Kwon Woo-Keun, Park Woong-Bae, Lee Gun-Young, Kim Joo Han, Park Youn-Kwan, Moon Hong Joo
Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea; Focused Training Center for Trauma, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
World Neurosurg. 2018 Dec;120:e53-e62. doi: 10.1016/j.wneu.2018.07.137. Epub 2018 Jul 29.
To introduce our technique and results of retropleural/peritoneal lateral pediculectomy for the decompression of thoracolumbar fractures and reconstruction using an expandable titanium cage and circumferential fixation at a single stage.
Eighteen patients who had single unstable, burst thoracolumbar fracture were treated by this technique between January 2014 and December 2016 (T12: n = 9, L1: n = 7, L2: n = 2). They were reviewed retrospectively in terms of radiologic outcomes (computed tomography [CT] scan and radiograph), clinical outcomes, and complications. The results were compared with another cohort of thoracolumbar fractures treated by posterior-only surgery.
There were no radiologic complications implying pseudoarthrosis or instrument failure on the postoperative 6-month CT scan. There was also no neurologic deterioration or infection during the same period. Two patients (11.1%) of iatrogenic injury and 1 patient of trauma-related injury of the dura were secured without any delayed complications. Three patients (16.7%) with transient weakness in left hip flexion immediately after operation were observed and recovered within 2 weeks in all cases. Six patients (33.3%) complained of dysesthesia and/or hypoesthesia on the incision site.
In this study, we suggest lateral pediculectomy as a distinct anatomic landmark to access and remove bony fragments effectively and safely in unstable thoracolumbar burst fractures. This provides a more straightforward access to the burst fragment and helps the surgeon to make better intraoperative decompression strategies. Moreover, this circumferential instrumentation with anterior support and fusion revealed better restoration of the thoracolumbar spine alignment compared with posterior-only surgery, with acceptable complications rates.
介绍我们采用胸膜后/腹膜后外侧椎弓根切除术治疗胸腰椎骨折减压，并使用可扩张钛笼进行一期环形固定和重建的技术及结果。
2014年1月至2016年12月期间，18例患有单一不稳定爆裂性胸腰椎骨折的患者接受了该技术治疗（T12：n = 9，L1：n = 7，L2：n = 2）。对他们的放射学结果（计算机断层扫描[CT]和X线片）、临床结果及并发症进行回顾性分析。将结果与另一组仅接受后路手术治疗的胸腰椎骨折患者进行比较。
术后6个月的CT扫描未发现提示假关节形成或内固定失败的放射学并发症。同期也未出现神经功能恶化或感染情况。2例医源性硬脊膜损伤患者（11.1%）和1例与创伤相关的硬脊膜损伤患者均得到妥善处理，未出现任何延迟性并发症。3例患者（16.7%）术后立即出现左髋屈曲短暂无力，所有病例均在2周内恢复。6例患者（33.3%）主诉切口部位感觉异常和/或感觉减退。
在本研究中，我们建议将外侧椎弓根切除术作为一个独特的解剖标志，以便在不稳定的胸腰椎爆裂骨折中有效且安全地显露和清除骨碎片。这为进入爆裂骨折块提供了更直接的途径，并有助于外科医生制定更好的术中减压策略。此外，与单纯后路手术相比，这种前路支撑融合的环形内固定在恢复胸腰椎脊柱对线方面效果更好，并发症发生率也可接受。
