Nolden Mark T, Sarwark John F, Vora Anand, Grayhack John J
Children's Memorial Hospital, Chicago, Illinois, USA.
Spine (Phila Pa 1976). 2002 Aug 15;27(16):1807-13. doi: 10.1097/00007632-200208150-00022.
The lumbar sacropelvis in 11 patients with myelomeningocele and kyphosis was treated with a subtraction kyphectomy technique and posterior instrumentation. The results of this procedure in the 11 patients were evaluated and compared with previous results.
To examine critically their experience using the subtraction (decancellation) vertebrectomy technique combined with posterior instrumentation for myelomeningocele kyphosis, the authors reviewed the charts of 18 myelomeningocele patients who underwent surgery for lumbar kyphosis between 1994 and 1998.
The benefits of restoring sagittal spinal alignment in myelomeningocele patients with severe lumbar kyphosis deformity to achieve postural stability and improved sitting balance generally are accepted. The optimal method of deformity correction, the extent of instrumentation, and the role of limited arthrodesis remain undefined.
Of the 18 patients considered, 11 met the inclusion criteria of having undergone reconstruction using a subtraction (decancellation) vertebrectomy technique, preservation of the thecal sac, limited arthrodesis with posterior transpedicular lumbosacral instrumentation, and a minimum follow-up evaluation of 2 years. The study considered the age of the patient, number of levels fused, estimated blood loss, preoperative deformity, immediate postoperative correction, magnitude of correction, and maintenance of correction at latest follow-up assessment.
The average age at the time of the index procedure was 6 years (range, 3-12 years). The average preoperative kyphosis was 88 degrees (range, 50-149 degrees ). Immediately after surgery, the average curve measurement was 3 degrees lordosis (range, 50 degrees to 50 degrees ). The average magnitude of postoperative sagittal plane deformity correction was 91 degrees (range, 43-126 degrees ). Finally, the magnitude of correction maintained at the final follow-up assessment averaged 66 degrees (range, 22-114 degrees ). This represented an average loss of correction at 2 years of 24 degrees (range, 0-84 degrees ). There were no deaths, episodes of acute-onset hydrocephalus, vascular complications, or chronic deep wound infections.
The subtraction (decancellation) vertebrectomy technique with preservation of the dural sac is a safe and efficacious technique for correction and stabilization of myelomeningocele kyphosis in young patients. Morbidity is reduced, as compared with that of excision techniques. Restoration of sagittal alignment at the time of initial correction and stabilization to achieve a balanced spine led to acceptable results.
对11例患有脊髓脊膜膨出和脊柱后凸的患者的腰骶骨盆采用减法截骨术和后路内固定进行治疗。评估了这11例患者的手术结果，并与先前的结果进行比较。
为严格审视他们使用减法（去松质骨）椎体切除术联合后路内固定治疗脊髓脊膜膨出性脊柱后凸的经验，作者回顾了1994年至1998年间接受腰椎后凸手术的18例脊髓脊膜膨出患者的病历。
恢复严重腰椎后凸畸形的脊髓脊膜膨出患者的矢状面脊柱排列以实现姿势稳定和改善坐位平衡的益处已得到普遍认可。畸形矫正的最佳方法、内固定的范围以及有限融合术的作用仍不明确。
在18例被考虑的患者中，11例符合纳入标准，即接受了使用减法（去松质骨）椎体切除术进行的重建、硬脊膜囊的保留、后路经椎弓根腰骶内固定的有限融合术以及至少2年的随访评估。该研究考虑了患者年龄、融合节段数、估计失血量、术前畸形、术后即刻矫正、矫正幅度以及最新随访评估时矫正的维持情况。
初次手术时的平均年龄为6岁（范围3 - 12岁）。术前平均脊柱后凸为88度（范围50 - 149度）。手术后即刻，平均曲度测量为3度前凸（范围 - 50度至50度）。术后矢状面畸形矫正的平均幅度为91度（范围43 - 126度）。最后，在最终随访评估时维持的矫正幅度平均为66度（范围22 - 114度）。这代表2年时矫正平均丢失24度（范围0 - 84度）。没有死亡、急性脑积水发作、血管并发症或慢性深部伤口感染。
保留硬脊膜囊的减法（去松质骨）椎体切除术是矫正和稳定年轻患者脊髓脊膜膨出性脊柱后凸的一种安全有效的技术。与切除技术相比，发病率降低。在初次矫正和稳定时恢复矢状排列以实现脊柱平衡取得了可接受的结果。
