Nishiura Tsukasa, Nishiguchi Mitsuhisa, Kusaka Noboru, Takayama Kazuhiro, Maeda Yasuhiko, Ogihara Kotaro, Nakagawa Minoru
Department of Neurosurgery, National Hospital Organization Iwakuni Clinical Center, Yamaguchi 740-8510, Japan.
No Shinkei Geka. 2007 Apr;35(4):377-84.
Intrasacral fixation technique devised by Jackson is said to provide rigid lumbosacral fixation. We treated 3 cases of lumbosacral lesions using this technique in which lumbosacral segment had become extremely unstable during surgical intervention adding to the effect of original lesions. In all cases, surgeries were performed in 2 stages, intrasacral fixation and anterior stabilization. Case 1: A 52-year-old male was diagnosed fungal discitis and spondylitis at L4 and L5. X-ray showed destruction of the vertebral bodies. L2, L3 and sacrum were fixed posteriorly using the intrasacral fixation technique. One week after the first operation, L4 and L5 vertebral bodies were replaced by long fibula grafts through the extraperitoneal approach. Case 2: A 25-year-old female with cauda equina syndrome and abnormal body form diagnosed as having spondyloptosis in which the entire vertebral body of L5 had descended below the endplate of S1. MR imaging revealed marked canal stenosis at the S1 level. In the first surgery, L5 vertebral body was resected through the transperitoneal approach. After 1 week of bed rest, posterior segments of L5 were resected, L4 was affixed to the sacrum and anterior stabilization was achieved with 2 mesh cages and lumbosacral spine was fixed using the intrasacral fixation technique. Case 3: A 64-year-old female was diagnosed as having pyogenic discitis and osteomyelitis at the L5-S1 level. In spite of successful medical treatment for infection, low back pain continued. Radiologically, L5 vertebral body was shown to have collapsed and slipped anteriorly over the sacrum. L3, L4 and sacrum were fixed by intrasacral fixation. One week after the first operation, the L5/S1 disc and the suppurtive vertebral bodies were resected through the extraperitoneal approach and anterior stabilization was performed with iliac bone grafts. At follow-up for a minimum of 6 months, initial fixation was maintained in all 3 cases and bony fusion was obtained. The intrasacral fixation technique was considered to be effective for extremely unstable lumbosacral lesions.
杰克逊设计的骶骨内固定技术据说能提供坚固的腰骶固定。我们使用该技术治疗了3例腰骶部病变患者，这些患者在手术干预期间腰骶段变得极其不稳定，加重了原有病变的影响。所有病例均分两期进行手术，即骶骨内固定和前路稳定术。病例1：一名52岁男性被诊断为L4和L5的真菌性椎间盘炎和脊柱炎。X线显示椎体破坏。采用骶骨内固定技术对L2、L3和骶骨进行后路固定。第一次手术后一周，通过腹膜外途径用长腓骨移植替代L4和L5椎体。病例2：一名25岁女性，患有马尾综合征且体型异常，诊断为椎体滑脱，其中L5的整个椎体已降至S1终板以下。磁共振成像显示S1水平有明显的椎管狭窄。在第一次手术中，通过经腹途径切除L5椎体。卧床休息1周后，切除L5的后段，将L4固定于骶骨，并使用2个网笼实现前路稳定，采用骶骨内固定技术固定腰骶椎。病例3：一名64岁女性被诊断为L5 - S1水平的化脓性椎间盘炎和骨髓炎。尽管感染的药物治疗取得成功，但腰背痛仍持续。影像学检查显示L5椎体塌陷并向前滑脱至骶骨上方。采用骶骨内固定固定L3、L4和骶骨。第一次手术后一周，通过腹膜外途径切除L5/S1椎间盘及受累椎体，并使用髂骨移植进行前路稳定。在至少6个月的随访中，所有3例患者的初始固定均得以维持，并实现了骨融合。骶骨内固定技术被认为对极其不稳定的腰骶部病变有效。
