今日の臨床サポート

脊椎外傷、骨折

著者: 湯川泰紹 名古屋共立病院 脊髄・脊髄外科センター

監修: 酒井昭典 産業医科大学 整形外科学教室

著者校正/監修レビュー済:2020/10/01
患者向け説明資料

概要・推奨   

  1. 高エネルギー外傷による脊椎損傷が疑われる場合には、呼吸状態、循環動態などの全身状態評価、必要な処置を優先し、その後に神経学的評価・画像評価を行うことが推奨される。
  1. 頭蓋頚椎、頚胸椎、胸腰椎の各移行部での脊椎損傷は他の臓器との重なりが多く、単純X線では見落とされることがあり、CTによる評価が推奨される。
  1. 非骨傷性頚髄損傷の確定診断には不安定性がないことが必須であり、前後屈機能撮影での不安定性評価が推奨される。
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  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要
薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
湯川泰紹 : 特に申告事項無し[2021年]
監修:酒井昭典 : 講演料(旭化成ファーマ(株),第一三共(株),中外製薬(株)),奨学(奨励)寄付など(旭化成ファーマ(株),第一三共(株),中外製薬(株))[2021年]

改訂のポイント:
  1. シンプルな構造に変更し、見やすさと書きやすさの両面で改良を図る。

病態・疫学・診察

疾患情報(疫学・病態)  
  1. 脊椎は後頭骨の直下から始まり、7個の頚椎、12個の胸椎、5個の腰椎、5個の仙椎が一体化した仙骨、および3~5個の尾椎から構成されている。脊椎骨は体幹の支持という役割と、脊髄や神経根などの神経要素を内包し保護する役割を担っており、損傷されると体幹支持性の喪失と神経要素の損傷(脊髄・馬尾・神経根損傷)という2つの事態を生じる。また、可動域の多い頚椎、腰椎の順に脊椎外傷を受傷しやすい。
 
脊椎晒骨模型

脊椎は後頭骨の直下から始まり、7個の頚椎、12個の胸椎、5個の腰椎、5個の仙椎が一体化した仙骨、および3~5個の尾椎から構成されている。頚椎部で前弯、胸椎部で後弯、腰椎部で前弯、仙尾骨部で後弯とゆるいS字状カーブの連続となっている。

出典

img1:  著者提供
 
 
 
  1. それぞれの脊椎骨は靱帯、椎間板、椎間関節により強固に連結されている。
  1. その配列は正面では直線状、側面では頚椎部で前弯、胸椎部で後弯、腰椎部で前弯、仙尾骨部で後弯とゆるいS字状カーブの連続となっている。
  1. 胸椎は肋骨、胸骨とともに構成される胸郭内に存在し、仙骨は腸骨、恥骨、坐骨で構成される骨盤輪の一部となっている。胸椎、仙椎の損傷は高エネルギー外傷で生じやすい。そのため同時に胸郭、骨盤輪も損傷されることが多く、内臓損傷の合併率が高い。<図表>
  1. 脊椎外傷には骨折、脱臼・亜脱臼、そして脱臼骨折がある。上位頚椎では特殊な損傷型があり、後頭骨環椎間の脱臼(多くは致命的)、環椎のジェファーソン骨折、軸椎の歯突起骨折(<図表>)、ハングマン骨折(<図表>)、そして環軸椎亜脱臼などがあり、それぞれ見逃されやすいので注意を要する。
 
脊椎損傷と脊髄損傷

脊椎の損傷が重篤となると、体幹支持性の喪失と内包する神経要素の損傷という2つの事態が生じる。
a:側面X線での第6/7頚椎レベルの脱臼像
b:MRI T2矢状断像で第6/7頚椎レベルの脊髄圧迫を認める。通常損傷部はT2矢状断像で高輝度を呈する。

出典

img1:  著者提供
 
 
 
  1. 受傷年齢は、以前は20歳代と50歳代の2峰性のピークがあったが、シートベルト着用の義務化、バイク人口や労働災害の減少などで、現在では高齢者の1峰性となっている。
  1. 脊椎損傷で生じた変形や不安定性は、治療、主に手術によって改善が期待できる。
  1. 同時に発生した脊髄損傷には有効な治療法がなく、不全損傷では部分的な回復は期待できるが、完全損傷では一般に麻痺の回復は期待できない。
 
