胸椎および腰椎への instrumentation surgery

Abstract

<Objective> The authors conducted a study to evaluate the clinical outcome of 21 patients in whom thoracolumbar spinal instrumentation surgery was used. <Methods> The study group was composed of 11 men and 10 women with the mean age being 43 years (range 19-73 years). The diagnosis was spinal trauma in 14 patients; metastatic spinal tumor in 4; and infectious disease in 3. The affected level was midthoracic in 8 patients, thoracolumbar in 12, and lumbar in one. Anterior spinal fixation was carried out in 13 patients using Kaneda device in six, and Z-plate in seven. Posterior spinal fixation was performed in eight patients using Texas Scottish Rite Hospital (TSRH) system. Solid bony fusion was achieved in all patients who received autologous bone transplantation. Good neurological outcome was obtained in 18 of 21 patients independently of whether the fixation was by anterior or posterior instrumentation. The 3 patients who had sustained complete spinal cord injury didn't recover neurologically. Radiographical recovery of kyphosis using Kaneda device, Z-plate and TSRH were obtained to the extent of 9 degrees, 3 degrees and 1 degree, respectively. One patient with posterior instrumentation developed deep wound infection. The infection was cured after total removal of the instrument and intravenous antibiotic therapy. <Conclusion> Anterior instrumentation fixation was superior to posterior fixation in radiographical recovery of kyphosis in midthoracic lesions. There were no differences in bony fusion rate and neurological outcome between anterior and posterior fixation.