I-lumbar decompression encane ehlaselayo kanye nokuhlinzwa kwe-fusion

1) I-lumbar hemilaminectomy engavamile kakhulu

Isimiso esisodwa esibalulekile sokunciphisa kancane kwe-lumbar ukulondoloza iphuzu lokufaka le-tendinous le-multifidus ye-multifidus inqubo ye-spinous. Ku-laminectomy yendabuko, inqubo ye-spinous iyasuswa futhi imisipha ye-multifidus idonselwa ezinhlangothini zombili. Lapho uvala isilonda, indawo yokuqala ye-multifidus muscle ayikwazi ukulungiswa kwinqubo ye-spinous. Kodwa-ke, usebenzisa inqubo ye-semi laminectomy, ukuchithwa okuphelele komgogodla womgogodla kungenziwa ohlangothini olulodwa ngokusebenzisa isiteshi esisebenzayo. Ukutshekisa isiteshi somsebenzi ngasemuva kuveza ingxenye engezansi yenqubo ye-spinous kanye ne-contralateral vertebral plate. Cindezela kancane ku-dural sac ukuze ususe i-ligamentum flavum kanye nenqubo ye-contralateral superior articular, ngaleyo ndlela uqedele indlela yakudala yohlangothi olulodwa yokuwohloka kwamazwe amabili. Isakhiwo se-anatomical se-lumbar spine engenhla sihlukile kunesomgogodla ophansi we-lumbar. Kumazinga e-L3 nangaphezulu, ipuleti le-vertebral phakathi kwenqubo ye-spinous kanye nenqubo ye-articular incane kakhulu. Uma kusetshenziswa indlela ehlangene, ukuze kuncishiswe i-recess ipsilateral, ukukhishwa okwengeziwe kwenqubo ye-articular engenhla ye-ipsilateral kuyadingeka. Enye inketho iwukusebenzisa indlela yokubhekana namazwe amabili, ehilela ukucindezelwa kwe-recess yangakwesokudla nge-hemilaminectomy yesobunxele, futhi ngokuphambene nalokho. Ucwaningo lusebenzise le ndlela yokubhekana namazwe amabili ukuwohloza izingxenye eziyisi-7 zeziguli ezi-4, nenani eliphelele lesikhathi sokuhlinzwa esiyimizuzu engama-32 ngesegimenti ngayinye, ukulahleka kwegazi okumaphakathi kwama-75ml, kanye nesilinganiso sokuhlala esibhedlela kwangemva kokuhlinzwa kwezinsuku eziyi-1.2. Zonke iziguli ezine-preoperative neurogenic claudication zanyamalala ngaphandle kwezinkinga.

Ucwaningo oluningi luye lwahlola ukuphepha nokusebenza kokuncishiswa kwe-posterior lumbar decompression. Ijika lokufunda lokuhlinza umgogodla okuhlasela kancane liye lathola ukunakwa, futhi ezinyathelweni zokuqala zezinye izifundo, izinga layo lezinkinga liphezulu uma kuqhathaniswa. I-Ikuta ibike isipiliyoni sabo sokusebenzisa indlela ehlangene ye-bilateral lumbar spinal decompression ukuze uphathe i-lumbar spinal stenosis, neziguli ezingu-38 kwezingu-44 ezibonisa ukusebenza kahle kwesikhashana esifushane. Inkomba yemiphumela ye-JOA ibe ngcono ngesilinganiso sama-72%. Izinkinga ze-postoperative ziphansi, futhi uma kuqhathaniswa nokuhlinzwa okuvulekile, ukulahlekelwa kwegazi kwe-intraoperative kuyancipha kakhulu. Isidingo samaphilisi ezinhlungu ngemva kokuhlinzwa sincipha kakhulu, futhi ukuhlala esibhedlela kufushane kakhulu. Kukhona isilinganiso se-25% senkinga, okuhlanganisa amacala angu-4 wezinyembezi ze-dural, amacala angu-3 okuphuka kwenqubo ephansi ye-articular ohlangothini lokuhlinzwa, icala le-1 le-cauda equina syndrome elidinga ukuhlinzwa kabusha ngemva kokuhlinzwa, kanye necala elingu-1 le-epidural hematoma elidinga ukuhlinzwa kabusha.