  1. 軸椎(第2頚椎)ハングマン骨折のLevine分類(推奨度2)(参考文献:[1]
  1. 転位の少ないTypeIから椎間関節の脱臼を伴うTypeIIIまでに分類される。
  1. 椎体間の転位を伴うTypeII-A, IIIでは手術治療を要し、通常軸椎-第3頚椎間で椎弓根スクリューを骨接合に用いた後方固定術が選択されることが多い。
 
軸椎(第2頚椎)ハングマン骨折のLevine分類

TypeⅠ、Ⅱ、Ⅲに分類されている。TypeⅡは第2/3椎間板損傷合併の有無により、TypeⅡとTypeⅡ-A(椎間板損傷あり)にさらに分類されている。

出典

img1:  The management of traumatic spondylolisthesis of the axis.
 
 J Bone Joint Surg Am. 1985 Feb;67(2):217・・・
 
  1. 軸椎(第2頚椎)歯突起骨折のAnderson分類(推奨度2)(参考文献:[2]
  1. 軸椎歯突起骨折はその骨折線の部位から3型に分類される。
  1. TypeIは歯突起上部の斜骨折で、靱帯性の不安定性が伴わなければ保存的治療が選択される。
  1. TypeII は歯突起基部、椎体との接合部での横骨折で骨癒合が得られにくく、通常手術が選択される。一般的に、前方からの中空螺子を用いた骨接合術が行われる。高齢者では骨粗鬆症がある場合には固定力が弱く、環軸椎後方固定術が選択されることが多い。
  1. TypeIIIは歯突起骨折に分類されているが、椎体体部の骨折で骨癒合は得られやすく、転位が少なければ保存療法を、多ければ手術療法が選択される。
 
軸椎(第2頚椎)歯突起骨折のAnderson分類

TypeⅠ、Ⅱ、Ⅲに分類されている。TypeⅡは手術適応となり、TypeⅢは症例により手術適応となる。

出典

img1:  Fractures of the odontoid process of the axis.
 
 J Bone Joint Surg Am. 1974 Dec;56(8):166・・・
問診・診察のポイント  
問診:
  1. 受傷機転を確認する(高エネルギー外傷か否か?)。

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文献 

著者: B L Allen, R L Ferguson, T R Lehmann, R P O'Brien
雑誌名: Spine (Phila Pa 1976). 1982 Jan-Feb;7(1):1-27.
Abstract/Text Closed, indirect fractures and dislocations of the lower cervical spine occur in families or groups within which there is a spectrum of anatomic damage to a cervical motion segment. This study of 165 cases demonstrates the various spectra of injury, called phylogenies, and develops a classification based on the mechanism of injury. The common groups are compressive flexion, vertical compression, distractive flexion, compressive extension, distractive extension, and lateral flexion. The probability of an associated neurologic lesion relates directly to the type and severity of cervical spine injury. With use of the classification, it is possible to formulate a rational treatment plan for injuries to the cervical spine.

