Abstract：
OBJECTIVE: The authors present clinical outcome data and satisfaction of patients who underwent minimally invasive vertebral body corpectomy and cage placement via a mini-open, extreme lateral, transpsoas approach and posterior short-segment instrumentation for lumbar burst fractures.
METHODS: Patients with unstable lumbar burst fractures who underwent corpectomy and anterior column reconstruction via a mini-open, extreme lateral, transpsoas approach with short-segment posterior fixation were reviewed retrospectively. Demographic information, operative parameters, perioperative radiographic measurements, and complications were analyzed. Patient-reported outcome instruments (Oswestry Disability Index [ODI], 12-Item Short Form Health Survey [SF-12]) and an anterior scar-specific patient satisfaction questionnaire were recorded at the latest follow-up.
RESULTS: Twelve patients (7 men, 5 women, average age 42 years, range 22-68 years) met the inclusion criteria. Lumbar corpectomies with anterior column support were performed (L-1, n = 8; L-2, n = 2; L-3, n = 2) and supplemented with short-segment posterior instrumentation (4 open, 8 percutaneous). Four patients had preoperative neurological deficits, all of which improved after surgery. No new neurological complications were noted. The anterior incision on average was 6.4 cm (range 5-8 cm) in length, caused mild pain and disability, and was aesthetically acceptable to the large majority of patients. Three patients required chest tube placement for pleural violation, and 1 patient required reoperation for cage subsidence/hardware failure. Average clinical follow-up was 38 months (range 16-68 months), and average radiographic follow-up was 37 months (range 6-68 months). Preoperative lumbar lordosis and focal lordosis were significantly improved/maintained after surgery. Patients were satisfied with their outcomes, had minimal/moderate disability (average ODI score 20, range 0-52), and had good physical (SF-12 physical component score 41.7% ± 10.4%) and mental health outcomes (SF-12 mental component score 50.2% ± 11.6%) after surgery.
CONCLUSIONS: Anterior corpectomy and cage placement via a mini-open, extreme lateral, transpsoas approach supplemented by short-segment posterior instrumentation is a safe, effective alternative to conventional approaches in the treatment of single-level unstable burst fractures and is associated with excellent functional outcomes and patient satisfaction.
METHODS: Patients with unstable lumbar burst fractures who underwent corpectomy and anterior column reconstruction via a mini-open, extreme lateral, transpsoas approach with short-segment posterior fixation were reviewed retrospectively. Demographic information, operative parameters, perioperative radiographic measurements, and complications were analyzed. Patient-reported outcome instruments (Oswestry Disability Index [ODI], 12-Item Short Form Health Survey [SF-12]) and an anterior scar-specific patient satisfaction questionnaire were recorded at the latest follow-up.
RESULTS: Twelve patients (7 men, 5 women, average age 42 years, range 22-68 years) met the inclusion criteria. Lumbar corpectomies with anterior column support were performed (L-1, n = 8; L-2, n = 2; L-3, n = 2) and supplemented with short-segment posterior instrumentation (4 open, 8 percutaneous). Four patients had preoperative neurological deficits, all of which improved after surgery. No new neurological complications were noted. The anterior incision on average was 6.4 cm (range 5-8 cm) in length, caused mild pain and disability, and was aesthetically acceptable to the large majority of patients. Three patients required chest tube placement for pleural violation, and 1 patient required reoperation for cage subsidence/hardware failure. Average clinical follow-up was 38 months (range 16-68 months), and average radiographic follow-up was 37 months (range 6-68 months). Preoperative lumbar lordosis and focal lordosis were significantly improved/maintained after surgery. Patients were satisfied with their outcomes, had minimal/moderate disability (average ODI score 20, range 0-52), and had good physical (SF-12 physical component score 41.7% ± 10.4%) and mental health outcomes (SF-12 mental component score 50.2% ± 11.6%) after surgery.