Ocwaningweni oluzokwenziwa ngu-Yagi, iziguli ze-41 ezine-lumbar spinal stenosis zahlukaniswa ngokungahleliwe zaba amaqembu amabili: iqembu elilodwa (amacala angu-20) labhekana nokuwohloka kwe-endoscopic okungavamile, kanti elinye iqembu (amacala angu-21) lathola ukuchithwa kwe-laminectomy yendabuko, ngokulandela okujwayelekile- kuze kube yizinyanga eziyi-18. Uma kuqhathaniswa neqembu lendabuko lokuhlinza i-laminectomy decompression, iqembu lokuhlinza elingaphansi kwe-laminectomy linesilinganiso esifushane sokuhlala esibhedlela, ukulahlekelwa igazi elincane, amazinga aphansi e-isoenzyme ye-muscle ye-creatine kinase egazini, amaphuzu e-VAS aphansi ezinhlungu eziphansi emuva ngonyaka owodwa ngemva kokuhlinzwa, futhi ukululama ngokushesha. I-90% yeziguli kuleli qembu zathola ukucindezelwa kwezinzwa okwanelisayo kanye nokukhululeka kwezimpawu. Azikho izimo zokungaqini komgogodla ngemuva kokuhlinzwa ezenzekile. U-Castro wasebenzisa ithubhu yokusebenza engu-18mm ukuze enze ukuhlinzwa kwe-endoscopic spinal decompression kuziguli ezingu-55 ezine-lumbar spinal stenosis. Ngokwesilinganiso seminyaka emi-4 yokulandelela, ama-72% eziguli athole imiphumela emihle kakhulu noma emihle kakhulu, kanti ama-68% eziguli abe nokwaneliseka okuzimele njengokuhamba phambili. Isilinganiso se-ODI sehle ngokwesilinganiso, futhi inkomba ye-VAS yobuhlungu bomlenze yehle ngo-6.02 ngokwesilinganiso.

U-Asgarzadie no-Khoo babike izehlakalo ezingu-48 ze-lumbar spinal stenosis ezilashwa ngokuwohloka komgogodla we-lumbar ongavamile. Phakathi kwazo, iziguli ezingama-28 zancipha ngokuwohloka kwengxenye eyodwa, kuyilapho ezinye ezingama-20 zancipha ngezigaba ezimbili. Uma kuqhathaniswa neqembu elilawulayo, elathola i-laminectomy evulekile yendabuko, iqembu elihlasela kancane lalinokopha okumaphakathi okumaphakathi (25 vs 193ml) kanye nokuhlala esibhedlela isikhathi esifushane (36 vs 94 amahora). Iziguli ezingama-32 kwezingama-48 zalandelelwa iminyaka emi-4 ngemuva kokuhlinzwa. Ezinyangeni eziyisithupha ngemva kokuhlinzwa, ukubekezelelana kokuhamba kwazo zonke iziguli kwaba ngcono, futhi u-80% weziguli zakugcina kwaze kwaba isilinganiso sezinyanga ezingu-38 ngemva kokuhlinzwa. Ngesikhathi sokulandelela, ukuthuthukiswa kwesikolo se-ODI kanye namaphuzu we-SF-36 kwagcinwa njalo. Kuleli qembu lamacala, azikho izinkinga zokulimala kwezinzwa ezenzeka. Ezimweni ze-spondylolisthesis ye-lumbar ewohlokayo, ukuwohloka komgogodla we-lumbar ongenayo kancane ngaphandle kokuhlanganiswa nakho kuyindlela ephumelelayo. U-Pao wenze kuphela ukuwohloka komgogodla ongathandeki kancane ezimweni ezingu-13 ze-lumbar spinal stenosis kuhlanganiswe ne-Ⅰ ° spondylolisthesis yelumba. Wonke amacala angemuva kokuhlinzwa abonise imiphumela emihle yomtholampilo futhi akukho ukuwohloka kokushelela. U-Sasai uphathe amacala we-23 we-spondylolisthesis ye-lumbar ewohlokayo kanye namacala angu-25 we-lumbar spinal stenosis ewohlokayo esebenzisa amasu okunciphisa unilateral kanye namazwe amabili. Ngemuva kweminyaka emibili yokulandelela, nakuba i-neurogenic intermittent claudication score kanye ne-ODI yeqembu le-lumbar spondylolisthesis eliwohlokayo lalibi kakhulu, lilonke, izikolo zamaqembu amabili zazifana. Phakathi kwezimo ze-23 ze-spondylolisthesis ye-lumbar ewohlokayo, iziguli ze-3 zithole ukwanda kwe-≥ 5% ku-postoperative slip. U-Kleeman wasebenzisa amasu okucindezela agcina inqubo ye-spinous kanye ne-interspinous ligament ukuphatha iziguli ze-15 ezine-lumbar spinal stenosis eyinkimbinkimbi ne-spondylolisthesis ye-lumbar ewohlokayo, nge-slip isilinganiso se-6.7mm. Ngemuva kweminyaka eyi-4 yokulandelela, iziguli ze-2 zabhekana nokuwohloka kokushelela nezimpawu, futhi iziguli eziyi-12 zithole imiphumela emihle noma emihle kakhulu yomtholampilo.

