Li Tao, Zhao Zhi, Wang Yingsong, Xie Jingming, Zhang Ying, Bi Ni, Shi Zhiyue, Lu Qiuan, Li Quan
Department of Orthopaedic Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China.
Medicine (Baltimore). 2020 Aug 7;99(32):e21579. doi: 10.1097/MD.0000000000021579.
Posterior vertebral column resection (PVCR) was the most powerful technique for treating severe rigid spinal deformity, but it has been plagued with high neurologic deficits risk. The fluctuations of spinal cord blood flow (SCBF) play an important role in secondary spinal cord injury during deformity correction surgery.The objective of this study was to first provide the characteristic of SCBF during PVCR with spinal column shortening in severe rigid spinal deformity.Severe rigid scoliokyphosis patients received PVCR above L1 level were included in this prospective study. Patients with simple kyphosis, intraspinal pathology and any degree of neurologic deficits were excluded. The deformity correction was based on spinal column shortening over the resected gap during PVCR. Laser Doppler flowmetry was used to monitor the SCBF at different surgical stages.There were 12 severe rigid scoliokyphosis patients in the study. The baseline SCBF was 316 ± 86 perfusion unite (PU), and the SCBF decreased to 228 ± 68 PU after VCR (P = .008). The SCBF increased to 296 ± 102 PU after the middle shortening and correction which has a 121% increased comparison to the SCBF after VCR (P = .02). The SCBF will slightly decrease to 271 ± 65 PU at final fixation. The postoperative neural physical examination of all patients was negative, and the MEP and SSEP of all patients did not reach the alarm value during surgery.These results indicate that PVCR is accompanied by a change in SCBF, a proper spinal cord shortening can protect the SCBF and can prevent a secondary spinal cord injury during the surgery.
后路脊柱切除术（PVCR）是治疗严重僵硬性脊柱畸形最有效的技术，但一直存在较高的神经功能缺损风险。脊髓血流（SCBF）的波动在畸形矫正手术中的继发性脊髓损伤中起重要作用。本研究的目的是首先提供严重僵硬性脊柱畸形患者在PVCR脊柱缩短过程中SCBF的特征。本前瞻性研究纳入了L1水平以上接受PVCR的严重僵硬性脊柱后凸畸形患者。排除单纯脊柱后凸、椎管内病变及任何程度神经功能缺损的患者。畸形矫正基于PVCR切除间隙处的脊柱缩短。采用激光多普勒血流仪监测不同手术阶段的SCBF。本研究中有12例严重僵硬性脊柱后凸畸形患者。基线SCBF为316±86灌注单位（PU），VCR后SCBF降至228±68 PU（P = 0.008）。在进行中部缩短和矫正后，SCBF增加至296±102 PU，与VCR后的SCBF相比增加了121%（P = 0.02）。在最终固定时，SCBF将略有下降至271±65 PU。所有患者术后神经体格检查均为阴性，所有患者的运动诱发电位（MEP）和体感诱发电位（SSEP）在手术期间均未达到报警值。这些结果表明，PVCR伴随着SCBF的变化，适当的脊髓缩短可以保护SCBF，并可防止手术期间继发性脊髓损伤。
