최소 침습적 신경공 경유 요추 추체간 유합술 = Minimally Invasive Transforaminal Lumbar Interbody Fusion

다국어 초록 (Multilingual Abstract)

Study design: A retrospective study
Objectives: To introduce the technique of minimally invasive transforaminal lumbar interbody fusion and examine its clinical
and radiologic results.
Summary of Literature Review: Transforaminal lumbar interbody fusion with a mini-incision using a tubular retractor was
recently developed. The aim of this procedure is to reduce the approach-related morbidity and achieve better results in an
effective and safe manner.
Materials and Methods: Thirty eight patients were followed up for more than 1 year. Their mean age was 57 years and the
mean follow-up was 19 months. The diagnosis was spinal stenosis, spondylolisthesis and recurred herniated nucleus pulposus in
22, 14 and 2 patients, respectively. The Oswestry disability index, intervertebral disc space height, fusion rate and complications
were evaluated.
Results: The Oswestry disability index improved from 30 points (range, 50~16 points) to 10 points (range, 2-24 points) at the
last follow-up. Thirty-four patients (90%) showed excellent or good results. The intervertebral disc space height increased from
8.7 mm to 10.8 mm. Two cases showed nonunion but the clinical results were good. Complications included one case of infectious
spondylitis requiring antibiotics, one case of cage dislodgement requiring additional surgery and one case of a pedicle
screw malposition showing no clinical symptoms.
Conclusions: Minimally invasive transforaminal lumbar interbody fusion reduced the soft tissue injury and blood loss and
shortened the recovery period compared to the traditional open techniques.

국문 초록 (Abstract)

연구계획: 후향적 연구
연구목적: 요추 질환에서 최소 침습적 신경공 경유 요추 추체간 유합술의 소개 및 그 결과를 알아보고자 하였다.
대상 및 방법: 최소 침습적 신경공 경유 요추 추체간 유합술을 시행한 환자 중 일년 이상 추시가 가능하였던 38명을
대상으로 하였다. 연령은 평균 57세, 평균 추시 기간은 19개월, 추간판 재탈출증이 2예, 척추관 협착증이 22예, 협부
결손형 척추 전방 전위증이 8예, 퇴행성 척추 전방 전위증이 6예이었다. 임상적 평가로는 Oswestry 장해평가 설문지
를 이용하였고, 방사선학적 평가로는 Bridwell 등의 전방 유합 기준에 의한 유합율, 전방 추체간 간격, 합병증 등을 분
석하였다.
결과: Oswestry disability index에 의한 기능평가는 수술 전 평균 30점(50~16점), 최종 추시상 평균 10점(2~24점)으로
향상되었으며, 34예(90%)에서 양호 이상의 결과를 보였다. 36예(95%)에서 골유합을 얻었으며, 2예의 불유합이 있었
으나 임상 증상은 양호하였다. 추체간 간격은 술 전 8.7 mm에서 최종 추시상 10.8 mm로 유지되었다. 합병증으로는
항생제 치료가 필요하였던 술 후 추간판염, 케이지가 이탈되어 재수술이 필요하였던 경우, 척추경 나사못의 이탈이
있었으나 임상 증상이 없던 경우가 각각 1예씩 있었다.
결론: 최소 침습적 신경공 경유 요추 추체간 유합술은 술기 습득에 시간이 걸리지만 연부조직 손상의 최소화, 출혈
량의 감소 및 회복 기간의 단축으로 보다 좋은 수술 술기로 사료된다.

참고문헌 (Reference)

• 1 Lee SH, "Transforaminal lumbar interbody fusion for the treatment of nonunion after posterolateral lumbar fusion" 11 : 223-230, 2004
• 2 Ray CD, "Threaded titanium cages for lumbar interbody fusions" 22 : 667-680, 1997
• 3 Harms JG, "The unilateral transforaminal approach for posterior lumbar interbody fusion" 6 : 88-99, 1998
• 4 Rantanen J, "The lumbar multifidus muscle five years after surgery for a lumbar intervertebral disc herniation" 18 : 568-574, 1993
• 5 Thomsen K, "The effects of pedicle screw instrumentation on functional outcome and fusion rates in posterolateral lumbar spinal fusion: a prospective, randomized, clinical study" 22 : 2813-2822, 1997
• 6 Gejo R, "Serial changes in trunk muscle performance after posterior lumbar surgery" 24 : 1023-1028, 1999
• 7 McLaughlin MR, "Posterior lumbar interbody fusion: indications, technique, and results" 47 : 514-527, 2000
• 8 Steffee AD, "Posterior lumbar interbody fusion and plates" 227 : 99-102, 1988
• 9 Schwender JD, "Minimally invasive transforaminal lumbar interbody fusion: technical feasibility and initial results" 18 : 1-6, 2005
• 10 Holly LT, "Minimally invasive transforaminal lumbar interbody fusion: indications, technique, and complications" 20 : 1-5, 2006
• 11 Foley KT, "Minimally invasive lumbar fusion" 15 : 26-35, 2003
• 12 Kirkaldy-Willis WH, "Lumbar spinal stenosis" 99 : 30-50, 1974
• 13 Park Y, "Comparison of one-level posterior lumbar interbody fusion performed with a minimally invasive approach or a traditional open approach" 32 : 537-543, 2007
• 14 Kawaguchi Y, "Back muscle injury after posterior lumbar spine surgery. Part 2: Histologic and histochemical analyses in humans" 19 : 2598-2602, 1994
• 15 Kawaguchi Y, "Back muscle injury after posterior lumbar spine surgery. A histologic and enzymatic analysis" 21 : 941-944, 1996
• 16 Bridwell KH, "Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects?" 20 : 1410-1418, 1995
• 17 Suk SI, "Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis" 22 : 210-219, 1997