2) Ukuhlinzwa kwe-Transforaminal lumbar interbody fusion

I-Transforaminal lumbar interbody fusion (TLIF) yahlongozwa okokuqala ngabakwa-Blume no-Rojas, futhi yakhuthazwa ngabakwaHarms noJeszensky. Lobu buchwepheshe buvele esiphakamisweni sokuqala sika-Cloward se-posterior lumbar interbody fusion (PLIF). Ukuhlinzwa kwe-PLIF kudinga ukucindezelwa okubanzi komgogodla kanye nokudonsa kwezimpande zezinzwa zombili ukuze kuvezwe indawo ye-lumbar intervertebral, kuyilapho ukuhlinzwa kwe-TLIF kuveza isikhala se-lumbar intervertebral kusuka ohlangothini olulodwa ngokusebenzisa i-intervertebral foramen. Ngakho-ke, uma kuqhathaniswa nokuhlinzwa kwe-PLIF okudinga ukuqedwa kwamazwe amabili, ukuhlinzwa kwe-TLIF kudinga ukunyakaziswa okuncane kwesakhiwo sezinzwa. Enye inzuzo enkulu yokuhlinzwa kwe-TLIF ukuthi ivumela ukuwohloka komgogodla we-lumbar kanyekanye kanye nokuhlanganiswa kwe-intervertebral yangaphambili ngokusebenzisa i-posterior incision ehlukile.

Peng et al. kuqhathaniswe imiphumela yomtholampilo neyezithombe yokuhlinzwa kwe-TLIF okungavamisile kancane nokuhlinzwa okungokwesiko okuvulekile kwe-TLIF. Imiphumela yokulandelela yeminyaka emibili yayifana, kodwa iqembu elincane elihlaselayo ekuqaleni lalinobuhlungu obuncane ngemva kokuhlinzwa, ukululama ngokushesha, ukuhlala esibhedlela okufushane, kanye nezinkinga eziphansi. Dhall et al. ngokubukezwa emuva kuqhathaniswe iziguli ezingama-21 ezihlinzwa kancane kancane i-TLIF kanye neziguli ezingama-21 ezihlinzwa nge-TLIF evulekile evamile. Ngemva kweminyaka emibili yokulandelela, kwatholakala ukuthi kwakungekho umehluko emiphumeleni yomtholampilo phakathi kwamaqembu amabili. Kodwa-ke, iqembu elivulekile labonisa ukwanda okukhulu kwevolumu yokopha kanye nokuhlala esibhedlela isikhathi eside. Selznick et al. bakholelwa ukuthi ukuhlinzwa kwe-TLIF okungavamisile kancane ezimweni ezibukezwayo kuyenzeka ngokobuchwepheshe futhi akunyusi ukwanda okubikiwe kwevolumu yokopha kanye nezinkinga zemizwa. Kodwa-ke, izehlakalo zokukhala kwezinyembezi ezimweni ezibuyekezwayo ziphezulu uma kuqhathaniswa, ngakho ukuhlinzwa kwe-TLIF okuhlasela kancane ezimweni zokubukeza kuyinselele futhi kufanele kwenziwe odokotela abahlinzayo abanolwazi oluncane.

