Joyce David M, Granville Michelle, Jacobson Robert E
Pain Management, Larkin Community Hospital, Miami, USA.
Neurosurgery, University of Miami Hospital, Miami, USA.
Cureus. 2021 Mar 11;13(3):e13839. doi: 10.7759/cureus.13839.
The surgical treatment of osteoporotic vertebral fractures with greater than 70% collapse, known as "Vertebra Plana (VP)" has been controversial. Originally VP was a considered a contraindication to vertebroplasty or kyphoplasty because of presumed difficulty of entering the collapsed vertebra as well as obtaining significant re-expansion or correct associated sagittal kyphosis. In some cases, multilevel pedicle screw fixation with or without attempts to correct the collapse is still performed to correct the kyphosis or prevent progression. With experience it was clear that the pedicle could be accessed and VP could be treated without added risk of epidural leak of cement or epidural extravasation. Now, with the introduction of newer third-generation intraspinal expansion devices that are larger and need to be placed bilaterally, their use in cases of VP was again an issue since VP cases were excluded from the original multicenter studies used for worldwide approval. This report reviews six cases of VP treated with bilateral SpineJack® implants (Stryker Corp, Kalamazoo, Michigan, USA) demonstrating it is not only feasible to place these larger size implants but achieve significant reconstitution of vertebral height as well as correction of the kyphotic deformity.
对于塌陷程度超过70%的骨质疏松性椎体骨折，即所谓的“椎体扁平症（VP）”，其手术治疗一直存在争议。最初，VP被认为是椎体成形术或后凸成形术的禁忌证，原因是进入塌陷椎体存在困难，以及难以实现显著的再扩张或纠正相关的矢状面后凸畸形。在某些情况下，仍会进行有或没有尝试纠正塌陷的多级椎弓根螺钉固定，以纠正后凸畸形或防止病情进展。随着经验的积累，人们清楚地认识到可以进入椎弓根，并且治疗VP不会增加骨水泥硬膜外渗漏或硬膜外外渗的风险。现在，随着更新的第三代椎管内扩张装置的引入，这些装置更大且需要双侧放置，它们在VP病例中的应用再次成为一个问题，因为VP病例被排除在用于全球批准的原始多中心研究之外。本报告回顾了6例使用双侧SpineJack®植入物（美国密歇根州卡拉马祖的史赛克公司）治疗的VP病例，表明放置这些较大尺寸的植入物不仅可行，而且能显著恢复椎体高度并纠正后凸畸形。