PMID 7071658  Spine (Phila Pa 1976). 1982 Jan-Feb;7(1):1-27.
著者: F Magerl, M Aebi, S D Gertzbein, J Harms, S Nazarian
雑誌名: Eur Spine J. 1994;3(4):184-201.
Abstract/Text In view of the current level of knowledge and the numerous treatment possibilities, none of the existing classification systems of thoracic and lumbar injuries is completely satisfactory. As a result of more than a decade of consideration of the subject matter and a review of 1445 consecutive thoracolumbar injuries, a comprehensive classification of thoracic and lumbar injuries is proposed. The classification is primarily based on pathomorphological criteria. Categories are established according to the main mechanism of injury, pathomorphological uniformity, and in consideration of prognostic aspects regarding healing potential. The classification reflects a progressive scale of morphological damage by which the degree of instability is determined. The severity of the injury in terms of instability is expressed by its ranking within the classification system. A simple grid, the 3-3-3 scheme of the AO fracture classification, was used in grouping the injuries. This grid consists of three types: A, B, and C. Every type has three groups, each of which contains three subgroups with specifications. The types have a fundamental injury pattern which is determined by the three most important mechanisms acting on the spine: compression, distraction, and axial torque. Type A (vertebral body compression) focuses on injury patterns of the vertebral body. Type B injuries (anterior and posterior element injuries with distraction) are characterized by transverse disruption either anteriorly or posteriorly. Type C lesions (anterior and posterior element injuries with rotation) describe injury patterns resulting from axial torque. The latter are most often superimposed on either type A or type B lesions. Morphological criteria are predominantly used for further subdivision of the injuries. Severity progresses from type A through type C as well as within the types, groups, and further subdivisions. The 1445 cases were analyzed with regard to the level of the main injury, the frequency of types and groups, and the incidence of neurological deficit. Most injuries occurred around the thoracolumbar junction. The upper and lower end of the thoracolumbar spine and the T10 level were most infrequently injured. Type A fractures were found in 66.1%, type B in 14.5%, and type C in 19.4% of the cases. Stable type A1 fractures accounted for 34.7% of the total. Some injury patterns are typical for certain sections of the thoracolumbar spine and others for age groups. The neurological deficit, ranging from complete paraplegia to a single root lesion, was evaluated in 1212 cases.(ABSTRACT TRUNCATED AT 400 WORDS)

PMID 7866834  Eur Spine J. 1994;3(4):184-201.
著者: Alexander R Vaccaro, Ronald A Lehman, R John Hurlbert, Paul A Anderson, Mitchel Harris, Rune Hedlund, James Harrop, Marcel Dvorak, Kirkham Wood, Michael G Fehlings, Charles Fisher, Steven C Zeiller, D Greg Anderson, Christopher M Bono, Gordon H Stock, Andrew K Brown, Timothy Kuklo, F C Oner
雑誌名: Spine (Phila Pa 1976). 2005 Oct 15;30(20):2325-33.
Abstract/Text STUDY DESIGN: A new proposed classification system for thoracolumbar (TL) spine injuries, including injury severity assessment, designed to assist in clinical management.
OBJECTIVE: To devise a practical, yet comprehensive, classification system for TL injuries that assists in clinical decision-making in terms of the need for operative versus nonoperative care and surgical treatment approach in unstable injury patterns.
SUMMARY OF BACKGROUND DATA: The most appropriate classification of traumatic TL spine injuries remains controversial. Systems currently in use can be cumbersome and difficult to apply. None of the published classification schemata is constructed to aid with decisions in clinical management.
METHODS: Clinical spine trauma specialists from a variety of institutions around the world were canvassed with respect to information they deemed pivotal in the communication of TL spine trauma and the clinical decision-making process. Traditional injury patterns were reviewed and reconsidered in light of these essential characteristics. An initial validation process to determine the reliability and validity of an earlier version of this system was also undertaken.
RESULTS: A new classification system called the Thoracolumbar Injury Classification and Severity Score (TLICS) was devised based on three injury characteristics: 1) morphology of injury determined by radiographic appearance, 2) integrity of the posterior ligamentous complex, and 3) neurologic status of the patient. A composite injury severity score was calculated from these characteristics stratifying patients into surgical and nonsurgical treatment groups. Finally, a methodology was developed to determine the optimum operative approach for surgical injury patterns.
CONCLUSIONS: Although there will always be limitations to any cataloging system, the TLICS reflects accepted features cited in the literature important in predicting spinal stability, future deformity, and progressive neurologic compromise. This classification system is intended to be easy to apply and to facilitate clinical decision-making as a practical alternative to cumbersome classification systems already in use. The TLICS may improve communication between spine trauma physicians and the education of residents and fellows. Further studies are underway to determine the reliability and validity of this tool.

