脊椎後方短縮骨切り術の適応と術式

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This article presents the author's experience using spinal-shortening osteotomy. Posterior-shortening spinal osteotomy corrected kyphotic deformity of the thoracolumbar and lumbar spine. Spinal osteotomy also corrected the skeletal alignment and neural alignment. The indication for spinal osteotomy is kyphotic deformity due to ankylosing spondylitis, congenital deformity, post-traumatic deformity with or without osteoporosis, degenerative deformity and so on. Surgical procedure of spinal-shortening osteotomy : (1) The patient was laid down on a Hall frame in the prone position. (2) Wide laminectomy of the deformed vertebra and lower half of the upper vertebra was carried out. (3) Pedicular screws were inserted into the pedicles one above and one below the deformed vertebra. (4) One rod was attached to the pedicular screws for preventing sudden over-correction change causing damage to nerve tissues. (5) The cancellous bone of the vertebra was removed through the pedicles with curette or chisel. After posterior wedge osteotomy was completed, kyphosis was corrected by manual pushing from the back. (6) Finally rods were thoroughly tightened to the pedicular screws. It should be checked under direct vision whether there is dura mater or root compression. Ultrasonography could ascertain the condition of the dural compression during surgery. If there were some bone pieces compressing the dura, they should be completely removed. Ultrasonography could also show the dural pulsation. It should be checked whether or not there is neural compression. Low-pressure general anesthesia and hemostasis from epidural bleeding using a bipolar coagulator could decrease blood loss. Our four cases did not need blood transfusion. The patients got up from their beds and walked by themselves using a corset about one week after surgery. Posterior-shortening spinal osteotomy brings about good clinical results.
日本脊髄外科学会の論文
2000-06-30

脊椎後方短縮骨切り術の適応と術式

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