Ｒａｙ ＴＦＣ単独によるＰＬＩＦの周術期合併症と１０８例の３年後治療成績:
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Background: Cylindrical titanium cages have been extensively used as a device in posterior lumbar interbody fusion (PLIF). This interbody fusion cage, when applied effectively, can confer enough stability to the symptomatic motion segment and restore disc height to achieve significant increase in the neuroforamen volume. Recently, however, many complication cases were reported when using cages without supplemental posterior fixation. We report perioperative complications and 3-year follow-up outcome in those who underwent PLIF in which a Ray TFC was implanted.<BR>Methods: A total of 125 patients underwent PLIF with Ray TFC without supplemental fixation (stand-alone PLIF) by a single surgeon. Four died of other diseases, five were under medical treatment for other disease, six were lost and two needed additional PLIF with pedicle screws for migration of cages before three years have passed. A total of 108 patients remained in a stand-alone PLIF group at 3-year follow-up. These patients included 65 males and 43 females with mean age of 52.8 yrs (17-81 yrs). These patients consist of 18 degenerative disc disease, 19 recurrence, 30 spondylolisthesis, 10 spondylolysis, 17 canal stenosis, 1 postlaminectomy syndrome, 10 degenerative scoliosis and 3 ossification of posterior longitudinal ligament (OPLL). Pre- and post-operative functions were evaluated by the Japanese Orthopedic Association (JOA) score. Normal score is 29 points.<BR>Results: Perioperative complications occurred in 10 cases (8%). Dural tear when inserting cages occurred in 3 cases and permanent foot drop occurred in 1 case. Additional operations were needed in 2 cases for migration of cages and in one OPLL case for pseudomeningocele. Although subsidence of the cages occurred in 3 cases, immediate bed-rest for one month rescued from collapse of the vertebral body. Device-related complications needed additional operation or suffered from permanent symptom occurred only in 3 cases(2.4%). Neither superficial nor deep infections occurred. The JOA Score improved from 9.2 before operation to 28.6 points at 3-year follow-up in degenerative disc disease, from 7.3 to 28.1 in recurrent cases, from 10.1 to 28.7 in spondylolisthesis, from 12.4 to 28.6 in spondylolysis, from 11 to 28.2 in canal stenosis, from 5 to 27.0 in postlaminectomy syndrome, from 9.1 to 28.4 in degenerative scoliosis and from 9.0 to 28.3 in OPLL. Only 5 cases needed symptomatic treatment at 3-year follow-up.<BR>Conclusion: A larger cage should be used to avoid retropulsion and migration of cages. Exact aftertreatment with a hard corset is required for 3 to 6 months after surgery, because spine instrumented with cages isn't stiff against postural change in all directions, as it's instrumented with both cages and pedicle screws. Under these conditions, stand-alone PLIF with Ray TFC will achieve good outcome for degenerative lumbar spine disease without serious or permanent complications. This procedure reduced the wound and soft tissue damages, plus risk of infection. Furthermore, patients are free from the pain due to pedicle screws.
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