PMID 16227897  Spine (Phila Pa 1976). 2005 Oct 15;30(20):2325-33.
著者: Alexander R Vaccaro, R John Hulbert, Alpesh A Patel, Charles Fisher, Marcel Dvorak, Ronald A Lehman, Paul Anderson, James Harrop, F C Oner, Paul Arnold, Michael Fehlings, Rune Hedlund, Ignacio Madrazo, Glenn Rechtine, Bizhan Aarabi, Mike Shainline, Spine Trauma Study Group
雑誌名: Spine (Phila Pa 1976). 2007 Oct 1;32(21):2365-74. doi: 10.1097/BRS.0b013e3181557b92.
Abstract/Text STUDY DESIGN: The classification system was derived through a literature review and expert opinion of experienced spine surgeons. In addition, a multicenter reliability and validity study of the system was conducted on a collection of trauma cases.
OBJECTIVES: To define a novel classification system for subaxial cervical spine trauma that conveys information about injury pattern, severity, treatment considerations, and prognosis. To evaluate reliability and validity of this system.
SUMMARY OF BACKGROUND DATA: Classification of subaxial cervical spine injuries remains largely descriptive, lacking standardization and prognostic information.
METHODS: Clinical and radiographic variables encountered in subaxial cervical trauma were identified by a working section of the Spine Trauma Study Group. Significant limitations of existing systems were defined and addressed within the new system. This system, as well as the Harris and Ferguson & Allen systems, was applied by 20 spine surgeons to 11 cervical trauma cases. Six weeks later, the cases were randomly reordered and again scored. Interrater reliability, intrarater reliability, and validity were assessed.
RESULTS: Each of 3 main categories (injury morphology, disco-ligamentous complex, and neurologic status) identified as integrally important to injury classification was assigned a weighted score; the injury severity score was obtained by summing the scores from each category. Treatment options were assigned based on threshold values of the severity score. Interrater agreement as assessed by intraclass correlation coefficient of the DLC, morphology, and neurologic status scores was 0.49, 0.57, and 0.87, respectively. Intrarater agreement as assessed by intraclass correlation coefficient of the DLC, morphology, and neurologic status scores was 0.66, 0.75, and 0.90, respectively. Raters agreed with treatment recommendations of the algorithm in 93.3% of cases, suggesting high construct validity. The reliability compared favorably to the Harris and Ferguson & Allen systems.
CONCLUSION: The Sub-axial Injury Classification and Severity Scale provides a comprehensive classification system for subaxial cervical trauma. Early validity and reliability data are encouraging.

PMID 17906580  Spine (Phila Pa 1976). 2007 Oct 1;32(21):2365-74. doi: ・・・
著者: M B Bracken, M J Shepard, W F Collins, T R Holford, D S Baskin, H M Eisenberg, E Flamm, L Leo-Summers, J C Maroon, L F Marshall
雑誌名: J Neurosurg. 1992 Jan;76(1):23-31. doi: 10.3171/jns.1992.76.1.0023.
Abstract/Text The 1-year follow-up data of a multicenter randomized controlled trial of methylprednisolone (30 mg/kg bolus and 5.4 mg/kg/hr for 23 hours) or naloxone (5.4 mg/kg bolus and 4.0 mg/kg/hr for 23 hours) treatment for acute spinal cord injury are reported and compared with placebo results. In patients treated with methylprednisolone within 8 hours of injury, increased recovery of neurological function was seen at 6 weeks and at 6 months and continued to be observed 1 year after injury. For motor function, this difference was statistically significant (p = 0.030), and was found in patients with total sensory and motor loss in the emergency room (p = 0.019) and in those with some preservation of motor and sensory function (p = 0.024). Naloxone-treated patients did not show significantly greater recovery. Patients treated after 8 hours of injury recovered less motor function if receiving methylprednisolone (p = 0.08) or naloxone (p = 0.10) as compared with those given placebo. Complication and mortality rates were similar in either group of treated patients as compared with the placebo group. The authors conclude that treatment with the study dose of methylprednisolone is indicated for acute spinal cord trauma, but only if it can be started within 8 hours of injury.

