Analysis of clinical effect and radiographic outcomes of Isobar TTL system for two-segment lumbar degenerative disease: a retrospective study
Analysis of clinical effect and radiographic outcomes of Isobar TTL system for two-segment lumbar degenerative disease: a retrospective study
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Isobar TTL系统治疗两节段腰椎退行性疾病的临床效果及影像学结果分析：回顾性研究
DOI：
10.1186/s12893-020-0680-8
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发表时间：
2020-01-17
期刊：
影响因子：
1.9
通讯作者：
Lin, Hong-Sheng
中科院分区：
文献类型：
--
作者：
Ji, Zhi-Sheng;Yang, Hua;Lin, Hong-Sheng
非融合固定是治疗腰椎退变的有效方法。在本研究中，我们分析了用于治疗两节段腰椎退行性疾病的Isobar TTL系统的临床效果和影像学结局。Method 41例诊断为两节段腰椎退行性疾病的患者从2013年1月至2017年6月接受了Isobar TTL动态稳定系统（n= 20）或刚性系统（n= 21）的手术植入。平均随访时间为23.6（范围15-37）个月。采用奥斯韦斯特里功能障碍指数（ODI）、改良Macnab标准和视觉模拟评分（VAS）评价临床结果。影像学评价包括椎间隙高度和治疗节段和相邻节段的活动度（ROM）。椎间盘信号进行分类，使用修改后的Pfirrmann分级系统和加州大学洛杉矶分校（UCLA）system.ResultsThe临床结果，包括ODI和VAS，显示有显着改善，在两组植入后，两组之间的差异并不显着。此外，两组的改良Macnab标准所指示的临床疗效相似。影像学结果包括椎间隙高度、腰椎活动度和椎间盘信号。末次随访时，刚性组上相邻节段L2/3椎间隙高度显著低于Isobar TTL组。此外，Isobar TTL组中固定节段L3/4的ROM数量明显少于植入前，表明Isobar TTL组中固定节段ROM有限。此外，刚性组末次随访时上相邻节段L2/3的ROM显著增加，而Isobar TTL组植入后无变化。最后，相邻节段变性（ASD）的发病率显着大于刚性组比在Isobar TTL组根据UCLA system.ConclusionThe Isobar TTL系统可以在临床上有效治疗两节段腰椎退行性疾病。与刚性固定相比，Isobar TTL系统获得了更好的影像学结局，并保持了治疗节段的活动度，对近端相邻节段的影响较小。
BackgroundNonfusion fixation is an effective way to treat lumbar degeneration. In the present study, we analyzed the clinical effects and radiographic outcomes of the Isobar TTL system used to treat two-segment lumbar degenerative disease.MethodForty-one patients diagnosed with two-segment lumbar degenerative disease underwent surgical implantation of the Isobar TTL dynamic stabilization system (n= 20) or a rigid system (n= 21) from January 2013 to June 2017. The mean follow-up time was 23.6 (range 15–37) months. Clinical results were evaluated with the Oswestry Disability Index (ODI), modified Macnab criteria, and the visual analog score (VAS). Radiographic evaluations included the height of the intervertebral space and the range of motion (ROM) of the treated and adjacent segments. The intervertebral disc signal was classified using the modified Pfirrmann grading system and the University of California at Los Angeles (UCLA) system.ResultsThe clinical results, including the ODI and VAS, showed that there was significant improvement in the two groups after implantation and that the difference between the two groups was not significant. In addition, the clinical efficacy indicated by the modified Macnab criteria for the two groups was similar. Radiological outcomes included the height of the intervertebral space, lumbar mobility, and intervertebral disc signal. The height of the intervertebral space of the upper adjacent segment L2/3 in the rigid group was significantly lower than that in the Isobar TTL group at the last follow-up. Furthermore, the number of ROMs of the fixed-segment L3/4 in the Isobar TTL group was significantly less than that before implantation, suggesting that the fixed-segment ROMs in the Isobar TTL group were limited. In addition, the ROM of the upper adjacent segment L2/3 in the last follow-up of the rigid group increased significantly, while that of the Isobar TTL group did not change after implantation. Finally, the incidence of adjacent-segment degeneration (ASD) was significantly greater in the rigid group than in the Isobar TTL group according to the UCLA system.ConclusionThe Isobar TTL system can be clinically effective for treating two-segment lumbar degenerative disease. Compared with rigid fixation, the Isobar TTL system yielded better radiographic outcomes and maintained the mobility of the treated segments with less impact on the proximal adjacent segment.