Carr Daniel, Cook Richard Floyd, Bahoura Matthew, Tong Doris, Soo Teck
Department of Surgery, Section of Neurosurgery, Providence-Providence Park Hospital, Southfield, Michigan, USA.
Asian J Neurosurg. 2018 Oct-Dec;13(4):1279-1281. doi: 10.4103/ajns.AJNS_109_18.
This is a case report and literature review. The objectives of the study are to describe minimally invasive treatment of pedicle fractures, to show contralateral pedicle changes with pedicle fracture treatment, and to review literature on incidence and mechanism of neural arch fractures. After conservative therapy, there are several options for the treatment of pedicle fractures including pediculoplasty, osteosynthesis, or fusion. As patients' age increases, the incidence of pedicle fracture may rise and minimally invasive pedicle screw treatment represents a good motion-preserving option to stabilize without fusion. We report a patient with spontaneous pedicle fractures above a degenerative spondylolisthesis and evidence of contralateral pedicle changes at L2 and L3. After minimally invasive pedicle screw placement, postoperative imaging demonstrated trabeculation across both L2 and L3 fractures with a resolution of contralateral pedicle sclerotic changes and healing of incompletely fracture contralateral pedicle at L2. Pedicle fractures lead to contralateral pedicle sclerotic changes and potential fracture and may cause significant back pain. Stabilization and healing of the neural arch can be achieved with minimally invasive placement of pedicle screws without need for fusion.
这是一篇病例报告及文献综述。本研究的目的是描述椎弓根骨折的微创治疗，展示椎弓根骨折治疗后对侧椎弓根的变化，并回顾有关神经弓骨折发生率及机制的文献。保守治疗后，椎弓根骨折的治疗有多种选择，包括椎弓根成形术、骨固定术或融合术。随着患者年龄的增加，椎弓根骨折的发生率可能会上升，而微创椎弓根螺钉治疗是一种很好的保留运动功能的选择，无需融合即可实现稳定。我们报告一例患有退行性椎体滑脱上方自发性椎弓根骨折且L2和L3对侧椎弓根有变化迹象的患者。在微创置入椎弓根螺钉后，术后影像学显示L2和L3骨折处均有骨小梁形成，对侧椎弓根硬化改变消失，L2处不完全骨折的对侧椎弓根愈合。椎弓根骨折会导致对侧椎弓根硬化改变及潜在骨折，并可能引起严重背痛。通过微创置入椎弓根螺钉可实现神经弓的稳定和愈合，无需融合。
