Abstract:Objective To investigate the clinical efficacy of posterior transpedicular lateral rotatory reduction in treatment of degenerative lumbar scoliosis(DLS).Methods 21 patients of DLS received posterior transpedicular lateral rotatory reduction,interbody fusion and internal fixation of pedicle system treatment from January 2013 to January 2016.All patients were followed up for 8 to 28 months with an average of (18.0±1.5)months.We retrospectively analyzedthe clinical materials,changes of oswestry disability index(ODI),Japanese orthopaedic association scores(JOA),apical vertebral rotation,lumbar lordotic angle and scoliosis Cobb angle pre-operationand post-operation were evaluated comprehensively.Results All patients underwent the operation successfully.One patient suffered from L4 neural root lesion after the operation but relieved after treatment and rehabilitation.Low back pain,lower limb pain,and neurogenic claudication improved significantly.Preoperative ODI was(39.1±8.0)on average and(15.2±2.2)for the last follow-up,which were obviously reduced compared to that before the surgery(P<0.05).Preoperative JOA was(11.5±2.3)on average and(25.4±1.3)for the last follow-up,which were significantly increased compared to that before the surgery(P<0.05).Apical vertebral rotation was corrected to (6.4±1.7)° from preoperative(17.5±2.2)°.Lumbar lordotic angle increased from (10.6±2.7)°to(26.3±1.5)°and scoliosis Cobb angle was reduced from (28.6±2.5)°to(8.7±1.3)°.Internal fixation loosening,rotation and breakage were not seen during follow-up.Conclusion After adoption of posterior transpedicular lateral rotatory reduction in combination with posterior decompression,interbody bone grafting and pedicle screw internal fixation in treating DLScan effectively correct lumbar scoliosis and recover lumbar lordosis,with satisfactory clinical efficacy.
[1]Kobayashi T,Atsuta Y,Takemitsu M,et al.A prospective study of de novo scoliosis in a community based cohort[J].Spine,2006,31(2):178-182.
[2]Silva FE,Lenke LG.Adult degenerative scoliosis:evaluation and management[J].Neurosurg Focus,2010,28(3):E1.
[3]Aaro S,Dahlborn M,Svensson L.Estimation of vertebral rotation in structural scoliosis by computer tomography[J].Acta Radiol Diagn(Stockh),1978,19(6):990-992.
[4]李彦明,李明,杨长伟.退行性脊柱侧凸患者冠状面和矢状面影像学参数分析[J].中国脊柱脊髓杂志,2016,26(12):1093-1098.
[5]BaoH,ZhuF,LiuZ,et al.Vertebral rotatory subluxation in degenerative scoliosis:facet joint tropism is related[J].Spine(Phila Pa 1976),2014,39(26):45-51.
[6]鲍虹达,朱锋,邱勇,等.退变性脊柱侧凸患者后路矫形术后腰椎前凸指数对矢状面平衡的预测作用[J].中国脊柱脊髓杂志,2016,26(4):289-293.
[7]Tsutsui S,Kagotani R,Yamada H,et al.Can decompression surgery relievelow backpaininpatientswith lumbarspinal stenosis combined withdegenerative lumbar scoliosis?[J].Eur Spine J,2013,22(9):2010-2014.
[8]Daubs MD,Lenke LG,Bridwell KH,et al.Decompression alone versus decompressionwith limited fusionfortreatment of degenerative umbarscnliosisinthe elderly patient[J].Evid Based Spine Care J,2012,3(4):27-32.
[9]Schwab FJ,Blondel B,Bess S,et al.Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity:a prospective multicenter analysis[J].Spine,2013,38(13):803-812.
[10]Poureisa M,Behzadmehr R,Daghighi MH,et al.Orientation of the facet joints in degenerative rotatory lumbar scoliosis:an MR study on 52 patients[J].ActaNeurochir(Wien),2016(158):473-479.
[11]贾梓,宋云龙,李相生,等.640层动态容积CT腰椎连续运动扫描的初步探讨[J].中国医学工程,2012,20(1):50-51.
[12]Toyone T,Tanaka T,Kato D,et al.Anatomic changes inlateral spondylolisthesis associated with adult lumbar scoliosis[J].Spine(Phila Pa 1976),2005,30(22):671-675.
[13]Liu H,Ishihara H,Kanamori M,et al.Characteristics of nerve root compression caused by degenerative lumbar spinal stenosis with scoliosis[J].Spine J,2003,3(6):524-529.
[14]唐金平,刘晓岚,陈群.退行性腰椎侧凸的影像学和临床特点的相关性研究[J].实用骨科杂志,2016,22(2):134-522.
[15]Smith JS,Shaffrey CI,Fu KM,et al.Clinical and radiographic evaluation of the adult spinal deformity patient[J].Neurosurg Clin N Am,2013,24(2):143-156.
[16]冯虎,郭开今,赵杰,等.改良Jaslow技术治疗退行性脊柱侧凸的临床应用[J].中华解剖与临床杂志,2014,19(5):371-375.
[17]Steffee AD,Biscup RS,Sitkowski DJ.Segmental spine plates with pedicle screw fixation.A new internal fixation device for disordersof the lumbar and thoraeolumbar spine[J].Clin Orthop Relat Res,1986(203):4553.