Ucwaningo oluzokwenzeka olwenziwe nguKasis et al. ithole ukuthi ukuhlinzwa kwe-PLIF okuhlasela kancane ngokuchayeka okulinganiselwe kungafinyelela imiphumela engcono yomtholampilo kanye nokuhlala esibhedlela okufushane uma kuqhathaniswa nokuhlinzwa okuvulekile okuvamile. Ukholelwa kumaphuzu angu-5 alandelayo: (1) ukulondolozwa kwesakhiwo sangemuva somgogodla; (2) Gwema ukuxebuka ngaphandle kwenqubo ephambene; (3) Ukuqedwa okuphelele kwezinqubo ze-articular yamazwe amabili namalunga; (4) Izinkinga ezincane zokulimala kwezinzwa; (5) Ukugwema ukusetshenziswa kwe-autologous iliac bone grafting kuhlobene eduze nokuthuthukiswa kwemiphumela yomtholampilo.

Ukuhlinzwa kwe-posterior endoscopic disc replacement kulindeleke ukuthi kuthathele indawo ukuhlinzwa kwe-fusion ingxenye ethile maduze nje. Izimila ze-intervertebral disc replacement ezikhona njengamanje zenzelwe ukushintshwa okuphelele, kodwa ngenxa yobukhulu bazo obukhulu, azikwazi ukufakwa ngokuhlinzwa kwe-posterior endoscopic. Ray et al. ithuthukise i-nucleus pulposus prosthesis esebenza njenge-cushion ukugcina ukuphakama kwe-intervertebral disc. Njengamanje, izimila ze-nucleus pulposus zokuhweba ziyatholakala. URaymedia et al. yenze ucwaningo lomtholampilo kuma-nucleus pulposus implants eJalimane ngo-1996, kwalandelwa olunye ucwaningo e-United States ngo-1998. URaymedia et al. kubike ngo-1999 ukuthi iziguli ezingu-101 zafakwa i-nucleus pulposus. Nakuba uRaymedia et al. ibike ukuthi iziguli ezingu-17 kwezingu-101 zithole ukukhishwa kwe-implant noma ukuxoshwa, iningi leziguli lisazuza ukukhululeka okukhulu kobuhlungu. Ukuze kuncishiswe ukukhishwa noma ukukhishwa kwe-nucleus pulposus implants futhi kukhuthaze ukuthuthukiswa kobuchwepheshe bokushintsha indawo ye-intervertebral disc encane, i-Advanced Biosurfaces (inkampani) ithuthukise isethi yamasu asebenzisa ama-polymers, amabhaluni ezokuthutha, ama-catheter e-balloon, nezibhamu zokujova i-polymer. Le polymer i-polyurethane, engenziwa i-polymerized in situ futhi inezakhiwo eziqinile zemishini uma iqhathaniswa nemikhiqizo yezokwelapha eyenziwe nge-polymerized yezimboni. Ibhaluni lakhiwe ngezinto ezinwebekayo, ezingakhula kakhulu lapho i-polymer ijova ekugcwaliseni, kodwa ibhaluni lisenamandla kakhulu. Odokotela bangasakaza endaweni ye-intervertebral ngaphansi kwengcindezi elawulwayo. Le nkampani yenze ucwaningo olunzulu lwe-vivo kanye ne-in vitro ukuze iqinisekise ukuhambisana kwe-polymer ekuhlinzeni kwamadolo. Lezi zifundo ziphakamisa ukuthi zimbalwa kakhulu izingxenye ze-monomeri ezivuzekayo. Esicwaningweni se-biomechanical semodeli ye-cadaveric intervertebral disc, kwaphakanyiswa ukuthi le nto ingagcina ukuphakama okujwayelekile kanye nezakhiwo ze-biomechanical ze-disc intervertebral. Njengamanje, izimila ze-intervertebral disc nucleus pulposus zingafakwa ngendlela evulekile yangemuva noma indlela ye-laparoscopic yangaphambili. Ordway et al. iphinde yakha indawo yokubuyisela idiski, ebizwa ngokuthi "i-hydrogel disc nucleus pulposus", engafakwa ngaphansi kwe-endoscope. Muva nje, i-SaluMedica nabanye bathuthukise uhlobo lwe-intervertebral disc prosthesis olubizwa ngokuthi i-Salubria, okuyi-hydrogel eqinile nenwebekayo. Ngokwemibiko yamanje, kunganciphisa i-herniation ye-intervertebral disc ehambisana nokulimala kwenzwa kanye nobuhlungu obuphansi emuva. Kulinganiselwa ukuthi i-Salubria elastic disc replacement izoba ngcono kakhulu ekuhlinzeni kwe-fusion yamanje, inikeze i-prosthesis yomgogodla ohambisana kangcono nezici ze-biomechanical kanye nomsebenzi wemvelo wokunyakaza kwe-lumbar.

