Staub Blake N, Holman Paul J
Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, Texas.
J Neurosurg Spine. 2015 Feb;22(2):162-5. doi: 10.3171/2014.10.SPINE14300. Epub 2014 Nov 21.
The authors present the first reported use of the lateral retroperitoneal transpsoas approach for interbody arthrodesis in a patient with achondroplastic dwarfism. The inherent anatomical abnormalities of the spine present in achondroplastic dwarfism predispose these patients to an increased incidence of spinal deformity as well as neurogenic claudication and potential radicular symptoms. The risks associated with prolonged general anesthesia and intolerance of significant blood loss in these patients makes them ideal candidates for minimally invasive spinal surgery. The patient in this case was a 51-year-old man with achondroplastic dwarfism who had a history of progressive claudication and radicular pain despite previous extensive lumbar laminectomies. The lateral retroperitoneal transpsoas approach was used for placement of interbody cages at L1/2, L2/3, L3/4, and L4/5, followed by posterior decompression and pedicle screw instrumentation. The patient tolerated the procedure well with no complications. Postoperatively his claudicatory and radicular symptoms resolved and a CT scan revealed solid arthrodesis with no periimplant lucencies.
作者报告了首例在软骨发育不全性侏儒症患者中使用外侧腹膜后经腰大肌入路进行椎间融合术的病例。软骨发育不全性侏儒症患者脊柱固有的解剖异常使这些患者脊柱畸形、神经源性间歇性跛行及潜在神经根症状的发生率增加。这些患者因长时间全身麻醉相关风险及对大量失血耐受性差，成为微创脊柱手术的理想候选者。该病例患者为一名51岁软骨发育不全性侏儒症男性，尽管之前接受过广泛的腰椎椎板切除术，但仍有进行性间歇性跛行和神经根性疼痛病史。采用外侧腹膜后经腰大肌入路在L1/2、L2/3、L3/4和L4/5置入椎间融合器，随后进行后路减压和椎弓根螺钉内固定。患者对手术耐受良好，无并发症。术后其间歇性跛行和神经根症状消失，CT扫描显示融合牢固，植入物周围无透亮区。
