Richaud J, Boetto S, Lazorthes Y
Neurosurgery. 1986 Aug;19(2):218-27. doi: 10.1227/00006123-198608000-00007.
The authors present seven cases of spinal trauma at the T-12--L-1 level with severe spinal canal stenosis secondary to compressive, anterior discocorporeal lesions. Associated neurological disorders were of varying severity. Six cases were investigated by computed tomography, which enabled the degree of thoracolumbar spinal canal stenosis to be determined. In all cases, the surgical procedure involved rectification of spinal deformity, with an initial unilateral posterolateral approach permitting anterior spinal canal recalibration, either by impaction of protrusive fragments or ablation of ejected disc fragments. The stabilization was in all cases achieved by complimentary bilateral plates using Roy-Camille material, associated with posterolateral arthrodesis by grafting with reconstruction of the articulopedicular structure. The functional spinal result was excellent in all cases, and recalibration was verified by tomography. In those cases showing neurological deficiency, good and early recovery was attributable to the suppression of spinal canal stenosis. The application of this posterolateral approach for severe lesions of the thoracolumbar junction seems to represent, in all cases of recent lesions, an alternative to the anterior or combined methods, which present widely recognized difficulties at the thoracoabdominal junction.
作者报告了7例T12 - L1水平的脊柱创伤病例，这些病例因前方椎间盘及椎体病变导致严重的椎管狭窄。相关神经功能障碍的严重程度各不相同。6例患者接受了计算机断层扫描检查，从而确定了胸腰椎椎管狭窄的程度。在所有病例中，手术过程包括矫正脊柱畸形，最初采用单侧后外侧入路，通过挤压突出的碎骨片或切除脱出的椎间盘碎骨片来实现椎管前路的重新校准。所有病例均使用Roy - Camille材料的双侧互补钢板进行固定，并通过植骨重建关节突结构进行后外侧融合。所有病例的脊柱功能结果均为优，且通过断层扫描证实了重新校准的效果。在那些存在神经功能缺损的病例中，良好且早期的恢复归因于椎管狭窄的解除。对于胸腰段交界处的严重损伤，这种后外侧入路的应用在所有近期损伤的病例中似乎是一种替代前路或联合入路的方法，因为前路或联合入路在胸腹交界处存在广泛公认的困难。
