Lazennec J Y, Saillant G, Saidi K, Arafati N, Barabas D, Benazet J P, Laville C, Roy-Camille R, Ramaré S
Department of Orthopaedics, Hôpital de la Pitié, Paris, France.
Eur Spine J. 1997;6(4):222-32. doi: 10.1007/BF01322443.
Corrective surgery for kyphotic deformities of the spine in ankylosing spondylitis is a major surgery for rare indications. The authors report 31 lumbar osteotomies. The goal is to correct the deformity through a posterior limited approach and to minimise the neurological risks. The modifications developed by the authors for monosegmental closing wedge osteotomies are explained. The posterior resection is rhomboid shaped with a bilateral lamina removal. An osteotomy is performed in a forwards direction on the lateral aspects of the vertebral body without bone resection. This osteoclasty allows progressive vertebral body compression. Pediclectomy is associated if the corresponding foramen at the osteotomy level becomes too narrow in the process of redressing the spine. The resection level is adjusted so that superior and inferior posterior arches come into contact with a good compression. The authors point out the risk of lateral translation. Before the osteotomy, the two adjacent vertebrae are implanted with 5-mm cylindrical pedicular screws, so that posterior fixation can be carried out at any time. Posterior monobloc fixation allows for very great compression of the osteoclasty. The authors compare the results of their experiences in opening and closing osteotomy. They progressively changed their technique for closing osteotomies, because of published vascular complications and mechanical risks (instability and pseudarthrosis in opening osteotomies). Closing osteotomy also minimises the risk of stenosis with radicular compression or traction if an important correction is performed. The level of the osteotomy varied in this series, which had a correction rate of up to 75 degrees. The choice of level depends on secondary effects on pelvic position and projection of the centre of gravity. The preferred procedure remains a monosegmental correction because it is faster and easier, with minimum bleeding. Short monobloc posterior fixation is sufficient to maintain reduction and to obtain stability from posterior compression.
强直性脊柱炎脊柱后凸畸形的矫正手术是一种针对罕见适应症的大型手术。作者报告了31例腰椎截骨术。目标是通过后路有限入路矫正畸形，并将神经风险降至最低。作者解释了针对单节段闭合楔形截骨术所做的改进。后路切除呈菱形，双侧椎板切除。在椎体侧面进行向前的截骨，不切除骨质。这种截骨术可使椎体逐渐压缩。如果在矫正脊柱过程中截骨水平处相应的椎间孔变得过窄，则进行椎弓根切除术。调整切除水平，以使上下后弓良好压缩时相互接触。作者指出了侧方移位的风险。在截骨术前，在相邻的两个椎体上植入5毫米圆柱形椎弓根螺钉，以便随时进行后路固定。后路整块固定可使截骨术得到极大的压缩。作者比较了开放截骨术和闭合截骨术的经验结果。由于已发表的血管并发症和机械风险（开放截骨术中的不稳定和假关节形成），他们逐渐改变了闭合截骨术的技术。如果进行重要矫正，闭合截骨术还可将神经根受压或牵拉导致狭窄的风险降至最低。本系列中截骨水平各不相同，矫正率高达75度。截骨水平的选择取决于对骨盆位置和重心投影的继发影响。首选的手术方法仍然是单节段矫正，因为它更快、更容易，出血最少。短节段后路整块固定足以维持复位并通过后路压缩获得稳定性。
