Fuentes Stéphane, Métellus Phillipe, Pech-Gourg Grégoire, Adetchessi Tarek, Dufour Henri, Grisoli François
Service de Neurochirurgie, Hôpital de la Timone, Marseille, France.
J Neurosurg Spine. 2007 Mar;6(3):284-8. doi: 10.3171/spi.2007.6.3.284.
Elderly patients in poor general health frequently suffer vertebral body (VB) fractures due to osteoporosis or vertebral metastatic lesions. Kyphoplasty and vertebroplasty have become the standard treatment for these types of fractures. In certain conditions that cause local kyphosis, such as spinal cord compression due to a metastatic epidural tumor or the shortening of the spinal canal secondary to vertebral compression, the surgical treatment should provide decompression and stabilization during a short intervention. In this study the authors evaluated a surgical technique that frequently combines a same-session surgical decompression, such as a laminectomy, and posterior instrumentation-assisted stabilization during the same open intervention in which the VB is stabilized by kyphoplasty.
During an 18-month period, the authors treated 18 patients with VB fractures according to this protocol: 14 patients with vertebral metastatic lesions and four with osteoporosis. The patients' mean age was 60 years. All suffered severe pain preoperatively (mean visual analog scale [VAS] score of 7). Fourteen of the 18 patients suffered a neurological deficit. Twenty-three vertebral levels were treated; in 15 patients it was necessary to place posterior instrumentation. The mean duration of the intervention was 90 minutes. Pain in all patients improved 3 days after the intervention, and the mean VAS score decreased to 2. Patients with a neurological dysfunction improved. The mean quantity of injected cement for the kyphoplasty procedure was 7 ml. The mean duration of hospitalization was 7 days. Neuroimaging revealed cement leaks in two cases: one into the disc interspace and one anteriorly into the fractured part of the vertebra. After the intervention, most patients with metastatic lesions underwent radiotherapy. No procedure-related complications occurred.
This procedure allows decompression of the spinal cord, consolidation of the VB and thus a stabilization of the vertebral column, and may provide an alternative treatment to invasive VB excision in patients in poor general health.
一般健康状况较差的老年患者常因骨质疏松或椎体转移瘤而发生椎体骨折。椎体后凸成形术和椎体成形术已成为这类骨折的标准治疗方法。在某些导致局部后凸的情况下，如转移性硬膜外肿瘤引起的脊髓压迫或椎体压缩继发的椎管缩短，手术治疗应在短时间干预内实现减压和稳定。在本研究中，作者评估了一种手术技术，该技术通常在同一开放手术中联合进行同期手术减压（如椎板切除术）以及后路器械辅助稳定术，在此手术中通过椎体后凸成形术稳定椎体。
在18个月期间，作者按照此方案治疗了18例椎体骨折患者：14例为椎体转移瘤患者，4例为骨质疏松患者。患者平均年龄为60岁。所有患者术前均有严重疼痛（平均视觉模拟评分[VAS]为7分）。18例患者中有14例存在神经功能缺损。共治疗了23个椎体节段；15例患者需要放置后路器械。手术平均持续时间为90分钟。所有患者术后3天疼痛均有改善，平均VAS评分降至2分。神经功能障碍患者有所改善。椎体后凸成形术平均注入骨水泥量为7毫升。平均住院时间为7天。神经影像学检查发现2例骨水泥渗漏：1例进入椎间盘间隙，1例向前渗漏至椎体骨折部位。干预后，大多数转移瘤患者接受了放疗。未发生与手术相关的并发症。
该手术可实现脊髓减压、椎体巩固从而稳定脊柱，对于一般健康状况较差的患者，可能是侵入性椎体切除的替代治疗方法。
