| BackgroundLumbar degenerative diseases have become a common clinical disease with a high incidence at present,and the incidence has a younger trend,which seriously affects the normal work and life of patients and brings a heavy burden to the national medical and health system.Since the spinal fusion surgery began to be applied in the clinic in 1911,fusion methods and fusion instruments have been constantly developed and improved,and the efficacy has been constantly advanced.Fusion surgery has gradually developed into one of the most important treatment methods in the field of spinal internal fixation.With the extension of clinical application time of fusion surgery,the number of cases increased,for example,stress shielding,loss of motion of surgical segment,failure of internal fixation,degeneration of adj acent segment.The concept of spinal non-fusion technology has been on the rise and gradually attracted more and more attention.In recent years,the lumbar dynamic internal fixation technology has developed rapidly.The dynamic internal fixation technology of the pedicle system represented by Isobar TTL system and Dynesys system gradually increases in clinical application,and the clinical efficacy is satisfactory,which indicates the prospect of non-fusion technology and encourages us to further explore the possibility of spinal non-fusion technology.ObjectivePolyetherketone(PEEK)rod is a spinal internal fixation rod synthesized by artificial polymer material.PEEK rod screw system is composed with titanium alloy pedicle screw,which can be used to assist in the reconstruction of spinal fusion stability after lumbar laminectomy and decompression and/or nucleus pulposus removal.This study explored the feasibility of treating lumbar degenerative diseases after lumbar laminectomy and decompression and/or nucleus pulposus removal,supplemented by PEEK rod screw system fixation,without bone graft fusion,and followed up to evaluate the postoperative efficacy and possible related complications of patients.MethodsFrom January 2017 to January 2019,24 patients with lumbar degenerative disease who had failed regular non-surgical treatment were treated with lumbar laminectomy and decompression and/or nucleus pulposus resection followed by PEEK rod pedicle screw internal fixation.No bone graft fusion was performed in all cases.The surgical efficacy was evaluated by The lumbar oswestry disability index(ODI),The visual analogue score(VAS)of lumbar and lower limbs,and patients' satisfaction with surgery.Lumbar X-ray imaging data were collected before and after surgery(1 week,3 months,6 months,and the last follow-up)to measure the lumbar curvature,the disc height index(DHI)of adjacent segments,the lumbar range of motion(ROM),the surgical segments range of motion,and the adjacent segments range of motion.The results of 1 week,3 months,6 months and the last outpatient follow-up were recorded,and the clinical and imaging results at each time point were compared and analyzed to observe whether there were any recent complications.ResultsAmong the 24 patients who received complete follow-up data after the operation,the follow-up time was 9-28 months,with an average of 18.8 months.The symptoms of the patients gradually improved with the extension of the postoperative time.The lumbar VAS score was 6.1±1.1,5.5±1.0,4.1±1.1,2.3±0.8,2.2±0.8 before and after operation,and the difference of lumbar VAS score before and after operation was statistically significant(P<0.01).The lower limbs VAS score was 6.9±2.0,4.2±1.6,2.8±1.3,1.6±1.1,1.5±1.1 before and after surgery,and the difference of lower limbs pain VAS score before and after surgery was statistically significant(P<0.01).The preoperative and postoperative ODI scores were 66±9,59±7,41±10,27±7,23±10(%),and the difference in lumbar ODI scores at each time point after surgery was statistically significant(P<0.05)compared with that before surgery.Patients' overall satisfaction with the surgical results was 95.8%(23/24).Lumbar curvature of preoperative and postoperative was 35.3°±9.0°,34.3°±6.1°,34.8°±7.6°,34.6°±8.4°,35.1°±8.2° respectively,surgical segment curvature in preoperative and postoperative was 24.2°±5.8°,23.9°±5.0°,25.2°±5.3°,24.9°±5.2°,24.5±°5.0°respectively.The disc height index before and after operation was 34.5±6.9,34.6±6.5,34.0±7.3,34.2±6.4,34.4±5.9(%).There was no statistically significant difference in lumbar curvature,curvature of surgical segment and disc height index between the postoperative and preoperative follow-up results(P>0.05).The overall lumbar ROM was 24.4°±9.2°,24.3°±8.9°,24.4°±10.8°,22.5°±8.2° before and after the operation,and the changes in the overall lumbar ROM before and after the operation were not significant(P>0.05).The ROM of surgical segment was successively 9.4°±5.6°,4.0°±2.3°,4.5°±1.8°,5.8°±3.6° before and after the operation.The ROM of the surgical segment 3 months after the operation was significantly reduced,and then increased at 6 months and at the last follow-up.The difference between the ROM of surgical segment before and after the operation was statistically significant(P<0.05).The ROM of adjacent segments was successively 4.1°±2.7°,4.4°±2.5°,4.8°±2.8°,6.2°±3.0° before and after the operation.And it gradually increased after the operation,there was no statistically significant difference at 3 months and 6 months after the operation(P>0.05),however,there was a statistically significant difference between the ROM of adjacent segments in the last follow-up and that before surgery(P<0.05).There were 4 cases of patients with internal fixation of screw loosening in the last follow-up,accounted for 16.7%(4/24),no screw breakage cases,L3 and L5 bilateral screw loosening in 1 case,L5 bilateral screw loosening in 2 cases,L4 bilateral screw loosening in 1 case,a total of 10 screws,accounted for 6.7%(10/148),the 4 patients were not associated with internal fixation device clinical symptoms,not special treatment.ConclusionLumbar laminectomy decompression combined with PEEK rod non-fusion internal fixation technique for the treatment of lumbar degenerative diseases shows good short-term clincal efficacy,reduces the surgical trauma,shortens the operation time to a certain extent compared with fusion surgery at the same time,which can keep part ROM of surgical segmental and postoperative follow-up found no obvious equipment related complications,screw loosening rate is low,and will not affect the surgical curative effect,that means it could be chosen as one of the surgical treatment for lumbar degenerative disease,and long-term efficacy still need large sample,long time clinical observations to verify. |
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