Operative Orthopadie und Traumatologie · 2019
[Posterior vertebral column resection for correction of kyphotic deformity due to osteoporotic fractures of the thoracic spine].
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Sehmisch S, Lehmann W, Dreimann M, Oberthür S, Viezens L, Weiser L
Аннотация
OBJECTIVE: The posterior vertebral column resection (PVCR) comprises a one-step resection of the vertebral body by a costotransversectomy together with a 360° spondylodesis. After removing the vertebral body, straightening of the existing kyphotic malposition is possible.
INDICATIONS: Pronounced thoracic kyphosis after osteoporotic sintering fractures in one or more vertebral bodies.
CONTRAINDICATIONS: General contraindications for surgical procedures, ASA >3 (American Society of Anesthesiologists).
SURGICAL TECHNIQUE: First, dorsal stabilization of the vertebral column on at least two levels cranial and caudal of the VCR. Next, in a one-step procedure the laminectomy with costotransversectomy and the resection of the vertebral body is done. The ventral defect gap is filled by a mesh cage to provide ventral support. By compression the malposition is reduced and the mesh cage is fixed into position. Finally the vertebrae joints are opened up using a chisel and bone or bone substitute is placed to complete the 360° spondylodesis.
POSTOPERATIVE MANAGEMENT: Functional treatment without peak load exercises as well as appropriate osteoporosis treatment.
RESULTS: In a retrospective study 10 patients treated with this surgical technique were investigated. The results show a very good correction of the kyphotic maldeformity while the complications remain moderate.
INDICATIONS: Pronounced thoracic kyphosis after osteoporotic sintering fractures in one or more vertebral bodies.
CONTRAINDICATIONS: General contraindications for surgical procedures, ASA >3 (American Society of Anesthesiologists).
SURGICAL TECHNIQUE: First, dorsal stabilization of the vertebral column on at least two levels cranial and caudal of the VCR. Next, in a one-step procedure the laminectomy with costotransversectomy and the resection of the vertebral body is done. The ventral defect gap is filled by a mesh cage to provide ventral support. By compression the malposition is reduced and the mesh cage is fixed into position. Finally the vertebrae joints are opened up using a chisel and bone or bone substitute is placed to complete the 360° spondylodesis.
POSTOPERATIVE MANAGEMENT: Functional treatment without peak load exercises as well as appropriate osteoporosis treatment.
RESULTS: In a retrospective study 10 patients treated with this surgical technique were investigated. The results show a very good correction of the kyphotic maldeformity while the complications remain moderate.