Kuner E H, Schlickewei W, Kuner A, Hauser U
Department of Surgery, Albert-Ludwigs-University Freiburg, Germany.
Eur Spine J. 1997;6(6):417-22. doi: 10.1007/BF01834072.
It has been observed that after reduction of an unstable vertebral fracture, treated either conservatively or operatively, the encroachment of the spinal canal remaining after reduction can decrease considerably with time. A series of 31 cases, each with a set of CT scans taken preoperatively, immediately after surgery and after implant removal respectively, was assessed using computer-aided planimetry. The mean initial narrowing of the spinal canal was 44.6%. Through surgery this was decreased by 20.4%, leaving a remaining deficit of 24.2%. After implant removal, 15 months after trauma and surgery, the area of the spinal canal increased a further 17.4%, leaving a remaining deficit of only 6.8%. Comparing the values of the spinal canal for T12-L5 directly after surgery and after implant removal, an almost identical degree of restoration for each level can be seen. This additional and gradual restoration of the spinal canal is termed remodeling. This study demonstrates that a residual postoperative narrowing of the spinal canal of up to 25% can be ignored, provided there is no initial neurologic damage.
据观察，不稳定型椎体骨折复位后，无论采用保守治疗还是手术治疗，复位后残留的椎管狭窄会随时间显著减轻。使用计算机辅助平面测量法对31例患者进行了评估，每位患者分别在术前、术后即刻及取出内固定物后进行了一系列CT扫描。椎管平均初始狭窄率为44.6%。通过手术，狭窄率降低了20.4%，仍有24.2%的残留缺损。在创伤和手术后15个月取出内固定物后，椎管面积进一步增加了17.4%，仅留下6.8%的残留缺损。比较术后即刻和取出内固定物后T12-L5节段的椎管值，可以发现每个节段的恢复程度几乎相同。椎管的这种额外的渐进性恢复被称为重塑。本研究表明，如果最初没有神经损伤，术后椎管残留狭窄达25%可被忽略。
