Bonaldi G, Brembilla C, Cianfoni A
Neuroradiology Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
Department of neurosurgery, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
Eur J Radiol. 2015 May;84(5):789-98. doi: 10.1016/j.ejrad.2014.04.012. Epub 2014 May 9.
The most diffused surgical techniques for stabilization of the painful degenerated and instable lumbar spine, represented by transpedicular screws and rods instrumentation with or without interbody cages or disk replacements, require widely open and/or difficult and poorly anatomical accesses. However, such surgical techniques and approaches, although still considered "standard of care", are burdened by high costs, long recovery times and several potential complications. Hence the effort to open new minimally-invasive surgical approaches to eliminate painful abnormal motion. The surgical and radiological communities are exploring, since more than a decade, alternative, minimally-invasive or even percutaneous techniques to fuse and lock an instable lumbar segment. Another promising line of research is represented by the so-called dynamic stabilization (non-fusion or motion preservation back surgery), which aims to provide stabilization to the lumbar spinal units (SUs), while maintaining their mobility and function. Risk of potential complications of traditional fusion methods (infection, CSF leaks, harvest site pain, instrumentation failure) are reduced, particularly transitional disease (i.e., the biomechanical stresses imposed on the adjacent segments, resulting in delayed degenerative changes in adjacent facet joints and discs). Dynamic stabilization modifies the distribution of loads within the SU, moving them away from sensitive (painful) areas of the SU. Basic biomechanics of the SU will be discussed, to clarify the mode of action of the different posterior stabilization devices. Most devices are minimally invasive or percutaneous, thus accessible to radiologists' interventional practice. Devices will be described, together with indications for patient selection, surgical approaches and possible complications.
用于稳定疼痛性退变且不稳定腰椎的最常用手术技术，以使用或不使用椎间融合器或椎间盘置换的椎弓根螺钉和棒系统为代表，需要广泛切开和/或困难且解剖结构不佳的入路。然而，尽管这些手术技术和方法仍被视为“标准治疗方法”，但却面临着高成本、长恢复时间和多种潜在并发症的问题。因此，人们努力开发新的微创手术方法以消除疼痛性异常活动。十多年来，外科和放射学界一直在探索替代的、微创甚至经皮技术，以融合和锁定不稳定的腰椎节段。另一个有前景的研究方向是所谓的动态稳定化（非融合或保留运动的脊柱手术），其目的是在保持腰椎脊柱单元（SU）的活动度和功能的同时，为其提供稳定。传统融合方法潜在并发症（感染、脑脊液漏、取骨部位疼痛、内固定失败）的风险降低了，尤其是过渡性疾病（即施加于相邻节段的生物力学应力，导致相邻小关节和椎间盘延迟退变）。动态稳定化改变了脊柱单元内的负荷分布，将其从脊柱单元的敏感（疼痛）区域移开。将讨论脊柱单元的基本生物力学，以阐明不同后路稳定装置的作用方式。大多数装置是微创或经皮的，因此放射科医生可进行介入操作。将描述这些装置，以及患者选择的适应症、手术入路和可能的并发症。
