| Objective:The Wallis system (non-fusion interspinous dynamic stabilization system) with the non-fusion technology in the treatment of lumbar disc disease progress being increasing emphasis. However, due to the lumbar/sacral a special segment, its application subject to certain restrictions. Principle and structure of the subject through the analysis of the Wallis system (interspinous non-fusion dynamic stabilization system) applications, lumbar/sacral a segment of anatomy and physiology, and clinical patient applications and a return visit to explore the the Wallis system (interspinous non integration of dynamic stabilization system) the feasibility of applying the L5/S1disc disease and provide data analysis to provide a reference for the preoperative evaluation.Method:1. Preparation phase:the treatment of lumbar disc disease clinical literature related Wallis system were retrospectively analyzed, summed up, the system master related to the pathogenesis and biomechanical principles to clear the hot issues, to provide a theoretical basis for the study, and then complete the clinical cases collected and comparative analysis. 2. Clinical studies:Surgery cases since October2008-2012in August, the statistics simply lumbar/sacral disc disease58cases, the successful application of the Wallis system (non-fusion interspinous dynamic stabilization system) in the treatment of37cases of simple L5/SI disc disease (A group), accounting for63.8%of the total number of all patients; treatment of non-application the Wallis system (non-fusion interspinous dynamic stabilization system) of21cases (B group).58patients are simply L5/sacral disc disease, is not associated with the other segments of the disc problem.58patients with lumbar5/sacral a segment disc disease patients, are in line with the Wallis system (non-fusion interspinous dynamic stabilization system) applications indications. After careful preoperative measurement of lumbar/sacral a segment the lumbosacral intervertebral angle geometric X-ray photography, L5spinous process and the middle sacral crest height preliminary determination whether intraoperative application the Wallis system (interspinous non-fusion dynamic stabilization system). All patients3months after the fonnal conservative treatment is invalid, no①The Pfirrmann MRI V degrees lumbar retreat changed;②The lumbar spondylolisthesis;③The bone loose disease;④non-specific low back pain;⑤of Modic2and of Modic type3lumbar retire change and other surgical applications taboo disease. Surgery are second-generation the Wallis system (non-fusion interspinous dynamic stabilization system) implant.3. Determination of imagingShooting preoperative lateral lumbar spine geometric X-ray analysis of the characteristics and stress analysis of the biomechanics of the lumbar5sacral1segment According to the the Wallis system’s structure, we think that the Wallis system can be placed, mainly related to the following data and careful measurement. Determine whether lumbar sacral or sacral vertebral lumbar and measurement lumbosacral intervertebral disc angle, the angle between the lower edge of your straight line with the upper edge of S1vertebral made a straight line that L5vertebral; L5spinous process height L5spinous process of the trailing edge vertex to the height of the edge of the lamina; sacral crest height, corresponding to the first sacral sacral crest height; L5spinous process and the angle between the middle sacral crest. Preliminary determination of the possibility of implantation surgery the Wallis system (non-fusion interspinous dynamic stabilization system). SPSS13.0statistical analysis software, data i±s, using analysis of variance between the indicators group was statistically significant at P<0.05. Measured the lumbosacral intervertebral angle, L5spinous process height, the height of the middle sacral crest, L5spinous process middle sacral crest angle data the input statistical software to analyze obtained to meet the placement Wallis system (non-fusion interspinous dynamic stabilization system) minimum.Results:Patients in group A after nine days stitches VAS scores when compared with group B (P <0.05), postoperative follow-up group A compared to group B (P<0.05), with statistical significance, suggesting that Group A placement Wallis system (The treatment of non-fusion interspinous dynamic stabilization system) is better than group B non-placement group. Tip Wallis system (non-fusion interspinous dynamic stabilization system) in the treatment of lumbar/sacral a segment disc disease can obtain more satisfactory results.Conclusion:Lumbar5sacral1disc disease treatment after decompression placement Wallis system (interspinous non-fusion dynamic stabilization system) treatment was significantly better than the non-placement group. Tip Wallis system (non-fusion interspinous dynamic stabilization system) in the treatment of lumbar/sacral a segment disc disease can obtain more satisfactory results. And obtained by preoperative measurement and analysis of the relevant data of the X-ray part of the reference data. Statistical analysis, the following conditions are met:①lumbosacral intervertebral disc angle≥10°;②L5spinous process middle sacral crest angle≤120°;③L5spinous process height≥15mm;④middle sacral crest height≥12mm.⑤No free L5spinous process.Prompted the lumbar/sacral one segment preoperative imaging measurement as to meet the five conditions, surgery can be placed in the basic Wallis system for the clinical treatment of lumbar/sacral1disc disease of non-fusion placed reference data. However, power fixed treatment mechanism is to control withdrawal renegade segment abnormal activity, so the stress of the motion segment conduction mode restored to normal or near normal. Which also produced the following problem:a reasonable range of motion control is how much? How to determine the range of activities that cause symptoms? The fixation devices rational share the load of the fixed segment? Biomechanics research on a variety of dynamic stabilization devices, kinematics research is still at an immature stage, only the various power fixed devices biomechanics, kinematic characteristics of clear, to provide effective guidance for their clinical use role. On this basis, further randomized, controlled, prospective clinical studies on their treatment the adaptation levy and treatment effect to provide a scientific basis and conclusions. In addition, in the case of disc load conditions improve and allow adjacent segments, disc there is the possibility of self-repair. Disc disease gene therapy is a promising research. The application of dynamic stabilization system to speed up the repair process of the intervertebral disc gene therapy. |
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