Rodgers W B, Williams M S, Schwend R M, Emans J B
Department of Orthopaedic Surgery, Children's Hospital, Boston, Massachusetts, USA.
Spine (Phila Pa 1976). 1997 Oct 15;22(20):2435-43. doi: 10.1097/00007632-199710150-00022.
A retrospective review of transpedicular instrumentation used in a series of 24 patients with myelodysplastic spinal deformities and deficient posterior elements.
To describe the usefulness and efficacy of these instruments in the treatment of complicated myelodysplastic spinal deformity.
The mean preoperative scoliosis was 75.7 degrees (range, 39-130 degrees) in the 22 patients with scoliotic deformities; 4 patients with thoracic hyperkyphoses averaged 70.5 degrees (range, 46-90 degrees) and 10 patients with lumbar kyphoses averaged 80.5 degrees (range, 42-120 degrees). The instrumentation extended to the sacrum in 4 patients and the pelvis in 9; 10 patients also underwent anterior release and fusion and 7 underwent concomitant spinal cord detethering. At an average follow-up of 4.0 years (2.0-7.7 years; one patient died at 8 months), all patients have fused (with the exception of two lumbosacral pseudarthroses).
At last follow-up, deformity measured 32.1 degrees scoliosis (range, 6-85 degrees), 30.8 degrees thoracic kyphosis (range, 24-35 degrees), and 0.0 degree lumbar kyphosis (range, 35 degrees kyphosis to 29 degrees lordosis). Three patients lost some neurologic function after surgery; two recovered within 6 months and one has incomplete recovery. No ambulatory patient lost the ability to walk. Five patients required additional surgical procedures; in three cases, there was instrumentation breakage associated with pseudarthrosis or unfused spinal segments.
Pedicle screw instrumentation is uniquely suited to the deficient myelodysplastic spine. Compared with historical control subjects, these devices have proven capable of significant correction of both scoliotic and kyphotic deformities. This instrumentation appears particularly useful in preserving lumbar lordosis in all patients and may preserve more lumbar motion in ambulatory myelodysplasia patients.
对24例患有脊髓发育不良性脊柱畸形且后方结构缺损的患者所使用的经椎弓根器械进行回顾性研究。
描述这些器械在治疗复杂脊髓发育不良性脊柱畸形中的实用性和有效性。
22例患有脊柱侧凸畸形的患者术前脊柱侧凸平均为75.7度（范围39 - 130度）；4例患有胸椎后凸畸形的患者平均为70.5度（范围46 - 90度），10例患有腰椎后凸畸形的患者平均为80.5度（范围42 - 120度）。4例患者的器械延伸至骶骨，9例延伸至骨盆；10例患者还接受了前路松解融合术，7例患者同时进行了脊髓松解术。平均随访4.0年（2.0 - 7.7年；1例患者在8个月时死亡），所有患者均已融合（除2例腰骶部假关节外）。
在最后一次随访时，脊柱侧凸畸形为32.1度（范围6 - 85度），胸椎后凸为30.8度（范围24 - 35度），腰椎后凸为0.0度（范围从后凸35度至前凸29度）。3例患者术后出现一些神经功能丧失；2例在6个月内恢复，1例恢复不完全。没有能行走的患者失去行走能力。5例患者需要额外的手术；3例中，器械断裂与假关节或未融合的脊柱节段有关。
椎弓根螺钉器械特别适用于发育不良的脊髓脊柱。与历史对照对象相比，这些器械已证明能够显著矫正脊柱侧凸和后凸畸形。这种器械在所有患者中似乎对保留腰椎前凸特别有用，并且可能在能行走的脊髓发育不良患者中保留更多的腰椎活动度。