I-3) I-anterior invasive anterior sacral approach i-axial intervertebral fusion ukuhlinzwa

Ngokombono we-biomechanical, kungenzeka ukubeka amathuluzi e-fusion eduze kwe-axis ye-spinal flexion ngenkathi wenza ukucindezela kwe-longitudinal yomzimba we-vertebral. Kodwa-ke, ukuthuthukiswa kwayo kunomkhawulo ngenxa yokuntuleka kwezinsimbi ezitholakalayo kanye nokuxhunyelelwa. Muva nje, ngokusho kochungechunge lwezifundo ze-cadaveric kanye nemitholampilo, ukufinyelela kwe-percutaneous kusuka endaweni yangaphambili ye-sacral kuya esifundeni se-lumbosacral kuye kwafinyelelwa ukuze kugwenywe ukudalula izakhiwo zangaphambili, ezingemuva, nezingemuva zomgogodla, ngaphandle kokulimaza imisipha yangemuva, imigqa, kanye izingxenye ze-vertebral posterior, noma ezidinga ukungena emgodini wesisu noma ukudonsa kwemithambo yegazi nezitho zangaphakathi. Ukusetshenziswa kobuchwepheshe be-biplane X-ray fluoroscopy kunikeza isiqinisekiso esithembekile sokunciphisa izinkinga ze-intraoperative.

Cragg et al. Indlela yokuqala ebikwe ngayo i-percutaneous anterior sacral (AxiaLIF) ye-L5/S1 intervertebral fusion: ① Yenza ukusika okuncane okungaba ngu-4mm eduze kwe-coccyx imbobo, faka inaliti yomhlahlandlela ngaphansi kwe-X-ray fluoroscopy navigation, bese ukhuphuka eduze kwendawo engaphambili ye-sacrum. ukufinyelela ku-sacral 1 umzimba we-vertebral, ukusungula isiteshi esisebenzayo; ② Khipha i-L5/S1 intervertebral disc bese ukhuhla i-endplate ye-cartilage, futhi uxhume ithambo endaweni ye-intervertebral; ③ Ukusebenzisa idivayisi ye-3D ye-titanium alloy eklanyelwe ngokukhethekile ukutshala nokubuyisela ukuphakama kwe-intervertebral disc, ukufeza ukuwohloka okuzenzakalelayo kwe-nerve root foramen; ④ Ukulungiswa kwe-Percutaneous kusukela ngemuva: Ihlinzeka ngokulungiswa okusheshayo okungu-360 ° kwe-L5-S1. Ukulandelwa komtholampilo kwathola ukuthi iziguli ezine-L5 slippage kanye ne-L5/S1 izinhlungu eziphansi ze-discogenic eziphathwa nge-AxiaLIF zibonise ukuthuthukiswa okuphawulekayo kumaphuzu we-VAS kanye ne-ODI uma kuqhathaniswa nokwelashwa kwangaphambili. Bakhishwe engakapheli amahora angama-24 babuyela emsebenzini zingakapheli izinsuku eziyi-15. Kwakungekho ukugudluka, ukuxega, noma ukukhubazeka kwe-sacral ngemva kokufakelwa, futhi izinga lokuhlanganisa lezinyanga ezingu-12 lalingu-88%. UMarotta et al. baqhube izifundo ezengeziwe zomtholampilo, futhi imiphumela iyakhuthaza. I-AxiaLIF iyindlela ephephile nesebenzayo. I-AxiaLIF idinga ubuchwepheshe obukhethekile nolwazi lwe-anatomical lwezindlela ezingajwayelekile, futhi odokotela abakwazi ukufinyelela umgogodla womgogodla noma benze i-discectomy ngokuqondile ngaphansi kombono oqondile, okuyinselele odokotela abahlinzayo.