PMID 1727165  J Neurosurg. 1992 Jan;76(1):23-31. doi: 10.3171/jns.199・・・
著者: Yasuo Ito, Yoshihisa Sugimoto, Masao Tomioka, Nobuo Kai, Masato Tanaka
雑誌名: Spine (Phila Pa 1976). 2009 Sep 15;34(20):2121-4. doi: 10.1097/BRS.0b013e3181b613c7.
Abstract/Text STUDY DESIGN: Consecutive cohort study.
OBJECTIVE: To reconsider effects of the Second National Acute Spinal Cord Injury Study.
SUMMARY OF BACKGROUND DATA: High dose methylprednisolone sodium succinate (MPSS) for the patients with acute spinal cord injury has been considered standard treatment in the several countries. However, many authors have criticized the effect of MPSS because of lack of evidence about neurologic improvement and the high incidence of complications.
METHODS: During 2-year, all patients with cervical cord injury were treated with MPSS within 8 hours of their injuries based on the Second National Acute Spinal Cord Injury Study protocol (MPSS group). During the next 2-year, all patients were treated without MPSS (non-MPSS group). There were 38 patients in the MPSS group and 41 in the non-MPSS. Early spinal decompression and stabilization was performed as soon after injury in both the groups.
RESULTS: According to The American Spinal Injury Association (ASIA) motor score, there was an average improvement by 3 months postinjury of 12.4 points in the MPSS group and 13.8 points in the non-MPSS group. In patients with complete motor loss, average ASIA motor score improved 9.0 points in the MPSS group and 12.6 points in the non-MPSS group. For patients with incomplete motor loss, average ASIA motor score improvement was 14.1 and 15.5 points in the MPSS and non-MPSS groups, respectively.In the MPSS group, 19 patients developed pneumonia, 13 developed urinary tract infections, and 5 developed wound infections. Incidence of pneumonia was significantly increased with the use of MPSS medication.
CONCLUSION: We found no evidence supporting the opinion that high-dose MPSS administration facilitates neurologic improvement in patients with spinal cord injury. We believe MPSS should be used under limited circumstances because of the high incidence of pulmonary complication.

PMID 19713878  Spine (Phila Pa 1976). 2009 Sep 15;34(20):2121-4. doi: ・・・
著者: R John Hurlbert, Mark N Hadley, Beverly C Walters, Bizhan Aarabi, Sanjay S Dhall, Daniel E Gelb, Curtis J Rozzelle, Timothy C Ryken, Nicholas Theodore
雑誌名: Neurosurgery. 2013 Mar;72 Suppl 2:93-105. doi: 10.1227/NEU.0b013e31827765c6.
Abstract/Text
PMID 23417182  Neurosurgery. 2013 Mar;72 Suppl 2:93-105. doi: 10.1227/・・・
著者: Yasutsugu Yukawa, Fumihiko Kato, Hisatake Yoshihara, Makoto Yanase, Keigo Ito
雑誌名: J Neurosurg Spine. 2006 Dec;5(6):488-93. doi: 10.3171/spi.2006.5.6.488.
Abstract/Text OBJECT: The authors conducted a study to introduce the imaging technique in which pedicle axis views are obtained using fluoroscopy to match the screw entry point with pedicle orientation and to report the clinical results and safety of cervical pedicle screw fixation (PSF) in patients treated for unstable cervical injuries.
METHODS: One hundred consecutive patients with unstable cervical injuries underwent PSF in which the authors used fluoroscopic imaging to acquire pedicle axis views. There were 87 men and 13 women whose mean age was 42.5 years. The accuracy of PS placement was examined postoperatively using axial computed tomography (CT) and oblique radiography. Screw malpositioning was classified either as screw exposure (< 50% of the screw outside the pedicle) or pedicle perforation (> 50% of the screw outside the pedicle boundaries). The mean operative time was 97.6 minutes, and the mean estimated blood loss was 221 ml. Local vertebral alignment around the injured segment measured 6.0 degrees of kyphosis preoperatively and 6.7 degrees of lordosis postoperatively. Solid posterior bone fusion was achieved in all but three patients who died shortly after surgery. There was no secondary dislodgment of instrumentation in 95% of these 97 cases. Of the 419 cervical PSs, 43 (10.3%) were of the screw-exposure type and 17 (4.0%) of the pedicle-perforation type. There were two surgery-related complications: one penetration of a probe into the vertebral artery and one radiculopathy. There were six postoperative complications: two cases of instrumentation failure associated with loss of correction, three cases of correction loss (> 10 degrees), and one case of deep wound infection.
CONCLUSIONS: Solid posterior fusion without secondary dislodgment of hardware was demonstrated in 95% of the cases. The incidence of complications associated with cervical PSF was not high. Postoperative CT scanning showed that 17 (4.0%) of 419 screws perforated the pedicle. It appears that fluoroscopy performed using pedicle axis views improves the accuracy and safety of cervical PS insertion.

