骨粗しょう症性椎体偽関節による遅発性脊髄・神経麻ひに対するリン酸カルシウム骨セメントを応用した脊柱再建術

概要

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Surgical treatment for osteoporotic vertebral pseudarthrosis with neurological deficits has been a challenging problem because of the fragility of the osteoporotic bone. We developed a new less-invasive surgical procedure, consisting of transpedicular injection of bioactive calcium phosphate cement (CPC) into the vertebral body after correcting the wedge deformity, partial laminectomy and posterolateral neural decompression by impacting the retropulsed bony fragments anteriorly, and posterolateral bone grafting combined with a short-range pedicle screw fixation augmented by the CPC. Six patients with a minimum 6-months follow-up were evaluated. Age at operation was 77 years and follow-up period was 11 months on average. All patients showed 1 grade neurological recovery on Frankel grade. According to a 10-point pain rating scale, average preoperative back pain was 8.8 points, and it was 1.0 at the final follow-up. Average preoperative and postoperative kyphosis angle of the fused segments were 51°and 13°, respectively. In 15°, the correction was maintained at the final follow-up. The posterolateral fusions were all successfully completed. This procedure could achieve reconstruction of anterior load sharing mechanism, direct neural decompression, and correction of kyphotic deformity through a single posterior approach in a relatively less invasive manner.
中国・四国整形外科学会の論文