Dreimann Marc, Hempfing Axel, Stangenberg Martin, Viezens Lennart, Weiser Lukas, Czorlich Patrick, Eicker Sven Oliver
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Hamburg Eppendorf, Martinistrasse 52, D-20246, Hamburg, Germany.
German Scoliosis Center, Bad Wildungen, Germany.
Neurosurg Rev. 2018 Jan;41(1):221-228. doi: 10.1007/s10143-017-0840-1. Epub 2017 Mar 9.
Osteoporotic fractures with severe kyphosis and neurologic deficits often require decompression and stabilisation. To reduce the risk of procedure-related complications, single-stage posterolateral vertebrectomy and a 360-degree fusion can be performed. An adequate reduction of kyphotic deformity through this approach has not been reported. The aim of this study is to investigate the efficacy of kyphotic deformity reduction by this approach in osteoporotic situation. A retrospective analysis and chart review was performed for 10 consecutive patients who underwent posterolateral decompression and posterior vertebrectomy with dorsal mesh stabilisation and reduction of kyphotic deformity. Preoperative back pain was 8.6 on a visual analogue scale; it was reduced to 5.5 at discharge and 3.7 at the latest follow-up (18 months). The Frankel score improved from D to E (three patients) or was equal (E). Radiological segmental kyphosis was corrected from a mean of 25° to 5° (p < 0.008) postoperatively with a loss of 3° at follow-up (p < 0.005). Single-stage posterolateral vertebrectomy allow for a fast and safe reconstitution/preservation of neurological function in patients with osteoporotic fracture and kyphotic deformity. A significant correction of often-accompanied hyperkyphosis is possible without neurological deterioration and with an improved sagittal profile and good pain reduction.
伴有严重脊柱后凸和神经功能缺损的骨质疏松性骨折通常需要减压和稳定治疗。为降低手术相关并发症的风险，可进行单阶段后外侧椎体切除术和360度融合术。尚未有报道称通过这种方法能充分矫正脊柱后凸畸形。本研究的目的是探讨在骨质疏松情况下通过这种方法矫正脊柱后凸畸形的疗效。对10例连续接受后外侧减压、后路椎体切除术、背侧网片稳定术及脊柱后凸畸形矫正术的患者进行了回顾性分析和病历审查。术前视觉模拟量表背痛评分为8.6分；出院时降至5.5分，最近一次随访（18个月）时降至3.7分。Frankel评分从D级改善为E级（3例患者）或维持不变（E级）。术后影像学节段性后凸从平均25°矫正至5°（p<0.008），随访时丢失3°（p<0.005）。单阶段后外侧椎体切除术能够快速、安全地恢复/保留骨质疏松性骨折和脊柱后凸畸形患者的神经功能。在不导致神经功能恶化的情况下，能够显著矫正常伴有的脊柱后凸，改善矢状面形态并有效减轻疼痛。
