Lattig F, Fekete T F, Jeszenszky D
Schulthess Clinic, Zurich, Switzerland.
J Bone Joint Surg Br. 2010 Jan;92(1):98-102. doi: 10.1302/0301-620X.92B1.22798.
Fracture of a pedicle is a rare complication of spinal instrumentation using pedicular screws, but it can lead to instability and pain and may necessitate extension of the fusion. Osteosynthesis of the fractured pedicle by cerclage-wire fixation and augmentation of the screw fixation by vertebroplasty or temporary elongation of the fixation, allows stabilisation without sacrifice of the adjacent healthy segment. We describe three patients who developed a fracture of the pedicle in the most caudal instrumented vertebra early after lumbar spinal fusion. During revision surgery the pedicles were reduced and secured by a soft cerclage wire bilaterally. Fusion was obtained at the site of the primary instrumentation and healing of the pedicles was achieved. Cerclage wiring of the fractured pedicle seems to be safe and avoids permanent extension of the fusion without the sacrifice of an otherwise healthy segment.
椎弓根骨折是使用椎弓根螺钉进行脊柱内固定的一种罕见并发症，但它可导致不稳定和疼痛，可能需要扩大融合范围。通过环扎钢丝固定对骨折椎弓根进行骨合成，并通过椎体成形术增强螺钉固定或暂时延长固定，可实现稳定而无需牺牲相邻的健康节段。我们描述了三名患者，他们在腰椎融合术后早期，最尾端的固定椎体发生了椎弓根骨折。在翻修手术中，双侧使用软质环扎钢丝对椎弓根进行复位和固定。在初次内固定部位实现了融合，椎弓根也实现了愈合。对骨折椎弓根进行环扎钢丝固定似乎是安全的，可避免在不牺牲其他健康节段的情况下永久性扩大融合范围。
