Kato Satoshi, Yokogawa Noriaki, Shimizu Takaki, Kobayashi Motoya, Yamada Yohei, Nagatani Satoshi, Demura Satoru
Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
Spine Surg Relat Res. 2024 Jun 10;8(5):534-539. doi: 10.22603/ssrr.2024-0041. eCollection 2024 Sep 27.
In high-grade spinal osteotomy involving large anterior column resection, restoration of the structural integrity of the posterior column at the osteotomy site can reduce postoperative instrumentation failure (IF). This study aimed to describe our technique of posterior strut bone grafting using an en bloc resected vertebral arch, which is useful for posterior column reconstruction after high-grade osteotomies during surgeries for spinal tumor and deformity in the lower lumbar spine.
Using a posterior approach, en bloc resection of the targeted vertebral arch was performed in accordance with the surgical technique for total en bloc spondylectomy (TES). The posterior elements in the upper and lower adjacent vertebrae were separated by a significant space after vertebral body resection followed by cage insertion in TES or anterior column osteotomy followed by correction in deformity surgery. To create a new posterior column, the en bloc resected vertebral arch was placed at 90° rotation to bridge the upper and lower vertebral arches. Using this technique, an abundant amount of bone chips made from the resected vertebral elements were placed over the en bloc resected posterior arch as an additional bone graft. The technique was used in three patients who underwent TES for spinal tumors and in one patient who underwent grade 4 osteotomy for adult spinal deformity in the lower lumbar spine. One year after surgery, computed tomography showed that the structural integrity of bony fusion was successfully achieved between the en bloc resected arch and the posterior elements of the adjacent vertebrae in all patients and showed no postoperative IFs.
This bone graft technique created new continuity of the posterior column after high-grade osteotomies in the lower lumbar spine. Bone fusion was achieved in the posterior elements to prevent IF after surgery.
在涉及大范围前柱切除的高位脊柱截骨术中，恢复截骨部位后柱的结构完整性可减少术后内固定失败（IF）。本研究旨在描述我们使用整块切除的椎弓进行后支柱植骨的技术，该技术对于下腰椎脊柱肿瘤和畸形手术中高位截骨术后的后柱重建很有用。
采用后路入路，按照全椎体整块切除术（TES）的手术技术对目标椎弓进行整块切除。在TES椎体切除后插入椎间融合器，或在畸形矫正手术中进行前柱截骨并矫正后，上下相邻椎体的后部结构被一个较大的间隙分开。为创建一个新的后柱，将整块切除的椎弓旋转90°放置，以连接上下椎弓。使用该技术，将由切除的椎骨制成的大量骨屑作为额外的植骨放置在整块切除的后弓上。该技术应用于3例接受脊柱肿瘤TES的患者和1例接受下腰椎成人脊柱畸形4级截骨术的患者。术后一年，计算机断层扫描显示，所有患者整块切除的椎弓与相邻椎体的后部结构之间成功实现了骨融合的结构完整性，且未出现术后内固定失败。
这种植骨技术在下腰椎高位截骨术后创建了后柱的新连续性。后结构实现了骨融合，以防止术后内固定失败。