CONCLUSIONS: Anterior corpectomy and cage placement via a mini-open, extreme lateral, transpsoas approach supplemented by short-segment posterior instrumentation is a safe, effective alternative to conventional approaches in the treatment of single-level unstable burst fractures and is associated with excellent functional outcomes and patient satisfaction.
摘要：
目的：作者介绍了通过小型开放进行微创椎体全切术和融合器放置的患者的临床结果数据和满意度，极端横向,腰椎爆裂骨折的经肌入路和后短节段器械。
方法：不稳定型腰椎爆裂骨折患者，通过小型开放进行椎体切除和前柱重建，极端横向,对短节段后路固定的跨肌入路进行了回顾性分析。人口统计信息,操作参数,围手术期射线照相测量，并对并发症进行分析。患者报告结果工具(Oswestry残疾指数[ODI]，在最新的随访中记录了12项简短的健康调查[SF-12]）和前疤痕患者满意度问卷。
结果：12名患者（7名男性，5女人，平均年龄42岁,范围22-68岁)符合纳入标准。进行了前柱支撑的腰椎切除术（L-1，n=8；L-2，n=2；L-3，n=2），并辅以短节段后部器械（4个开放，8经皮)。四名患者术前出现神经功能缺损,所有这些都在手术后得到改善。没有发现新的神经系统并发症。前切口长度5-8cm,平均6.4cm,导致轻微的疼痛和残疾，并且在美学上为大多数患者所接受。三名患者因胸膜侵犯而需要放置胸管，1例患者因笼子下沉/硬件故障需要再次手术。平均临床随访38个月(16-68个月),随访6～68个月,平均37个月。术前腰椎前凸和局灶性前凸在手术后得到明显改善/维持。患者对他们的结果感到满意，有轻度/中度残疾（平均ODI评分20，范围0-52），术后有良好的身体(SF-12身体成分评分41.7%±10.4%)和心理健康结果(SF-12心理成分评分50.2%±11.6%)。
结论：通过小型开放的前体切除术和笼子放置，极端横向,经足肌入路辅以短节段后部器械是一种安全的方法，在单级别不稳定爆裂骨折的治疗中，可有效替代常规方法，并与出色的功能结局和患者满意度相关。
方法：不稳定型腰椎爆裂骨折患者，通过小型开放进行椎体切除和前柱重建，极端横向,对短节段后路固定的跨肌入路进行了回顾性分析。人口统计信息,操作参数,围手术期射线照相测量，并对并发症进行分析。患者报告结果工具(Oswestry残疾指数[ODI]，在最新的随访中记录了12项简短的健康调查[SF-12]）和前疤痕患者满意度问卷。
结果：12名患者（7名男性，5女人，平均年龄42岁,范围22-68岁)符合纳入标准。进行了前柱支撑的腰椎切除术（L-1，n=8；L-2，n=2；L-3，n=2），并辅以短节段后部器械（4个开放，8经皮)。四名患者术前出现神经功能缺损,所有这些都在手术后得到改善。没有发现新的神经系统并发症。前切口长度5-8cm,平均6.4cm,导致轻微的疼痛和残疾，并且在美学上为大多数患者所接受。三名患者因胸膜侵犯而需要放置胸管，1例患者因笼子下沉/硬件故障需要再次手术。平均临床随访38个月(16-68个月),随访6～68个月,平均37个月。术前腰椎前凸和局灶性前凸在手术后得到明显改善/维持。患者对他们的结果感到满意，有轻度/中度残疾（平均ODI评分20，范围0-52），术后有良好的身体(SF-12身体成分评分41.7%±10.4%)和心理健康结果(SF-12心理成分评分50.2%±11.6%)。
结论：通过小型开放的前体切除术和笼子放置，极端横向,经足肌入路辅以短节段后部器械是一种安全的方法，在单级别不稳定爆裂骨折的治疗中，可有效替代常规方法，并与出色的功能结局和患者满意度相关。
