下腰椎融合术52例

随着内固定技术的发展,腰椎间融合手术应用越来越广,手术疗效也得到肯定。然而,如何选择创伤小、融合率高且并发症少的融合方法一直是医师广泛关注的课题之一。我院2003年1月～2006年12月应用经单侧椎间孔腰椎间融合术（Trasforaminal lumbar interbody fusion,TLIF）行下腰椎融合52例,取得较好疗效。     

Technical strategies and anatomic considerations for parapedicular access to thoracic and lumbar vertebral bodies

Objectives To investigate and illustrate a variation on the traditional percutaneous access to the vertebral body via a parapedicular approach. Design An effective parapedicular access technique that could safely and reliably guide the needle tip into the center of the vertebral body was developed from cadaver dissection observations for the purpose of clinical use. Patients A total of 102 vertebral compression fractures from T-4 to L-5 were treated via the parapedicular access at our institution between July 2005 and March 2006. There were 72 patients between the ages of 17 and 96 years (mean age: 68.2 years) who underwent treatment. Results The cadaver dissection revealed a relatively avascular and aneural portion of the vertebral body along the superior margin of the vertebral body-pedicle junction. A total 102 vertebral fractures were treated using the parapedicular access technique without any recognized clinical complications from the needle access or the instrumentation. Conclusions The thoracic and lumbar vertebral bodies may be safely, reliably, and reproducibly accessed using a percutaneous parapedicular access technique. The technique presented represents a relatively avascular and aneural approach to vertebral body.     

Prediction of the compressive strength of vertebral bodies of the lumbar spine by quantitative computed tomography

The ultimate compressive strength of 36 thoracolumbar vertebrae was determined experimentally. In addition, the trabecular bone mineral content was measured by single energy quantitative computed tomography. The areas of fractured endplates were also determined by computed tomography. The results show that a linear relationship exists between the compressive strength and the product of bone density and endplate area. These data allow an in vivo prediction of vertebral body strength using a noninvasive method with a standard error of estimate amounting to less than 0.95 kN.This study was supported by a grant from the Wolfgang Ritter-Stiftung     

Idiopathic segmental sclerosis of vertebral bodies

Five cases of idiopathic vertebral sclerosis are presented. The features of this condition are segmental vertebral sclerosis of a single lumbar vertebra in a young adult without disc space narrowing or alteration of vertebral contour. The differential diagnosis is discussed. Lumbar vertebra biopsies of three patients showed reactive nonspecific osteosclerosis.     

Vacuum clefts of the vertebral bodies

BACKGROUND AND PURPOSE: The appearance of vacuum clefts (VCs) of the vertebral bodies has frequently been considered pathognomonic for avascular necrosis. Until recently, this was considered to be a rare finding that might indicate excessive motion at the fracture site. Our aim in this retrospective study was to determine the occurrence and location of these clefts in patients with osteoporotic vertebral fractures and evaluate the risk factors involved for developing these clefts in such patients. METHODS: The records of 66 patients with 101 painful osteoporotic vertebral fractures who were treated by vertebroplasty in our department were reviewed. All the fractures with VCs were collected. Age, sex, degree of deformity, and extent of degenerative changes in the adjacent disk space were compared with those found in the patients without clefts. RESULTS: VCs were found in 26 fractured vertebrae of 26 patients. They were significantly more common in elderly men who had deformed fractures located at the thoracolumbar junction, when compared with fractures without clefts, especially when degenerative changes were observed in the adjacent disk space. CONCLUSION: This study suggests that VCs, which have long been considered pathognomonic for avascular necrosis (Kümmell disease), are not rare and most probably represent fracture nonunion. Elderly patients who have deformed fractures at the thoracolumbar area have a higher risk for developing clefts, mainly when there is degeneration of the adjacent disk space.     

Progressive non-infectious anterior vertebral fusion

Four cases of progressive non-infectious anterior vertebral fusion are described. Three cases remain relatively asymptomatic, but one has developed spinal cord compression secondary to an acute angled kyphosis. The clinical, radiological, and pathological features are reviewed and some comparisons with the spinal changes in thalidomide embryopathy are made.     

Anterior lumbar interbody fusion

A new technique for lumbar fusion surgery incorporates threaded interbody cages. In contrast to its posterior counterpart, the anterior approach to this surgery appears to result in better fusion, less morbidity and quicker operations. This article reviews spinal anatomy and fusion and discusses the indications for anterior lumbar interbody fusion. The radiographer's role in diagnostic imaging, surgery and post-operative routines is chronicled. Radiation dose considerations are addressed and suggestions for improving follow-up assessment are offered.     

Osteoblastoma in a lumbar vertebral body

We report a young man with low back pain suspected to have a disc protrusion. Imaging suggested a tumour of the dorsal portion of the fifth lumbar vertebral body. Operation suggested a giant-cell tumour and subsequent histology showed an osteoblastoma. All typical imaging features of osteoblastoma are demonstrated in this rather uncommon location. Contrast-enhancing bone-marrow oedema on MRI, with mild enhancement of the tumour, together with the CT appearances were the clues to the diagnosis. Received: 11 December 1997 Accepted: 3 September 1998     

Volume-selective proton MRS in vertebral bodies.

Volume-selective 1H magnetic resonance spectra of small volume elements of (13 mm)3 positioned in lumbar vertebral bodies have been investigated in 15 healthy persons of different ages and sexes and in 11 patients with leukemia using double spin-echo sequences. Signal intensities and positions of the spectral lines have been evaluated. Interindividual spectra of VOI located in the center of vertebral bodies, intraindividual spectra of central VOI in different vertebral bodies, and spectra of different localizations within the same vertebral body have been compared as well as spectra before and partly after cytostatic treatment in leukemia patients. Unexpected phenomena of the signal shapes have been found. The water signal distributions in healthy persons compared to patients after bone marrow transplantation show significant differences. The success of the cytostatic treatment in cases of leukemia is accompanied by an increase in the intensity of the lipid signals and a decrease in the water signals.     

Posterior lumbar vertebral arthrography. Pathologic aspects

Findings on arthrography of posterior lumbar spine joints in 55 patients were compared with those reported in the literature. Two major degenerative lesions of these joints, diverticula and cysts, can provoke back pain and symptomatic nerve compression. Whereas diagnosis of a cyst is dependent mainly on computed tomography imaging, that of a diverticulum is ensured by arthrography, an investigation which also has a therapeutic aim since it allows infiltrations to be performed.     

TLIF手术治疗腰椎退行性滑脱

目的总结TLIF手术在腰椎退行性滑脱治疗中应用价值。方法应用TLIF手术治疗腰椎退行性滑脱12例。结果术后随访3-12个月,所有椎间融合器未见移位、松动,内固定无断裂、滑脱等并发症。术后JOA评分22-29分,平均28．2分,满意率91．7％。结论TLIF手术入路在椎管外,椎管内干扰小,避免术后椎管内瘢痕形成,具有固定牢固、卧床时间短、融合率高等优点。     

Blood-pool scintigraphic diagnosis of fractured lumbar vertebral hemangioma

A 57-year-old woman complained of lumbago of 1 year’s duration. Radiographs showed a compression fracture of the third lumbar vertebra. CT and MR images revealed an enhancing mass confined to the vertebral body suggestive of a malignant process. A blood-pool scintigram with ^99mTc-human serum albumin combined with DTPA (HSA-D) revealed marked accumulation. This strongly suggested a hemangioma, which was confirmed by biopsy. Received: 26 October 2000 Revision requested: 21 November 2000 Revision received: 23 December 2000 Accepted: 28 December