Byvaltsev Vadim A, Kalinin Andrei A, Polkin Roman A, Shepelev Valerii V, Aliyev Marat A, Dyussembekov Yermek K
Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia.
Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia.
J Craniovertebr Junction Spine. 2021 Jul-Sep;12(3):294-301. doi: 10.4103/jcvjs.jcvjs_47_21. Epub 2021 Sep 8.
The objective of this study was to analyze the results of surgical treatment of patients with unstable injuries of the thoracolumbar spine using simultaneous minimally invasive corpectomy and percutaneous transpedicular stabilization.
The retrospective study included 34 patients with isolated single-level unstable injuries of the thoracolumbar spine (5 or more points according to the Thoracolumbar Injury Classification and Severity Score (TLICS), operated on from the moment of injury from 8 to 24 h using the technique of minimally invasive corpectomy and percutaneous transpedicular stabilization simultaneously. The technical features of surgery, clinical data (pain level according to the Visual Analog Scale, quality of life according to the SF-36 questionnaire, subjective satisfaction with the operation according to the MacNab scale, and the presence of complications), and instrumental data (angle of segmental kyphotic deformity and sagittal index to and after surgery). The assessment of clinical data was carried out before surgery, at discharge, after 6 months, and in the long-term period, on average, 30 months after surgery.
When evaluating the clinical data, a significant decrease in the severity of pain syndrome was found on average from 90 mm to 5.5 mm in the late follow-up ( < 0.001), as well as a significant improvement in the physical and psychological components of health according to the SF-36 questionnaire on average from 28.78 to 39.26 ( < 0.001), from 36.93 to 41.43 ( = 0.006), respectively. In the long-term period, according to the MacNab scale, the patients noted the result of the operation: excellent - 18 (52.9%), good - 13 (38.3%), and satisfactory - 3 (8.8%); no unsatisfactory results were registered. Four (11.8%) perioperative surgical complications were registered, which were successfully treated conservatively. A significant restoration of the sagittal profile with an insignificant change in blood pressure was recorded in the long-term postoperative period. An average follow-up assessment of 30 months according to the American Spinal Injury Association scale showed the presence of E and D degrees in 85.4% of patients.
Minimally invasive corpectomy with percutaneous transpedicular stabilization in the treatment of patients with unstable injuries of the thoracolumbar spine can effectively eliminate kyphotic deformity and prevent the loss of its reduction with a low number of postoperative surgical complications. The technique has minimal surgical trauma with the possibility of early postoperative rehabilitation and provides a significant stable reduction in vertebrogenic pain syndrome, improvement of neurological deficits, and restoration of the quality of life of patients and in the follow-up.
本研究的目的是分析采用同期微创椎体次全切除术和经皮椎弓根内固定术治疗胸腰椎不稳定损伤患者的手术结果。
这项回顾性研究纳入了34例孤立的单节段胸腰椎不稳定损伤患者（根据胸腰椎损伤分类和严重程度评分（TLICS）为5分或更高），在受伤后8至24小时采用微创椎体次全切除术和经皮椎弓根内固定术同期进行手术。记录手术的技术特点、临床数据（根据视觉模拟量表的疼痛程度、根据SF-36问卷的生活质量、根据MacNab量表对手术的主观满意度以及并发症情况）以及影像学数据（术前和术后的节段后凸畸形角度和矢状指数）。临床数据评估在术前、出院时、术后6个月以及长期随访（平均术后30个月）时进行。
在评估临床数据时，发现晚期随访时疼痛综合征的严重程度平均从90毫米显著降至5.5毫米（P<0.001），并且根据SF-36问卷，健康的身体和心理成分平均分别从28.78显著提高至39.26（P<0.001）、从36.93提高至41.43（P = 0.006）。在长期随访中，根据MacNab量表，患者对手术结果的评价为：优 - 18例（52.9%），良 - 13例（38.3%），可 - 3例（8.8%）；未出现不满意结果。记录到4例（11.8%）围手术期手术并发症，经保守治疗成功治愈。术后长期随访时记录到矢状面形态显著恢复，血压变化不显著。根据美国脊髓损伤协会量表进行的平均30个月随访评估显示，85.4%的患者存在E级和D级。
采用微创椎体次全切除术联合经皮椎弓根内固定术治疗胸腰椎不稳定损伤患者，可有效消除后凸畸形并防止其复位丢失，术后手术并发症数量少。该技术手术创伤极小，术后可早期康复，能显著稳定减轻椎源性疼痛综合征，改善神经功能缺损，恢复患者生活质量并在随访中保持良好效果。
