu flexion simba. Varwere vazhinji vanofamba pasi pazuva mushure mekuvhiyiwa uye vanoburitswa pazuva rekutanga mushure mekuvhiyiwa.

Panyaya yemaitiro mashoma ekugadzirisa maitiro kune vakwegura lumbar degenerative scoliosis, Akbarnia et al. yakashuma varwere ve13 vakawana multi segment lateral fusion kurapwa kwe lumbar scoliosis yakakura kudarika 30 °. Zvikamu zvitatu zvakasanganiswa paavhareji, uye zviitiko zvese zvakapinda posterior fusion uye kugadzirisa panguva imwe chete. Mushure mevhareji yekutevera kwemwedzi ye9, zvose lumbar scoliosis uye lordosis zvakaratidza kuvandudzwa kwakanyanya. Imwe nyaya yaida kuvhiyiwa kudzokororwa nekuda kwekubviswa kweiyo intervertebral implant, nepo imwe nyaya yakasangana incisional hernia panzvimbo ye lateral fusion incision. Mukati memwedzi mitanhatu mushure mekuvhiyiwa, zviitiko zvese zvakasangana nekunyangarika zvachose kwekushaya simba muchiuno chemhasuru kana chiveve muzvidya. Kuenzaniswa neasati avhiyiwa, iyo pfupi-yenguva-pfupi postoperative VAS mamaki, SRS-22 mamakisi, uye ODI mamakisi zvese zvakagadziridzwa. Anand et al. vakawana migumisiro yakafanana mukudzidza kwavo kwevarwere ve12, nezvikamu zvakasanganiswa kubva ku2 kusvika ku8 (avhareji ye3.64) uye avhareji yekubuda ropa kwehuwandu hwe163.89ml panguva yepamberi uye 93.33ml panguva yemashure percutaneous pedicle screw fixation. Ivhareji nguva yekuvhiya yekuvhiya kwepamberi maawa 4.01, uye nguva yeavhareji yekuvhiyiwa kwemashure maawa 3.99. Iyo Cobb angle yakavandudzwa kubva paavhareji preoperative angle ye18.93 ° kusvika paavhareji postoperative angle ye6.19 °.

Kushandiswa nyore kwe intervertebral fusion cages for anterior fusion kunowedzera kuitika kwekuumbwa kwenhema kwekubatana nekuda kwekusagadzikana kusina kukwana kwechikamu chekutanga chekubatanidza. Mumakore achangopfuura, nzira yemashure yakabatsira kugadzirisa yakashandiswa kuvandudza chiyero che intervertebral fusion. Posterior percutaneous pedicle screw fixation (Sextant) inzira inoshanda, ine zvakanakira kudzivirira kukuvara kwemhasuru panguva yekuvhiyiwa kwemashure, kuderedza intraoperative kurasikirwa kweropa, nekukurumidza postoperative kupora, nekuvandudza fusion rate. Zvisinei, oparesheni yacho yakaoma. Percutaneous facet screw fixation (PFSF) inzira inoshanda yekubatsira ALIF, ine yakaderera tekinoroji zvinodiwa uye yakaderera mutengo, uye nekukurumidza kuwana mukurumbira. Kandziora et al. akaenzanisa biomechanical maitiro ePFSF, translaminar facet screw fixation, uye pedicle screw fixation in vitro, uye akawana kuti biomechanical kugadzikana kwe lumbar facet screw fixation padanho rekutanga yakanga yakafanana neye translaminar screw fixation, asi zvishoma zvishoma kudarika iyo pedicle. screw fixation. Kang et al. yakashuma kuti percutaneous translaminar articular process screw (TFS) fixation yakaitwa pasi peCT navigation, uye ese screws akaiswa nemazvo pasina matambudziko. Mhedzisiro yekutevera yeongororo yekudzokorora naJang et al. paPFSF + ALIF uye TFS + ALIF yakaratidza kusakosha musiyano muODI neMacnab zvibodzwa, mhedzisiro yekuvhiya, uye fusion mitengo. Nekudaro, yekutanga yaive nenjodzi dzepamusoro dzekuvhiya uye kuchengeteka. Percutaneous PFSF inogona kuva yekuwedzera inoshanda kune posterior pedicle screw fixation kuvhiya.