Shaw B, Mansfield F L, Borges L
Orthopedic Service, Massachusetts General Hospital, Boston.
J Neurosurg. 1989 Mar;70(3):405-10. doi: 10.3171/jns.1989.70.3.0405.
During the past decade, anterior approaches to the spine have been shown to be much more effective than laminectomy for the relief of pain and neurological deficits due to vertebral metastases. Laminectomy has failed because it does not allow adequate decompression of epidural lesions anterior to the thecal sac. In an effort to combine the advantages of the posterior approach with an adequate decompression, a one-stage posterolateral decompression-stabilization procedure was performed on nine patients with thoracolumbar spine tumors. The approach has been used for decompression and stabilization after thoracolumbar burst fractures. Marked lasting improvement was seen in all six patients with preoperative neurological deficits and in four patients with severe back pain and/or radiculopathy. Three nonambulators and two marginal ambulators could walk postoperatively without assistance. Of five patients who were working preoperatively, four returned full-time to their prior occupations. Three patients had serious complications, including one early postoperative death. No patient deteriorated neurologically due to the procedure. Although the series is small, it demonstrates that adequate one-stage decompression-stabilization of spinal epidural lesions is possible via the posterolateral approach and should be considered in certain cases as an alternative to the anterior approach.
在过去十年中，对于因椎体转移瘤导致的疼痛和神经功能缺损，脊柱前路手术已被证明比椎板切除术更有效。椎板切除术失败是因为它无法充分减压硬膜囊前方的硬膜外病变。为了将后路手术的优势与充分减压相结合，对9例胸腰椎脊柱肿瘤患者实施了一期后外侧减压稳定手术。该方法已用于胸腰椎爆裂骨折后的减压和稳定。所有6例术前有神经功能缺损的患者以及4例有严重背痛和/或神经根病的患者均有明显的持续改善。3例不能行走者和2例勉强能行走者术后可独立行走。术前工作的5例患者中，4例全职恢复了原工作。有3例患者出现严重并发症，包括1例术后早期死亡。没有患者因手术导致神经功能恶化。尽管该系列病例数较少，但表明通过后外侧入路对脊柱硬膜外病变进行充分的一期减压稳定手术是可行的，在某些情况下应考虑作为前路手术的替代方法。
