| Objective:To evaluate the short-term efficacy of hybrid surgery in the treatment of double segment lumbar disc herniation,and to verify whether it can delay the adjacent segment degeneration,so as to provide clinical data support for the selection of its indications.Methods:A retrospective analysis of the clinical data of patients with double-segment lumbar intervertebral disc herniation admitted to our department from December 2012 to December 2018.According to the inclusion and exclusion criteria,a total of 32 cases were included,including 12 cases in the hybrid surgery group and 20 cases in the posterior lumbar interbody fusion(PLIF)group.Collect the clinical data and imaging data of the above patients before operation,3 months after operation,6 months after operation,and 1 year after operation.The clinical evaluation indicators include the pain visual analog scale score(VAS),the Japanese Orthopedic Association score(JOA),and the Oswestry dysfunction index(ODI)of the two groups of patients.The imaging evaluation indicators include the cephalic adjacent segment intervertebral space height ratio(ISR),the intervertebral range of motion(ROM)of adjacent cephalic segments.Results:All the patients included in the study received satisfactory clinical follow-up.All patients’ symptoms improved significantly after the operation,and the symptoms of low back and leg pain were already relieved at the first follow-up.Clinical indicators:there was no difference in VAS score between hybrid surgery group and the PLIF group before surgery,three months after surgery,and six months after surgery.However,at one year postoperatively,the VAS score of the hybrid group was lower than that of the fusion group(P < 0.05);ODI and JOA scores had no significant difference at each follow-up time point(P> 0.05);imaging index: ISR score: there was no difference between the hybrid group and PLIF group before operation,three months after operation and six months after operation,and the ISR score of PLIF group was lower than that of the hybrid group one year after operation(P < 0.05);the ROM changes of adjacent vertebrae in the two groups were significantly different after operation There was a trend of gradual increase.The ROM of adjacent vertebrae in hybrid operation group increased gradually before and after operation,but there was no significant difference before and after operation.In PLIF group,ROM of adjacent vertebrae increased significantly at 6 months and 1 year after operation.During the follow-up period,one patient in the hybrid group had L4 fixation apical wire fall off and underwent internal fixation revision 14 months after the operation;one patient in the fusion group had S1 screw loose and underwent removal of vertebral internal fixation15 months after the operation;the other patients did not need secondary operation.Conclusion:1.Compared with traditional PLIF surgery,hybrid surgery based on the K-rod dynamic fixation system can definitely improve the symptoms of patients with lumbar disc herniation,and has more advantages in the control of postoperative low back pain.2.Compared with PLIF surgery,patients undergoing hybrid surgery based on the K-rod dynamic fixation system have fewer adjacent segment height loss at the one-year follow-up time point after surgery.3.Compared with PLIF surgery,hybrid surgery based on K-rod dynamic fixation system can reduce the occurrence of adjacent vertebral instability,which is beneficial to the delay of adjacent segment degeneration. |
