正側融合手術是治療較嚴重椎間盤移位(prolapsed lumbar intervertebral disc)，脊椎移位 (lumbar spondylolisthesis 和脊柱側彎 (scoliosis) 的微創手術。 較其他融合手術最重要的好處是 (1)無必要切除正常硬骨 (2)無需顯露椎管內神經線，減少神經受損的風險 (3)部份病人可避免植入金鏍絲 (4)能有效改善脊椎弧度和矯正脊椎移位和側彎 (5)減少手術流血 年長人仕脊椎容易因退化和長期勞損引至駝背、脊骨移位、脊柱側彎。嚴重的病人，行動困難，雙腳無力，背部和腳部痛楚。 因為病人多年紀大，有其他病，而且多節脊椎變形，加上可能有骨質疏鬆，很多醫生會覺得手術風險高而不建議手術治療。 但現在有新形微創手術，經腰的側面，經特制管道，用人造骨(PEEK cage)和骨的代替物，代替已退化變形的椎間盤，使脊骨回復原有的形態，使神經線不再受壓。 由於微創，小傷口但能同時治療多節關節，人造骨支撐力強，康服時間快，非常適合年長人仕。 資料提供: http://www.brain-spine.com.hk Indications for Direct Lateral Interbody Fusion (DLIF) - Spinal instability caused by • Degenerative conditions (eg. Degenerative Disc Disease), • Deformity, • Injury of the spine - MRI shows L4 and L5 dislocation and swelling. - Leading to pressure on the spinal cord or surrounding tissues which often are the culprit of chronic back pain and sciatica. - Suitable for patients who fail to respond to conservative treatments. - Compared with conventional interbody fusion techniques, DLIF only requires a small incision on the lateral side, without the need to make a large incision on the front or back, avoiding retraction and damages of the muscles, major organs and vertebral column at the back. Procedures of DLIF - The procedure will be done under general anesthesia. - A special neuro-monitoring system (eg. SSEP and MEP) may be used to locate the nerves to avoid unwanted damages to the nerves. - A small incision will be made on the skin of patient's lateral side to avoid major organs in the abdomen, such as major blood vessels. - Under X-ray imaging guidance, the instrument will be placed at the vertebral body located between L4 and L5. - The affected disc will be removed - Bone surfaces will be prepared - The interbody device (PEEK cage, calcium triphosphate and Demineralized bone matrix) will be inserted. - Then titanium screws and rods will be placed at L4 and L5 from a wound at the back. - Then the tubular portal will be removed and the incision will be sutured. Post-operative care of DLIF - Keep wound dry and clean, though shower is allowed, the wound site should be covered. - No heavy weight-lifting allowed - Walking is encouraged - Avoid alcohol and smoking - Contact your surgeons if you have High fever, Redness or swelling around the incision site, Change in amount and odor of the incision drainage, Increased pain of the wound site, and Increased numbness of the lower body. Description provided by http://www.brain-spine.com.hk