PMID 17176011  J Neurosurg Spine. 2006 Dec;5(6):488-93. doi: 10.3171/s・・・
著者: Yasutsugu Yukawa, Fumihiko Kato, Keigo Ito, Yumiko Horie, Tetsurou Hida, Hiroaki Nakashima, Masaaki Machino
雑誌名: Eur Spine J. 2009 Sep;18(9):1293-9. doi: 10.1007/s00586-009-1032-7. Epub 2009 Jun 2.
Abstract/Text Cervical pedicle screw fixation is an effective procedure for stabilising an unstable motion segment; however, it has generally been considered too risky due to the potential for injury to neurovascular structures, such as the spinal cord, nerve roots or vertebral arteries. Since 1995, we have treated 144 unstable cervical injury patients with pedicle screws using a fluoroscopy-assisted pedicle axis view technique. The purpose of this study was to investigate the efficacy of this technique in accurately placing pedicle screws to treat unstable cervical injuries, and the ensuing clinical outcomes and complications. The accuracy of pedicle screw placement was postoperatively examined by axial computed tomography scans and oblique radiographs. Solid posterior bony fusion without secondary dislodgement was accomplished in 96% of all cases. Of the 620 cervical pedicle screws inserted, 57 (9.2%) demonstrated screw exposure (<50% of the screw outside the pedicle) and 24 (3.9%) demonstrated pedicle perforation (>50% of the screw outside the pedicle). There was one case in which a probe penetrated a vertebral artery without further complication and one case with transient radiculopathy. Pre- and postoperative tracheotomy was required in 20 (13.9%) of the 144 patients. However, the tracheotomies were easily performed, because those patients underwent posterior surgery alone without postoperative external fixation. The placement of cervical pedicle screws using a fluoroscopy-assisted pedicle axis view technique provided good clinical results and a few complications for unstable cervical injuries, but a careful surgical procedure was needed to safely insert the screws and more improvement in imaging and navigation system is expected.

PMID 19488794  Eur Spine J. 2009 Sep;18(9):1293-9. doi: 10.1007/s00586・・・
著者: M Machino, Y Yukawa, K Ito, H Nakashima, F Kato
雑誌名: Spinal Cord. 2011 Apr;49(4):573-9. doi: 10.1038/sc.2010.159. Epub 2010 Nov 16.
Abstract/Text STUDY DESIGN: A prospective clinical study.
OBJECTIVE: The purpose of this study was to evaluate prospectively a large group of patients with thoracolumbar burst fractures who were treated with a posterior/anterior combined procedure and to report on the surgical outcomes, complications and radiographic results.
METHODS: A total of 100 consecutive patients were surgically managed with posterior instrumentation, anterior decompression and anterior strut grafting. There were 71 males and 29 females; the mean age was 36 years. Patients with osteoporotic delayed vertebral body collapse were excluded. The mean follow-up period was 30 months. Surgical outcomes such as operative time, blood loss and sagittal alignment were investigated. A neurological assessment was performed by a rating system based on the American Spine Injury Association impairment scale. An interbody fusion was judged using plain X-ray and computed tomographic scans.
RESULTS: The mean operative time was 256 min and the mean operative bleeding was 985 ml. Most of the patients were ambulatory within 3 days after surgery. Of the 76 patients with neurological injury, 54 (71.1%) recovered function following surgery. The mean local kyphosis angle was 12.2° kyphotic preoperatively and 0.8° lordotic at the final observation. The mean correction angle was 15.7° and correction loss was 2.6°. No instrumentation failure was observed and the postoperative fusion rate was 99%.
CONCLUSIONS: Posterior/anterior combined surgery with posterior pedicle screws and hooks fixation, and reconstruction by simultaneous strut grafting and anterior decompression, achieved short segment fixation and can be a useful option for surgically treating thoracolumbar burst fractures.

PMID 21079623  Spinal Cord. 2011 Apr;49(4):573-9. doi: 10.1038/sc.2010・・・

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