Kostuik J P, Errico T J, Gleason T F
Clin Orthop Relat Res. 1986 Feb(203):219-31.
The indications and techniques for internal fixation of the lumbar spine in degenerative conditions have changed drastically since internal fixation was first applied to the spine almost 100 years ago. Anterior instrumentation and fusion may be used for repair of pseudarthrosis after posterolateral fusion; symptomatic lumbar scoliosis associated with degenerative disc disease; late pain secondary to posttraumatic kyphosis; postlaminectomy instability; and lumbar pain secondary to thoracolumbar kyphosis. Posterior instrumentation and fusion has been performed with Luque instrumentation over 3-4 levels in cases of multilevel instability. Combined anterior and posterior instrumentation and fusion are required for lumbosacral fusion in lumbar scoliosis with degenerative disease, and surgical correction of postsurgical lumbar kyphosis (flat-back syndrome). The techniques are demanding but with attention to detail can be performed with acceptably low-complication rates.
自从大约100年前首次将内固定应用于脊柱以来，腰椎退变疾病的内固定适应证和技术发生了巨大变化。前路器械固定和融合可用于后路外侧融合术后假关节的修复；与退行性椎间盘疾病相关的症状性腰椎侧弯；创伤后驼背继发的晚期疼痛；椎板切除术后不稳定；以及胸腰段驼背继发的腰痛。对于多节段不稳定病例，已采用Luque器械在3 - 4个节段进行后路器械固定和融合。对于伴有退行性疾病的腰椎侧弯的腰骶融合以及术后腰椎后凸（平背综合征）的手术矫正，需要联合前路和后路器械固定及融合。这些技术要求较高，但注意细节可使并发症发生率保持在可接受的低水平。