I-4) Ukuhlinzwa kwe-Lateral lumbar interbody fusion

I-Lumbar interbody fusion iyindlela evamile kakhulu enezinzuzo ezintathu: (1) ukususa izicubu ze-intervertebral disc njengomthombo wobuhlungu; (2) Izinga lokuhlanganisa eliphezulu kakhulu; (3) Buyisela ukuphakama kwesikhala se-lumbar intervertebral kanye ne-lumbar lordosis. I-Lumbar interbody fusion ihlanganisa i-anterior interbody fusion, i-posterior interbody fusion, i-intervertebral foramen fusion noma i-endoscopic lateral interbody fusion ngendlela ye-extraperitoneal. Kube nemibiko yezincwadi mayelana nokuhlangana okuncane kwe-retroperitoneal lateral interbody ngokusebenzisa i-lumbar muscle pathway. Le nqubo yenziwa nge-lumbar major muscle retroperitoneum ngaphansi kokuqapha kwe-neurophysiological kanye nesiqondiso se-fluoroscopy, eyaziwa ngokuthi i-DLIF noma i-XLIF yokuhlinzwa okuncane okuvamayo kwe-lumbar fusion.

Ngenxa yokuthi i-plexus ye-lumbar itholakala engxenyeni engemuva ye-psoas enkulu ye-muscle, ukuhlukaniswa okulinganiselwe kwe-anterior 1/3 kuya endaweni yangaphambili ye-1/2 ye-psoas enkulu ye-muscle kunganciphisa ingozi yokulimala kwezinzwa. Ngaphezu kwalokho, ukusetshenziswa kwe-intraoperative yokuqapha i-electromyography nakho kunganciphisa ingozi yokulimala kwezinzwa. Lapho ubhekana nezikhala ze-lumbar intervertebral kanye nokufaka amadivaysi e-intervertebral fusion, kubalulekile ukugwema ukulimaza i-endplate yamathambo futhi unqume isiqondiso sedivayisi ye-fusion ngokusebenzisa i-anteroposterior kanye ne-lateral fluoroscopy. I-intervertebral fusion ingakwazi ukufeza ukuchithwa okungaqondile kwe-intervertebral foramen ngokubuyisela ukuphakama kwe-neural foramen kanye nokulungiswa komgogodla. Nquma ukuthi ingabe ukuhlanganiswa kwangemuva kanye nokuwohloka kusadingeka yini ngokusekelwe esimweni somuntu ngamunye. Knight et al. babike izinkinga zakuqala ezigulini zesifazane ze-43 kanye neziguli zesilisa ze-15 ezahlinzwa kancane kancane ukuhlinzwa kwe-lateral lumbar interbody fusion: Amacala angu-6 abhekana nobuhlungu bethanga bangaphambili ngemuva kokuhlinzwa, kanti amacala angu-2 abhekana nokulimala kwezimpande ze-lumbar L4.

