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Safety of posterior lumbar interbody fusion in the treatment of elderly patients with lumbar disc herniation

LI Bin,XU Wen-gen,PAN Bing,et al.Orthopedic Center,117th Hospital of PLA,Hangzhou 310013,China  
Objective To investigate the posterior lumbar interbody fusion(PLIF) in the treatment of senile disc herniation.Methods Eighty-nine elder patients with lumbar disc herniation were subjected to open posterior lumbar interbody fusion,including middle open approach,expanded window by half laminectomy or laminectomy,laminoplasty,pedicle screw implantation,removal of intervertebral disc,scraping the endplate cartilage layer,implantation of pruning granular bone or facet bone lamina bone,or interbody Cage fusion,compression and fixation of pedicle screw system.Results All patients were confirmed by detailed checks to exclude absolute contraindications for surgery,of which approximately 65% had asked relevant departments for consultation to guide perioperative management.The average operative time was 100 min,and the average blood loss was 350 mL.All cases were postoperatively followed up for 12 to 24 months.Most of the original nerve compression symptoms were relieved without intermittent claudication,and lower back pain significantly alleviated.Patient satisfaction rate was 91%.The intervertebral height before operation was 3.4-7.8 mm(mean 5.1 mm),and at 3rd month after operation it was increased to 9.6-12.4 mm(mean 11.2 mm).The average height at 12th month was 9.0-12.1 mm(mean 10.8 mm).Interbody fusion rate at 12th month was 91.0%.Major complications were nerve root irritation(10 cases),and cerebrospinal fluid leakage(4 cases),and all of them were relieved.There were no cases of serious infection or critical complications.Conclusion PILF combined with pedicle screw fixation technique in the treatment of elderly patients with lumbar disc herniation can fully decompress,restore and maintain the height of the intervertebral space,and reconstruct the lumbar spine stability with surgical safety.
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