ZÁrate-KalfÓpulos BarÓn, Navarro-Aceves Luis Alberto, Reynoso-CantÚ Hugo, Reyes-SÁnchez Alejandro, GarcÍa-Ramos Carla Lissette, Reyes-TarragÓ Fernando, AlpÍzar-Aguirre Armando
Spine Surgery Service, National Institute of Rehabilitation, Mexico City, Mexico.
Int J Spine Surg. 2020 Jun 30;14(3):300-307. doi: 10.14444/7040. eCollection 2020 Jun.
In the retrospective study of a prospectively maintained database, we present a case series of patients with kyphotic deformity secondary to spinal infection treated using a posterior-only approach with 3-column shortening and posterior instrumentation.
This is a case series of patients presenting with postural deformity and sagittal imbalance treated consecutively by 1 surgeon between 2012 and 2014. Clinical assessments and radiographic evaluations were made preoperatively and at 12- and 24-month postoperative follow-ups. All patients underwent computed tomography 24 months after surgery to evaluate spinal fusion.
The study included 5 patients with a mean age of 50 years (range, 32-60 years). Three patients had comorbidities. Three patients were classified as American Spinal Injury Association (ASIA) grade C and were not ambulatory; 2 were ASIA grade D. At follow-up, all patients were ambulatory and classified as ASIA grade E. Kyphosis was corrected from a preoperative mean of 32° (range, 15°-58°) to 10° (range, 1°-42°) at the 2-year follow-up. A mean improvement of 22° and 75% reduction in kyphosis was obtained with fixation 2 levels above and below the lesion. Interbody fusion was observed in all patients. No major complications occurred during surgery.
Posterior grade 4 osteotomy with vertebral shortening can be performed safely in patients with kyphosis associated with vertebral discitis/osteomyelitis in the thoracolumbar region. The single approach allowed the surgeon to debride the infection, correct the kyphosis, decompress the spinal canal, and stabilize the spine.
在一项对前瞻性维护数据库的回顾性研究中，我们展示了一系列因脊柱感染继发脊柱后凸畸形的患者病例，这些患者采用单纯后路三柱缩短和后路内固定方法进行治疗。
这是一组2012年至2014年间由1名外科医生连续治疗的伴有姿势性畸形和矢状面失衡的患者病例系列。在术前以及术后12个月和24个月随访时进行临床评估和影像学评估。所有患者在术后24个月接受计算机断层扫描以评估脊柱融合情况。
该研究纳入了5名平均年龄为50岁（范围32 - 60岁）的患者。3名患者有合并症。3名患者被分类为美国脊髓损伤协会（ASIA）C级，不能行走；2名是ASIA D级。在随访时，所有患者都能行走，且被分类为ASIA E级。后凸畸形从术前平均32°（范围15° - 58°）在2年随访时矫正至10°（范围1° - 42°）。在病变上下各固定2个节段，后凸畸形平均改善22°，减少75%。所有患者均观察到椎间融合。手术期间未发生重大并发症。
对于胸腰段椎间盘炎/骨髓炎相关的脊柱后凸患者，后路4级截骨椎体缩短术可安全实施。单一手术入路使外科医生能够清除感染、矫正后凸、减压椎管并稳定脊柱。
4级。