Ozgur et al. kubika izehlakalo ze-13 zokuhlinzwa kwe-single or multi segment lateral lumbar interbody fusion. Zonke iziguli zithole ukukhululeka okuphawulekayo ebuhlungu be-postoperative, izikolo ezithuthukisiwe zokusebenza, futhi akukho ukuvela kwezinkinga. Anand et al. kubikwe izehlakalo eziyi-12 ze-lateral kanye ne-L5/S1 ye-sacral interbody fusion. Ngokwesilinganiso, amasegimenti angu-3.6 ahlanganisiwe, futhi i-engeli ye-Cobb yalungiswa kusukela ku-preoperative 18.9 ° kuya ku-6.2 ° yangemva kokuhlinzwa. UPimenta et al. belaphe iziguli ezingama-39 ngobuchwepheshe bokuhlanganiswa kwezinhlangothi, ngesilinganiso sokuhlanganisa isigaba esingu-2. I-engeli egobile engemuva ithuthuke isuka esilinganisweni esingu-18 ° ngaphambi kokuhlinzwa yaya esilinganisweni esingu-8 ° ngemva kokuhlinzwa, futhi i-lumbar lordosis angle yanda isuka esilinganisweni esingu-34 °. ngaphambi kokuhlinzwa kuya ku-41 ° ngemva kokuhlinzwa. Wonke amacala angahamba phansi futhi abe nokudla okuvamile ngosuku lokuhlinzwa. Isilinganiso sokulahlekelwa kwegazi singaphansi kwe-100ml, isikhathi sokuhlinzwa esijwayelekile imizuzu engu-200, kanti ukuhlala esibhedlela okujwayelekile izinsuku ezingu-2.2. Isikolo sobuhlungu kanye nesikolo sokusebenza kokubili kuthuthukisiwe ngemva kokuhlinzwa. Wright et al. kubike iziguli ze-145 ezivela ezikhungweni eziningi zocwaningo ezahlinzwa i-lateral lumbar interbody fusion ngenxa yesifo se-lumbar degenerative. Amasegimenti ahlanganisiwe asukela ku-1 kuye ku-4 (72% abe amasegimenti eyodwa, 22% abe izingxenye ezimbili, 5% abe amasegimenti amathathu, futhi u-1% abe amasegimenti amane). Ukusekelwa kwe-Intervertebral (86% PEEK impahla, i-8% allograft, kanye ne-6% ye-intervertebral fusion cage) isetshenziswe ngokuhambisana ne-bone morphogenetic protein (52%), i-demineralized bone matrix (39%), ne-autologous bone (9%), ngokulandelana. I-20% yokuhlinzwa isebenzisa i-intervertebral fusion yodwa, i-23% isebenzisa isistimu ye-screw rod ye-lateral ukuze ilungiswe, futhi i-58% isebenzisa i-posterior percutaneous pedicle screw system ukuze kulungiswe usizo. Isikhathi sokuhlinzwa esijwayelekile imizuzu engama-74 kanti ukulahleka kwegazi okujwayelekile kungu-88ml. Amacala amabili abhekana nokulimala kwesikhashana ku-nerve ye-femoral yokuzala, futhi amacala amahlanu athola ukuncishiswa kwesikhashana kwamandla e-hip flexion. Iziguli eziningi zihamba phansi ngosuku lwangemva kokuhlinzwa futhi zikhishwa ngosuku lokuqala ngemva kokuhlinzwa.

