Kim Myeong-Soo, Eun Jong-Pil, Park Jeong-Soo
Department of Neurosurgery, Research Institute of Clinical Medicine, Institute for Medical Science, Chonbuk National University Medical School/Hospital, Jeonju, Korea.
J Korean Neurosurg Soc. 2011 Sep;50(3):224-30. doi: 10.3340/jkns.2011.50.3.224. Epub 2011 Sep 30.
This study aimed to show the possibility of neural canal enlargement and restoration of bony fragments through laminectomy and minimal facetectomy without pediculectomy or an anterior approach, and also to prove the adequacy of posterior stabilization of vertebral deformities after thoracolumbar bursting fracture.
From January 2003 to June 2009, we experienced 45 patients with thoracolumbar burst fractures. All patients enrolled were presented with either a neural canal compromise of more than 40% with a Benzel-Larson Grade of VI, or more than 30% compromise with less than a Benzel-Larson Grade of V. Most important characteristic of our surgical procedure was repositioning retropulsed bone fragments using custom-designed instruments via laminectomy and minimal facetectomy without removing the fractured bone fragments. Beneath the dural sac, these custom-designed instruments could push the retropulsed bone fragments within the neural canal after the decompression and bone fragment repositioning.
The mean kyphotic deformities measured preoperatively and at follow-up within 12 months were 17.7 degrees (±6.4 degrees) and 9.6 degrees (±5.2 degrees), respectively. The mean midsagittal diameter improved from 8.8 mm (±2.8 mm) before surgery to 14.2 mm (±1.6 mm) at follow-up. The mean traumatic vertebral body height before surgery was 41.3% (±12.6%). At follow-up assessment within 12 months, this score showed a statistically significant increase to 68.3% (±12.8%). Neurological improvement occurred in all patients.
Though controversy exists in the treatment of severe thoracolumbar burst fracture, we achieved effective radiological and clinical results in the cases of burst fractures causing severe canal compromise and spinal deformity by using this novel custom-designed instruments, via posterior approach alone.
本研究旨在表明通过椎板切除术和微创小关节切除术（无需椎弓根切除术或前路手术）实现神经根管扩大和骨碎片复位的可能性，并证明胸腰椎爆裂骨折后椎体畸形后路稳定的充分性。
2003年1月至2009年6月，我们收治了45例胸腰椎爆裂骨折患者。所有纳入患者均表现为神经根管受压超过40%且Benzel-Larson分级为VI级，或受压超过30%且Benzel-Larson分级低于V级。我们手术方法的最重要特点是通过椎板切除术和微创小关节切除术，使用定制器械重新定位后凸的骨碎片，而不切除骨折的骨碎片。在硬脊膜囊下方，这些定制器械可在减压和骨碎片重新定位后将神经根管内的后凸骨碎片推回原位。
术前及术后12个月内随访测量的平均后凸畸形分别为17.7度（±6.4度）和9.6度（±5.2度）。矢状面中部平均直径从术前的8.8毫米（±2.8毫米）改善至随访时的14.2毫米（±1.6毫米）。术前创伤性椎体高度平均为41.3%（±12.6%）。在术后1个月内的随访评估中，该评分显著提高至68.3%（±12.8%）。所有患者神经功能均有改善。
尽管在严重胸腰椎爆裂骨折的治疗上存在争议，但我们通过单独采用后路手术，使用这种新型定制器械，在导致严重椎管受压和脊柱畸形的爆裂骨折病例中取得了有效的影像学和临床效果。
