Suk Se-Il, Kim Jin-Hyok, Kim Won-Joong, Lee Sang-Min, Chung Ewy-Ryong, Nah Ki-Ho
Seoul Spine Institute, Inje University Sanggye Paik Hospital, Seoul, Korea.
Spine (Phila Pa 1976). 2002 Nov 1;27(21):2374-82. doi: 10.1097/00007632-200211010-00012.
Retrospective study.
To report a technique of vertebral column resection through a single posterior approach and its preliminary results in the treatment of moderate to severe spinal deformities with limited flexibility.
Vertebral column resection is a formidable operation reserved for moderate to severe deformities with limited flexibility. The authors devised a technique of vertebral column resection through a single posterior approach that offers significant advantages over the anterior-posterior vertebral column resection.
Seventy spinal deformity patients treated by posterior vertebral column resection were reviewed. Minimum follow-up was 2 years (range 2-3.3 years). There were 34 males and 36 females with a mean age of 27.4 years at the time of the operation. Etiologic diagnoses were adult scoliosis in 7, congenital kyphoscoliosis in 38, and postinfectious kyphosis in 25. The surgery consisted of temporary stabilization of the vertebral column with segmental pedicle screw fixation, resection of the vertebral column at the apex of the deformity via the posterior route, followed by gradual deformity correction and global fusion.
The total number of resected vertebrae was 143: 76 in thoracic and 67 in lumbar. Mean operation time was 4 hours, 31 minutes with average blood loss of 2333 mL. The deformity correction was 61.9% in the coronal plane and 45.2 degrees in the sagittal plane. Complications were encountered in 24 patients: 2 complete cord injuries in severe adult scoliosis and thoracic kyphosis patient who had significant preoperative cord compromise, 6 hematomas, 4 root injuries (all incomplete), 5 fixation failures, 2 infections, and 5 hemopneumothoraxes.
Posterior vertebral column resection is an effective alternative for moderate to severe deformities with limited flexibility. However, it is a technically demanding and exhausting procedure with possible risks for major complications.
回顾性研究。
报告一种经单一后路进行脊柱切除术的技术及其治疗柔韧性受限的中重度脊柱畸形的初步结果。
脊柱切除术是一种针对柔韧性受限的中重度畸形的复杂手术。作者设计了一种经单一后路进行脊柱切除术的技术，该技术相对于前后路联合脊柱切除术具有显著优势。
回顾了70例接受后路脊柱切除术治疗的脊柱畸形患者。最短随访时间为2年（范围2 - 3.3年）。手术时，男性34例，女性36例，平均年龄27.4岁。病因诊断为成人脊柱侧凸7例，先天性脊柱后凸畸形38例，感染后脊柱后凸25例。手术包括通过节段性椎弓根螺钉固定对脊柱进行临时稳定，经后路在畸形顶点切除脊柱，随后逐步矫正畸形并进行整体融合。
共切除椎体143个，其中胸椎76个，腰椎67个。平均手术时间为4小时31分钟，平均失血量为2333毫升。冠状面畸形矫正率为61.9%，矢状面矫正45.2度。24例患者出现并发症：2例严重成人脊柱侧凸和胸椎后凸患者发生完全性脊髓损伤，术前脊髓严重受损；6例血肿，4例神经根损伤（均为不完全性），5例内固定失败，2例感染，5例血气胸。
后路脊柱切除术是治疗柔韧性受限的中重度畸形的有效替代方法。然而，这是一项技术要求高且耗费精力的手术，存在发生重大并发症的风险。
