Department of Neurosurgery, Timone Teaching Hospital, 249, rue Saint-Pierre, 13005 Marseille, France.
Orthop Traumatol Surg Res. 2009 Sep;95(5):359-64. doi: 10.1016/j.otsr.2009.06.001. Epub 2009 Jul 28.
The majority of osteoporotic, spinal cord compressive, vertebral fractures occurs at the thoracolumbar junction level. When responsible for neurological impairment, these rare lesions require a decompression procedure. We present the results of a new option to treat these lesions: an open balloon kyphoplasty associated with a short-segment posterior internal fixation.
Twelve patients, aged a mean 72.3 years, were included in this prospective series; all of them presented osteoporotic burst fractures located between T11 and L2 associated with neurological impairment. The surgical procedure first consisted of a laminectomy, for decompression, followed by an open balloon kyphoplasty. A short-segment posterior internal fixation was subsequently put into place when the local kyphosis was considered severe. A CAT scan study evaluated local vertebral body's height restoration using two pre- and postoperative radiological indices.
All of the patients in the series were followed up for a mean 14 months. Local kyphosis improved a mean 10.8 (p<0.001). Vertebral body height was also substantially restored, with a mean gain of 26% according to the anterior height/adjacent height ratio and 28% according to the Beck Index (p<0.001). Two cases of cement leakage were recorded, with no adverse clinical side effect. Complete neurological recovery was observed in 10 patients; two retained a minimal neurological deficit but kept a walking capacity.
The results presented in this study confirm the data reported in the literature in terms of local kyphosis correction and vertebral body height restoration. The combination of this technique with laminectomy plus osteosynthesis allowed us to effectively treat burst fractures of the thoracolumbar junction and led to stable results 1 year after surgery. This can be advantageous in a population often carrying multiple co-morbidities. With a single operation, we can achieve neurological decompression and spinal column stability in a minimally invasive way; this avoids more substantial surgery in these fragile patients.
Level IV. Therapeutic prospective study.
大多数骨质疏松性、脊髓压迫性、椎体骨折发生在胸腰椎交界处水平。当这些罕见的病变负责神经损伤时，需要进行减压手术。我们提出了一种新的治疗这些病变的选择：开放性球囊扩张椎体后凸成形术联合短节段后路内固定。
12 名患者，平均年龄 72.3 岁，纳入本前瞻性系列研究；所有患者均患有位于 T11 和 L2 之间的骨质疏松性爆裂骨折，伴有神经功能障碍。手术过程首先进行椎板切除术以进行减压，然后进行开放性球囊扩张椎体后凸成形术。当局部后凸被认为严重时，随后进行短节段后路内固定。CAT 扫描研究使用两个术前和术后影像学指标评估局部椎体高度的恢复情况。
本系列中的所有患者均平均随访 14 个月。局部后凸角度平均改善 10.8°（p<0.001）。椎体高度也得到了显著恢复，根据前柱高度/相邻椎体高度比，平均增加 26%，根据 Beck 指数，平均增加 28%（p<0.001）。记录到 2 例骨水泥渗漏，但无临床不良副作用。10 例患者完全恢复神经功能；2 例患者仍有轻微的神经功能缺损，但仍保持行走能力。
本研究结果与文献报道的数据在局部后凸矫正和椎体高度恢复方面一致。该技术与椎板切除术加骨合成术相结合，使我们能够有效地治疗胸腰椎交界处爆裂性骨折，并在手术后 1 年获得稳定的结果。对于经常患有多种合并症的人群，这可能是有利的。通过一次手术，我们可以以微创的方式实现神经减压和脊柱稳定性，避免在这些脆弱的患者中进行更广泛的手术。
四级。治疗性前瞻性研究。
