Boswell Scott, Sather Michael, Kebriaei Meysam, Lydiatt Katie, Bowdino Brad, Tomes Daniel, Treves John, Hellbusch Les
University of Nebraska Medical Center, Omaha, NE 68198-2035, USA.
Clin Neurol Neurosurg. 2012 Sep;114(7):902-6. doi: 10.1016/j.clineuro.2012.01.043. Epub 2012 Mar 2.
Vertebral compression fractures are common, and can occur concomitantly in patients with symptomatic degenerative stenosis. Less commonly, complicated vertebral body fractures may involve retropulsion of bone into the spinal canal, resulting in stenosis with myelopathy and/or radiculopathy. Decompression of the neural elements can lead to destabilization and progressive kyphotic deformity. Laminectomy combined with open vertebroplasty provides a way to decompress the neural elements and stabilize the anterior columns in patients who cannot tolerate extended surgical time or complications associated with instrumentation and fusion. The authors describe the combination of decompressive laminectomy and open transpedicular vertebroplasty as a means to decompress neural elements and simultaneously stabilize the anterior vertebral column.
Forty-one patients with a total of 51 thoracolumbar fractures were included in this retrospective case review. A decompressive laminectomy was performed first, followed by vertebroplasty using an open transpedicular approach. For subjective assessment of outcome, the patients were assessed using the Oswestry Low Back Disability Questionnaire and additional questions pertaining to the patient's condition.
Out of 51 fractures, there were 15 burst fractures and 36 compression fractures. Fracture levels ranged from T12 to S1. The average follow-up period was 27 months (range, 0.5-60 months). The mean post-operative Oswestry score was 16 (range, 0-39), and all patients except for one were subjectively pleased with the results of the procedure and said they would recommend it to others. All patients were able to return to all routine activities of daily living.
The authors' cases indicate combining open decompressive laminectomies with vertebroplasty can be an effective treatment for patients with complicated thoracic and lumbar fractures without involving bone fusion or spinal instrumentation and with good long-term outcomes.
椎体压缩骨折很常见，可同时发生于有症状的退行性椎管狭窄患者。较少见的情况下，复杂的椎体骨折可能涉及骨块向椎管内的后凸，导致伴有脊髓病和/或神经根病的椎管狭窄。神经结构减压可导致不稳定和进行性后凸畸形。对于无法耐受延长手术时间或与内固定和融合相关并发症的患者，椎板切除术联合开放椎体成形术提供了一种减压神经结构并稳定前柱的方法。作者描述了减压性椎板切除术和开放经椎弓根椎体成形术的联合应用，作为一种减压神经结构并同时稳定椎体前柱的方法。
本回顾性病例研究纳入了41例共51处胸腰椎骨折的患者。首先进行减压性椎板切除术，然后采用开放经椎弓根入路进行椎体成形术。为了对结果进行主观评估，使用Oswestry下腰痛残疾问卷和与患者病情相关的其他问题对患者进行评估。
51处骨折中，有15处爆裂骨折和36处压缩骨折。骨折节段范围从T12至S1。平均随访期为27个月（范围为0.5 - 60个月）。术后Oswestry平均评分为16分（范围为0 - 39分），除1例患者外，所有患者对手术结果主观上都很满意，并表示会向他人推荐。所有患者都能够恢复所有日常生活常规活动。
作者的病例表明，将开放减压性椎板切除术与椎体成形术相结合，对于复杂的胸腰椎骨折患者可能是一种有效的治疗方法，无需进行骨融合或脊柱内固定，且长期效果良好。
