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首页> 美国卫生研究院文献>Revista Brasileira de Ortopedia >Multilevel Anterior Lumbar Interbody Fusion Combined with Posterior Stabilization in Lumbar Disc Disease—Prospective Analysis of Clinical and Functional Outcomes
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Multilevel Anterior Lumbar Interbody Fusion Combined with Posterior Stabilization in Lumbar Disc Disease—Prospective Analysis of Clinical and Functional Outcomes

机译：多级前路腰椎椎间融合术联合后路稳定术治疗腰椎间盘突出症-临床和功能结果的前瞻性分析

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>Objective  This was a prospective controlled study with lumbar degenerative disc disease patients submitted to instrumented anterior lumbar interbody fusion (ALIF) combined with posterior stabilization. >Methods  A sample with 64 consecutive patients was operated by the same surgeons over 4 years. Half of the ALIFs occurred at 2 levels, 43.8% at 3 levels, and 6.25% at 1 level. Interbody cages with integrated screws, filled with bone matrix and bone morphogenetic protein 2, were used. >Results  Half of the patients had undergone previous lumbar spine surgeries, 75% presented with associated degenerative listhesis, and 62.5% had posterior lumbar compression disease. Approximately 56% of the sample had at least 1 risk factor for nonunion. The Oswestry index changed from 71.81 ± 7.22 at the preoperative assessment to 24.75 ± 7.82 at the final follow-up evaluation, while the visual analogue pain scale changed from 7.88 ± 0.70 to 2.44 ± 0.87 ( p  < 0.001). Clinical and functional improvements increased with the number of operated levels, proving the efficacy of multilevel ALIF, performed in 93.75% of the sample. The global complication rate was of 7.82%, with no major complications. No cases of nonunion were observed. >Conclusion  Instrumented ALIF combined with posterior stabilization is a successful option for uni- and multilevel degenerative disc disease of the L3 to S1 segments, even in the significant presence of risk factors for nonunion and of previous lumbar surgeries, assuring very satisfactory clinical-functional and radiographic outcomes with a low medium-term complication rate.
机译：>目的这是一项前瞻性对照研究，研究对象是腰椎退行性椎间盘疾病患者，他们接受了前路腰椎椎间融合术（ALIF）联合后路稳定术。 >方法由同一名外科医生在4年内对连续64例患者进行了手术。一半的ALIF出现在2个级别，43.8％出现在3个级别，6.25％出现在1个级别。使用带有整体螺钉的椎间融合器，其中填充了骨基质和骨形态发生蛋白2。 >结果一半的患者曾经接受过腰椎手术，其中75％的患者伴有退行性变性，而62.5％的患者患有后腰椎压缩性疾病。大约56％的样本至少有1个发生骨不连的危险因素。 Oswestry指数从术前评估的71.81±7.22变为最终随访评估的24.75±7.82，而视觉模拟疼痛评分从7.88±0.70变为2.44±0.87（p <0.001）。临床和功能方面的改善随手术水平的增加而增加，证明了在93.75％的样本中进行的多水平ALIF的有效性。总体并发症发生率为7.82％，无重大并发症。没有观察到不愈合的情况。 >结论 AL即使在存在严重的骨不连和先前的腰椎手术危险因素的情况下，ALIF联合后路稳定治疗对于L3至S1段的单级和多级退行性椎间盘疾病也是一种成功的选择中期并发症发生率低，临床功能和影像学结果令人满意。

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