Chandra Sarat Poodipedi, Ramdurg Shashank Ravindra, Kurwale Nilesh, Chauhan Avnish, Ansari Abuzer, Garg Ajay, Sarkar Chitra, Sharma Bhawani Shankar
Department of Neurosurgery, CN Center, Ansari Nagar, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Department of Neurosurgery, CN Center, Ansari Nagar, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Spine J. 2014 Sep 1;14(9):2094-101. doi: 10.1016/j.spinee.2013.12.028. Epub 2014 Jan 18.
Conventional circumferential stabilization for pathologies causing instability of the thoracic spine requires a two or even a three-staged procedure. The authors present their tertiary care center experience of single-staged procedure to establish a circumferential fusion through an extended costotransversectomy approach.
To demonstrate neural canal decompression, removal of the pathology, achieve circumferential fusion, and correcting the deformity through a single procedure.
Prospective and observational.
Forty-six patients with pan thoracic column instability due to various pathologies.
Neurologic condition was evaluated using American Spinal Injury Association and Eastern Cooperative Oncology Group grading systems. Outcome was evaluated with regard to the decompression of neural canal, correction of deformity, and neurologic improvement. All patients were evaluated for neural canal compromise and degree of kyphosis preoperatively, early, and late postoperatively.
All patients had severe spinal canal compromise (mean, 59%±9%) and loss of vertebral body height (mean, 55%±10%). A single-stage circumferential fusion was performed (four-level pedicle screw fixation along with a ventral cage fixation after a vertebrectomy or corpectomy) through an extended costotransversectomy approach.
The pathologies included trauma (21), tuberculosis (18), hemangioma (2), aneurysmal bone cyst (1), recurrent hemangioendothelioma (1), solitary metastasis (1) and plasmacytoma (1), and neurofibromatosis (1). Thirty-five of 46 patients (76%) demonstrated improvement in the performance status. The major complications included pneumonitis (3), pneumothorax (3) and neurologic deterioration (3; improved in two), deep venous thrombosis (2), and recurrent hemoptysis (1). No implant failures were noted on last radiology follow-up. There were two mortalities; one because of myocardial infarction and another because of respiratory complications.
The following study demonstrated that extended costotrasversectomy approach is a good option for achieving single-staged circumferential fusion for correcting unstable thoracic spine due to both traumatic and nontraumatic pathologies.
对于导致胸椎不稳定的病症，传统的环形稳定手术需要分两期甚至三期进行。作者介绍了他们在三级医疗中心采用单期手术，通过扩大肋横突切除术建立环形融合的经验。
通过单一手术实现神经根管减压、病变切除、环形融合以及畸形矫正。
前瞻性观察研究。
46例因各种病症导致全胸段脊柱不稳定的患者。
使用美国脊髓损伤协会和东部肿瘤协作组分级系统评估神经功能状况。从神经根管减压、畸形矫正和神经功能改善方面评估手术结果。术前、术后早期和晚期对所有患者进行神经根管受压情况和后凸畸形程度评估。
所有患者均有严重的椎管受压（平均59%±9%）和椎体高度丢失（平均55%±10%）。通过扩大肋横突切除术进行单期环形融合手术（椎板切除或椎体次全切除后，四级椎弓根螺钉固定并联合前路椎间融合器固定）。
病变包括创伤（21例）、结核（18例）、血管瘤（2例）、动脉瘤样骨囊肿（1例）、复发性血管内皮瘤（1例）、孤立性转移瘤（1例）、浆细胞瘤（1例）和神经纤维瘤病（1例）。46例患者中有35例（76%）功能状态有所改善。主要并发症包括肺炎（3例）、气胸（3例）和神经功能恶化（3例；2例好转）、深静脉血栓形成（2例）和反复咯血（1例）。最后一次影像学随访未发现内固定失败。有2例死亡；1例死于心肌梗死，另1例死于呼吸并发症。
本研究表明，扩大肋横突切除术是因创伤性和非创伤性病变导致的不稳定胸椎进行单期环形融合矫正的良好选择。
