合并椎板骨折的L_2-L_5爆裂性骨折伴硬膜及马尾神经卡压

目的 探讨合并椎板骨折的L2-L5爆裂性骨折中硬脊膜撕裂及马尾神经卡压的创伤机制、发生率,以及哪些临床和影像学表现有助于术前判断硬脊膜撕裂和马尾神经卡压.方法 对36例行手术治疗的合并椎板骨折的L2-L5爆裂性骨折进行回顾性分析.结果 36例中,16例(44.4%)并发硬脊膜撕裂,有硬脊膜撕裂的患者神经损伤程度明显重于无硬脊膜撕裂的患者,前者伤椎椎弓根间距增宽率明显高于后者.结论 对于椎板骨折,尤其是裂缝骨折的患者,术前很难通过影像学表现明确判断是否有硬脊膜撕裂及马尾神经卡压.因此只要怀疑有硬脊膜撕裂,应首先选择后路手术方案,任何复位操作宜在椎管减压之后进行.     

Treatment of Patients with Unstable Fractures of the Thoracic and Lumbar Spine: A Follow-up Study of Surgical and Conservative Treatment

A follow-up study was made to compare the effect of surgical reduction and stabilization of unstable vertebral fractures with the results of conservative treatment. Twenty patients treated by conservative methods and 18 patients subjected to surgical stabilization were analyzed with respect to period of immobilization, healing time, degree of residual deformity, neurological restitution and incidence of complications. The wide variety of initial impairment did not permit any definite conclusions with regard to neurological restitution. In all other respects, however, surgical stabilization produced better results as reflected by shorter periods of immobilization, hospitalization and rehabilitation, less residual deformity, and a lower incidence of complications. It may be concluded therefore that surgical treatment of unstable vertebral fractures may be of benefit to both patients and society.     

后路减压椎弓根钉内固定治疗胸腰椎骨折伴不全瘫

目的探讨经后路减压椎弓根钉内固定手术治疗胸腰椎骨折合并不全瘫的术后神经功能恢复效果。方法回顾性分析2005年1月到2006年1月收治的胸腰椎骨折脱位合并不全瘫病例共30例,其中男性21例,女性9例。神经损伤按照ASIA分级,B级10例,C级12例,D级8例。所有病例均采用后路椎弓根钉短节段固定减压手术。结果所有病例均得到有效随访,平均28.3个月,脊柱后凸角度（Cobb′s角）由术前的（24.3±4.6）°平均恢复到（3.6±1.2）°;伤椎椎体前缘高度恢复率由术前（35.8±5.3）%平均恢复到（90.2±3.8）%;椎管占有率由手术前平均（58.3±10.7）%恢复至术后平均（8.4±1.7）%。神经功能ASIA分级术后随访部分有明显改善。Dennis工作评分：11例患者可以再次获得稳定工作。结论后路减压椎弓根内固定手术治疗胸腰段骨折固定确实,且手术后对于神经恢复有良好改善,能使部分患者恢复工作。     

Nerve Root Signs on Postoperative Lumbar MR Imaging A Prospective Cohort Study with Contrast Enhanced MRI in Symptomatic and Asymptomatic Patients one Year After Microdiscectomy

Summary  The association between postoperative nerve root signs and outcome was investigated in 54 out of one hundred patients operated on by lumbar microdiscectomy in a prospective cohort study with one year follow up. The patients were classified as failures or successes at the 12 month follow up according to a clinical overall score. All the 14 failures were investigated with MRI at the one year follow up, and 40 patients classified as successes were picked at random for MRI. Three patients with signs of recurrent disc herniation on MRI were excluded from the study. The MRI scans were independently read by two neuroradiologists who were ignorant of treatment outcome. No association between nerve root thickening, nerve root enhancement or nerve root displacement and the clinical outcome was found when patients with recurrent disc herniation were excluded.     

Intra-Operative Neurophysiological Monitoring in Patients with Thoracic Spinal Stenosis: Its Feasibility and High-Risk Factors for New Neurological Deficit

Objective

Considering the high risk of postoperative neurological complications for patients with thoracic spinal stenosis (TSS), intra-operative neurophysiological monitoring (IONM) has been used for detecting possible iatrogenic injury timely. However, the IONM waveforms are often unreliable. This article is designed to determine the test performance of somatosensory evoked potentials (SEP) and motor evoked potentials (MEP) during surgical thoracic decompression in patients with TSS, and to investigate the risk factors associated with deteriorated neurologic function at immediate postoperation.

