Exchange of experience.
Treatment of lumbar spondylolisthesis with pedicle screw system and spinal fusion thread cages å¯‡ å½¬ ã€, Chen Hongwei 1å†€å…ƒ, æŽå®å…¶,é˜®è‰¯ä¸ 2 (1. Department of Orthopaedics, Tianjin Railway Central Hospital, Tianjin 300140, China; 2. Department of Orthopaedics, Feicheng Mineral Center Hospital, Shandong, Shandong 271600) The RF-2 system was used to open, lift and reset the spondylolisthesis, and the bone cage of the autologous bone was inserted from the posterior aspect of the intervertebral space to perform interbody fusion. Results All cases were followed up for 3 to 10 months, and the early results were satisfactory. Conclusion The combination of RF-2 system and bone cage is an effective and reliable method for the treatment of lumbar spondylolisthesis. From October 2000 to May 2001, we used RF-pedicle screw system and spinal fusion thread cage. Eight patients with lumbar spondylolisthesis were treated with satisfactory early results. The report is as follows.
1 Clinical data 1.1 General information The group of 3 males and 5 females; aged 42 to 67 years, mean 52.4 years; duration of disease 4 months to 6 years average 2.4 years. Eight cases showed refractory low back pain and progressive ablation, 6 cases had symptoms of difficulty in turning over, and 2 cases had dysfunction. X-ray films showed 2 cases of L4 slippage I degree, 2 cases, 1 case; 5 cases of slip 1 degree, 2 cases. CT showed obvious small facet joints, cohesion and lateral recess stenosis.
1.2 The treatment method was selected from the RF-2 pedicle screw system produced by Beiao Company and the spinal fusion thread cage produced by Shanxi Medical Tissue Library. Continuous epidural anesthesia, C-arm machine fluoroscopy, prone position, median longitudinal incision, full exposure of the fusion gap upper and lower lamina and bilateral joints, resection of the whole lamina, most or all of the small joints, to achieve nerve roots Thoroughly decompressed, placed into the RF-2 system according to the Weinsten positioning method, lifted and reset, and opened with the nerve roots not tight. The posterior disc and the upper and lower intervertebral cartilage were cut from the posterior aspect of the intervertebral space with a 13 mm circumcision. The 14 mm tapping was applied to tap the silk, and the 14 mm bone cage with the outer diameter of the pre-rehydrated bone was implanted. Use RF-system system to slightly pressurize the intervertebral space and lock the RF-2. The patient was placed in bed for 1 month. After 1 month, the patient was placed under the apron protection to get up and down, and 2 months with the waist to get out of bed, 3 months review X-ray film. 1.3 Results All cases were restored to normal intervertebral height and vertebral body sequence. After 3 to 10 months of follow-up, the symptoms of low back pain disappeared, and no immunological rejection or infection occurred. X-ray examination showed no deformation of the bone cage, and no re-displacement of the vertebral body was observed. The early results were satisfactory.
2 Discussion Most of the treatment of spondylolisthesis before 1990 was conservative treatment, even if the operation was only decompression plus in situ bone graft fusion, long course of treatment, pseudoarthrosis and complication. The advent of the pedicle screw technology has brought hope to the reduction of the vertebral body. Especially the RF-internal fixation system has proven to be reliable for vertebral body reduction and fixation after many years of clinical application. At the same time, the application of RF-2 is the fusion between the vertebral bodies. Resection of the facet joints eliminates worries. Posterior lumbar interbody fusion has been the most classic surgical procedure for lumbar spondylolisthesis, but the intraoperative bone graft is strict and not stable enough. In addition, postoperative donor bone area is sore, massive bleeding and planting. The bones are absorbed and so on. The appearance of the bone cage better solves the above problems, and it is a non-metallic foreign body, and no stress shielding effect occurs. Some scholars have reported that bone cages have the advantages of accelerating osteogenesis, crawling substitution, and achieving bone connection through the pores inside and outside the bone cage. f1. The surface of the bone cage can improve the stability of the implant while restoring the intervertebral height. Yang Junlin and other biomechanical studies on the cervical spine implanted in the bone cage also proved that the three-dimensional motion can be better controlled than the implanted tibia.
Precautions for surgery: (1) The RF system acts as an indirect decompression of the nerve root through the reduction, but the decompression of the nerve root canal is the key to the small joint resection, which is not only necessary to completely release the nerve root, but also It can prevent excessive pulling and damage of nerve roots when placing the bone cage on the posterolateral side; (2) Before and during surgery, it is necessary to measure and estimate the height of the fusion gap, and select the appropriate ring saw and bone cage. The ring saw is 1~2 large to better prevent loosening after implantation; (3) RF expansion and compression should be limited to the nerve roots are not tight and the bone cage is firm and not loose.
And clinical application|J Chinese Journal of Orthopaedics, 199919 (6): 325. Biomechanical evaluation of cervical spine | J. Chinese Journal of Orthopaedics, 1999, 19 (9): 522. Yan Xianbin (1965-), male, Hengshui, Hebei , attending physician.
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