Department of Orthopedic Surgery, Ain Shams University, Cairo, Egypt.
J Neurosurg Spine. 2011 Jun;14(6):734-41. doi: 10.3171/2011.1.SPINE10251. Epub 2011 Mar 11.
The posterolateral transpedicular approach (PTA) is a widely used method for the surgical treatment of vertebral body metastases. It is crucial to understand the optimal location of the anterior graft in terms of sound and durable reconstruction following PTA. The purpose of this study was to investigate whether postoperative construct stability is related to the location of anterior grafts.
The authors conducted a retrospective review of 45 cases of metastatic spine disease with epidural tumor extension in which patients underwent circumferential decompression and fusion by means of PTA. Mechanical (anterior construct stability), pain (visual analog scale score), and neurological (American Spinal Injury Association scale) outcomes were evaluated and correlated with the anterior graft location (lateral or central) and surgical approach (unilateral or bilateral), number of decompressed levels, types of anterior graft, screw density of posterior fixation (number of screws used divided by the number of pedicles spanned), and kyphotic angle change from the immediate postoperative period to the most recent follow-up.
Seven of 45 constructs were judged unstable--5 with a lateral location of the anterior graft and 2 with a central location. The anterior graft was located laterally in 31 cases (69%), centrally in 11 (24%), and bilaterally in 3 (7%). A unilateral approach was used in 33 cases and a bilateral approach in 12. Neither the location of the anterior graft nor the approach had a significant effect on the stability of the reconstructed spine (p > 0.05). There was a significant difference in construct stability between the single-level decompression group (33 patients) and the multiple-level decompression group (12 patients) (p = 0.0001). The types of anterior graft, screw density, and kyphotic angle change were not correlated to the mechanical outcome.
The anterior graft location showed no significant relationship to the final mechanical, pain, and neurological outcomes.
经皮双侧椎弓根入路（PTA）是一种广泛应用于治疗椎体转移瘤的手术方法。了解 PTA 后前路植骨的最佳位置对于实现稳固、持久的重建至关重要。本研究旨在探讨后路手术中前路植骨位置与术后脊柱结构稳定性的关系。
回顾性分析 45 例伴有硬膜外肿瘤侵犯的脊柱转移瘤患者的临床资料，所有患者均采用 PTA 行全脊柱环形减压融合术。对患者的力学（前路重建稳定性）、疼痛（视觉模拟评分）和神经功能（美国脊髓损伤协会评分）进行评估，并将其与前路植骨位置（外侧或中央）、手术入路（单侧或双侧）、减压节段数量、前路植骨材料、后路固定螺钉密度（使用螺钉数除以所跨越的椎弓根数）和术后即刻至末次随访时后凸角度变化进行相关性分析。
7 例（15.6%）患者术后脊柱结构失稳，其中 5 例为外侧植骨，2 例为中央植骨。31 例患者行外侧植骨，11 例患者行中央植骨，3 例患者行双侧植骨。33 例患者采用单侧入路，12 例患者采用双侧入路。前路植骨位置和手术入路均与脊柱重建的稳定性无显著相关性（P＞0.05）。单节段减压组（33 例）与多节段减压组（12 例）的脊柱结构稳定性差异有统计学意义（P=0.0001）。前路植骨材料、螺钉密度及后凸角度变化与力学结果无相关性。
前路植骨位置与术后最终的力学、疼痛和神经功能结果无显著相关性。
