Moura Diogo Lino, Cavaca Ana Rita
Spine Unit, Orthopedics Department, Coimbra University Hospital, Coimbra, Portugal, Coimbra, Portugal.
Anatomy Institute and Orthopedics Department, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
Front Surg. 2023 Apr 27;10:1142679. doi: 10.3389/fsurg.2023.1142679. eCollection 2023.
Post-traumatic vertebral necrosis and pseudarthrosis represents one of the most concerning and unpredictable challenges in spinal traumatology. The evolution of this disease at the thoracolumbar transition usually courses with progressive bone resorption and necrosis, leading to vertebral collapse, retropulsion of the posterior wall and neurological injury. As such, the therapeutic goal is the interruption of this cascade, seeking to stabilize the vertebral body and avoid the negative consequences of its collapse.
We present a clinical case of a pseudarthrosis of T12 vertebral body with severe posterior wall collapse, treated with removal of intravertebral pseudarthrosis focus by transpedicular access, T12 armed kyphoplasty with VBS® stents filled with cancellous bone autograft, laminectomy and stabilization with T10-T11-L1-L2 pedicle screws. We present clinical and imaging detailed results at 2-year follow-up and discuss our option for this biological minimally invasive treatment for vertebral pseudarthrosis that mimics the general principles of atrophic pseudarthrosis therapeutic and allows to perform an internal replacement of the necrotic vertebral body, avoiding the aggression of a total corpectomy.
This clinical case demonstrates a successful outcome of the surgical treatment of pseudarthrosis of vertebral body (mobile nonunion vertebral body) in which expandable intravertebral stents allow to perform an internal replacement of the necrotic vertebral body by creating intrasomatic cavities and filling them with bone graft, obtaining a totally bony vertebra with a metallic endoskeleton, which is biomechanically and physiologically more similar to the original one. This biological internal replacement of the necrotic vertebral body technique can be a safe and effective alternative over cementoplasty procedures or total vertebral body corpectomy and replacement for vertebral pseudarthrosis and may have several advantages over them, however long-term prospective studies are needed in order to prove the effectiveness and advantages of this surgical option in this rare and difficult pathological entity.
创伤后椎体坏死和假关节形成是脊柱创伤学中最令人担忧且难以预测的挑战之一。胸腰段交界处这种疾病的演变通常伴随着进行性骨质吸收和坏死，导致椎体塌陷、后壁后凸以及神经损伤。因此，治疗目标是中断这一连锁反应，力求稳定椎体并避免其塌陷带来的不良后果。
我们展示了一例T12椎体假关节伴严重后壁塌陷的临床病例，通过经椎弓根入路清除椎体内假关节病灶，使用填充自体松质骨的VBS®支架进行T12强化后凸成形术，行椎板切除术并用T10 - T11 - L1 - L2椎弓根螺钉进行固定。我们展示了2年随访时的临床和影像学详细结果，并讨论了这种针对椎体假关节的生物微创治疗方案，该方案模仿萎缩性假关节治疗的一般原则，能够对坏死椎体进行内部置换，避免了全椎体切除术的侵袭性。
该临床病例证明了椎体假关节（活动型椎体不愈合）手术治疗的成功结果，其中可扩张椎体内支架通过创建体内腔隙并用骨移植填充，从而对坏死椎体进行内部置换，获得一个带有金属内骨骼的完全骨性椎体，其在生物力学和生理学上与原始椎体更相似。这种坏死椎体的生物内部置换技术相对于骨水泥成形术或全椎体切除术及置换术治疗椎体假关节而言，可能是一种安全有效的替代方法，并且可能具有一些优势，然而需要长期前瞻性研究来证明这种手术方案在这种罕见且困难的病理实体中的有效性和优势。