Ngokuphathelene namasu okulungisa angena kancane kubantu asebekhulile be-lumbar degenerative scoliosis, u-Akbarnia et al. kubike iziguli ze-13 ezithole ukwelashwa kwe-multi segment lateral fusion ye-lumbar scoliosis enkulu kune-30 °. Amasegimenti amathathu ahlanganiswe ngokwesilinganiso, futhi wonke amacala ahlanganiswe ngemuva nokulungiswa ngesikhathi esisodwa. Ngemuva kokulandela isilinganiso sezinyanga ze-9, kokubili i-lumbar scoliosis ne-lordosis ibonise ukuthuthukiswa okukhulu. Icala elilodwa lalidinga ukuhlinzwa okubukeziwe ngenxa yokugudluzwa kokufakelwa kwe-intervertebral, kuyilapho elinye icala labhekana ne-hernia yokusikeka endaweni ye-lateral fusion incision. Phakathi nezinyanga ezingu-6 ngemva kokuhlinzwa, zonke izimo zabhekana nokunyamalala okuphelele kobuthakathaka emisipha ye-lumbar noma ukuba ndikindiki emathangeni. Uma kuqhathaniswa nangaphambi kokuhlinzwa, isikolo se-VAS sangemva kokuhlinzwa, isikolo se-SRS-22, kanye nesikolo se-ODI konke kube ngcono. Anand et al. bathole imiphumela efanayo ekutadisheni kwabo iziguli ze-12, ezinezingxenye ze-fusion ezisukela ku-2 kuya ku-8 (isilinganiso se-3.64) kanye nesilinganiso sokuphuma kwegazi kwe-163.89ml ngesikhathi sokuhamba kwangaphambili kanye ne-93.33ml ngesikhathi sokulungiswa kwesikulufu se-posterior percutaneous pedicle. Isikhathi esijwayelekile sokuhlinzwa sokuhlinzwa kwangaphambili amahora angu-4.01, kanti isikhathi esijwayelekile sokuhlinzwa ngemuva amahora angu-3.99. I-engeli ye-Cobb ithuthuke ukusuka ku-engeli emaphakathi yangaphambi kokusebenza engu-18.93 ° ukuya ku-engeli ye-postoperative eyisilinganiso engu-6.19 °.

Ukusetshenziswa okulula kwamakheji e-intervertebral fusion for fusion anterior kwandisa izehlakalo zokubunjwa kwamalungu angamanga ngenxa yokungaqini okwanele kwesigaba sokuqala sokuhlanganisa. Eminyakeni yamuva, indlela yangemuva yokusiza ukulungiswa iye yasetshenziselwa ukuthuthukisa izinga lokuhlanganiswa kwe-intervertebral. I-posterior percutaneous pedicle screw fixation (i-Sextant) iyindlela ephumelelayo, enezinzuzo zokugwema ukulimala kwemisipha ngesikhathi sokuhlinzwa kwangemuva, ukunciphisa ukulahlekelwa kwegazi kwangaphakathi, ukubuyisela ngokushesha ngemva kokuhlinzwa, nokuthuthukisa izinga lokuhlanganisa. Nokho, ukusebenza kuyinkimbinkimbi. I-Percutaneous facet screw fixation (PFSF) iyindlela ephumelelayo yokusiza i-ALIF, enezidingo eziphansi zobuchwepheshe nezindleko eziphansi, futhi yathola ukuduma ngokushesha. Kandziora et al. kuqhathaniswa izici ze-biomechanical ze-PFSF, ukulungiswa kwesikulufu se-translaminar facet, kanye nokulungiswa kwesikulufu se-pedicle ku-vitro, futhi kwatholakala ukuthi ukuzinza kwe-biomechanical ye-lumbar facet fixation screw esigabeni sokuqala kwakufana nesokulungiswa kwesikulufu se-translaminar, kodwa kubi kakhulu kune-pedicle. ukulungiswa kwesikulufu. Kang et al. ibike ukuthi ukulungiswa kwe-percutaneous translaminar articular process screw (TFS) kwenziwa ngaphansi kokuzulazula kwe-CT, futhi zonke izikulufu zafakwa ngokunembile ngaphandle kwezinkinga. Imiphumela yokulandelela yocwaningo lokubheka emuva olwenziwe ngu-Jang et al. ku-PFSF+ALIF ne-TFS+ALIF abonisanga umehluko obalulekile ngokwezibalo kuzikolo ze-ODI ne-Macnab, imiphumela yokuhlinzwa, namazinga okuhlanganisa. Nokho, okokuqala kwakunezingozi eziphakeme zokuhlinzwa nokuphepha. I-Percutaneous PFSF ingaba isengezo esisebenzayo ekuhlinzweni kokulungisa isikulufu se-pedicle ngemuva.