Methods

Patients undergoing posterior spinal fusion from February 2009 to December 2020 were retrospectively reviewed. Patients were divided into the deteriorated neurologic function (DNF) group and the improved/intact neurological function (INF) group based on the postoperative neurological status. Demographic parameters such as gender, age, height, weight, etiology and IONM data were compared between groups. Demographics and IONM data between DNF and INF groups were compared by independent t or nonparametric tests. The incidence of abnormal SEP was analyzed by Chi-square test.

Results

A total of 108 patients (63 males, 45 females) with an average age of 53.5 ± 14.0 years were included. The SEP and MEP records were available in 94 and 98 patients, with the overall success rates being 87.0% and 90.7%, respectively. The sensibilities and specificities were 100% and 88.2% for SEP, 100% and 98.8% for MEP, respectively. There were 17 patients in DNF group and 91 patients in INF group. High weight (79.1 ± 14.6 vs 69.7 ± 15.7 kg, P = 0.024), high inter-side difference of MEP amplitude (899.1 ± 997.5 vs 492.3 ± 512.4 μV, P = 0.013) and high incidence of abnormal SEP (94.1% vs 64.8%, P = 0.024) were observed in the DNF group. Fourteen (82.4%) patients in the DNF group showed improvement in neurological status during follow-up.

Conclusions

The overall success rates were 87.0% for SEP and 90.7% for MEP in patients with TSS.     

Long-Term Results in Patients Treated with Posterior Instrumentation and Fusion for Degenerative Scoliosis of the Lumbar Spine

Summary  The authors report a homogeneously investigated and surgically treated series of 4 0 patients with degenerative scoliosis of the lumbar spine. The series included 22 females and 18 males with a mean age of 62.8 years. The clinical presentation, the diagnostic work-up, the indication for surgery, the surgical techniques and results are reported. Final evaluation was possible in 30 patients at a mean period of observation of 59.5 months. Following a very precise diagnostic and therapeutic protocol excellent, good and satisfactory surgical results were obtained in 13 (43.3%), 16 (53.3%) and 1 (3.3%) patients, respectively. While scoliosis was converted from a mean preoperative Cobb angle of 18.7° to 7.6° mean pre-operative lumbar lordosis was slightly augmented from 37° to 41.5°. The results suggest that maintainance or correction of lumbar lordosis is more important than the conversion of the scoliotic deformity which is probably treated sufficiently by partial correction and stabilization.  Observation over time indicates that the degenerative cascade evolves despite internal fixation and fusion in the majority of the patients until a stable state is reached. This stable state is probably rather the result of ankylosis of the facet joints than the effect of posterolateral fusion.     

Bone Density Reduction in Various Measurement Sites in Men and Women with Osteoporotic Fractures of Spine and Hip: The European Quantitation of Osteoporosis Study

We have measured bone mineral density (BMD) using dual X-ray absorptiometry (DXA) of the spine and hip, spinal quantitative computed tomography (QCTspi), and peripheral radial quantitative computed tomography (pQCTrad) in 334 spine and 51 hip fracture patients. The standardized hip and spine BMD for each patient was calculated and compared with the combined reference ranges published previously, each densitometer having been cross-calibrated with the prototype European Spine Phantom (ESPp) or the European Forearm Phantom (EFP). Male and female fracture cases had similar BMD values after adjusting for body size, where appropriate. This suggests that the relationship between bone density (mass per unit volume) and fracture risk is similar between men and women. However, compared with age-matched controls, mean decreases in BMD ranged from 0.78 SD units (women with hip fracture, DXAspi) to 2.57 SD units (men with spine fractures, QCTspi). The proportion of spine and hip fracture patients falling below the cutoff for osteoporosis (T-score <−2.5 SD) proposed by the World Health Organization (WHO) study group varied according to different BMD measurement procedures (range 18–94%). This finding suggests that the WHO definition requires different thresholds when used with non-DXA BMD measurement techniques. Receiver operator characteristic (ROC) analysis was used to compare measurement techniques for their ability to discriminate between cases and controls. Among DXA sites, the proximal femur was preferred when evaluating generalized bone loss, particularly in elderly people. An additional spinal BMD measurement may add clinical value if spine fracture risk assessment has a high priority. Both axial and peripheral QCT techniques performed comparably to DXA in spinal osteoporosis, so investigators and clinicians may use any of the three technologies with similar degrees of confidence for the diagnosis of generalized or site-specific bone loss providing straightforward clinical guidelines are followed. Received: 21 May 1997 / Accepted: 24 June 1998