Alsaleh Khalid, Alduhaish Amjad
Department of Orthopedics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
J Craniovertebr Junction Spine. 2019 Apr-Jun;10(2):88-93. doi: 10.4103/jcvjs.JCVJS_20_19.
Surgical treatment for elderly patients with thoracolumbar (TL) kyphosis and spinal cord (SC) compression presents significant challenges due to compression location, the amount of deformity, and patient's medical status might not permit full correction of the deformity. In this series, we present a surgical approach that provides adequate decompression without the risks associated with a pedicle subtraction osteotomy/posterior vertebral column resection or an anterior corpectomy.
Three patients presented with TL kyphosis and progressive neurologic symptoms. All had acute weakness; none were ambulatory. SC was compressed over the apex of kyphosis, and for some, there was spinal stenosis at the proximal junction of the TL spine. The surgical technique involved unilateral resection of the pars, pedicles, the posterior one-third of the lateral wall of the vertebral body, decancellation of the impinging kyphus, and finally resection of the posterior vertebral body wall compressing the SC followed by instrumentation and fusion two levels above and below the fused segments.
All patients survived the procedure and left the hospital after 10-22 days. Estimated blood loss was 653 ml. No deep infections occurred. One patient developed acute tubular necrosis but recovered fully. The other two showed improvement of one Frankel grade and were independent in the final follow-up. One patient developed acute tubular necrosis but recovered fully yet his neurologic status was unchaged. The other two showed improvement of one Frankel grade and were independent in the final follow-up.
The procedure described presents a compromise that fits the more elderly patient that might not be able to tolerate major deformity correction and at the same time provides similar results in the short and medium term to more extensive procedures.
由于压迫部位、畸形程度以及患者的身体状况可能不允许对畸形进行完全矫正，老年胸腰椎（TL）后凸畸形合并脊髓（SC）压迫的手术治疗面临重大挑战。在本系列研究中，我们提出一种手术方法，该方法可提供充分减压，且无椎弓根截骨/后路脊柱全切除或前路椎体次全切除相关风险。
3例患者表现为TL后凸畸形并伴有进行性神经症状。所有患者均有急性肌无力，均无法行走。脊髓在脊柱后凸顶点处受压，部分患者在胸腰段脊柱近端交界处存在椎管狭窄。手术技术包括单侧切除椎弓根峡部、椎弓根、椎体侧壁后三分之一，去除压迫性后凸的骨松质，最后切除压迫脊髓的椎体后壁，然后在融合节段上下各两个节段进行内固定和融合。
所有患者手术均成功，术后10 - 22天出院。估计失血量为653毫升。未发生深部感染。1例患者发生急性肾小管坏死，但已完全康复。另外2例患者Frankel分级提高了一级，在末次随访时可独立活动。1例患者发生急性肾小管坏死但已完全康复，但其神经功能状态未改变。另外2例患者Frankel分级提高了一级，在末次随访时可独立活动。
所描述的手术方法是一种折衷方案，适合那些可能无法耐受严重畸形矫正的老年患者，并且在短期和中期内可提供与更广泛手术相似的效果。
