Fuentes Stéphane, Blondel Benjamin, Metellus Philippe, Adetchessi Tarek, Gaudart Jean, Dufour Henry
Department of Neurosurgery, Timone Hospital, Marseille, France. sfuentes@ ap- hm.fr
Neurosurgery. 2009 May;64(5 Suppl 2):350-4; discussion 354-5. doi: 10.1227/01.NEU.0000337066.59130.61.
Osteoporotic compression fractures, which can lead to neurological complications in some cases, are an increasingly frequent occurrence. These lesions require decompression surgery with or without spinal stabilization procedures. In this article, we present the preliminary results obtained using open kyphoplasty, a new method of treating vertebral compression disorders.
Sixteen patients were included in this prospective study, and a total of 17 vertebrae were treated. All of the patients had vertebral compression fractures associated with neurological disorders. The surgical treatment consisted of open kyphoplasty after laminectomy and decompression. Short-segment vertebral osteosynthesis was also performed in patients with pronounced local kyphosis. Pain was rated at clinical assessments, and radiological assessments were performed to determine the restored vertebral height and the correction of any local vertebral kyphosis.
Analysis of the results obtained using this method showed that vertebral height was significantly improved (P < 0.001) and local kyphosis was significantly reduced (P < 0.001). The mean operating time was 90 minutes. The neurological status of all patients improved; 14 patients recovered completely from their neurological symptoms. The last 2 patients had associated neurological disease but were able to walk. There were 2 superficial postoperative infections.
This method for treating severe osteoporotic compression fractures associated with neurological disorders gives successful results and can be used to treat neurological compression fractures while consolidating the vertebral body. Therefore, this less invasive approach seems to be particularly useful for treating compression fractures in the thoracolumbar spine junction in elderly patients who often have comorbidities.
骨质疏松性压缩骨折在某些情况下可导致神经并发症，且其发生率日益增加。这些损伤需要进行减压手术，可能还需要进行脊柱稳定手术。在本文中，我们展示了使用开放性椎体后凸成形术（一种治疗椎体压缩性疾病的新方法）所获得的初步结果。
本前瞻性研究纳入了16例患者，共治疗了17个椎体。所有患者均患有与神经功能障碍相关的椎体压缩骨折。手术治疗包括椎板切除减压术后的开放性椎体后凸成形术。对于有明显局部后凸畸形的患者，还进行了短节段椎体骨合成术。在临床评估中对疼痛进行评分，并进行影像学评估以确定椎体高度的恢复情况以及局部椎体后凸畸形的矫正情况。
对使用该方法获得的结果进行分析表明，椎体高度显著改善（P < 0.001），局部后凸畸形显著减轻（P < 0.001）。平均手术时间为90分钟。所有患者的神经功能状态均有所改善；14例患者的神经症状完全恢复。最后2例患者伴有神经疾病，但能够行走。术后有2例浅表感染。
这种治疗与神经功能障碍相关的严重骨质疏松性压缩骨折的方法取得了成功的结果，可用于治疗神经压迫性骨折并巩固椎体。因此，这种侵入性较小的方法对于治疗常有合并症的老年患者胸腰椎交界处的压缩骨折似乎特别有用。
