Clinical Observation of the Treatment of Non-Union of Thoracolumbar Fracture with Reconstruction of Middle Column before Unilateral Pedicle Resection
Objective:To investigate the feasibility and technical points of prevertebral column reconstruction for stage ⅢKummell's disease after unilateral pedicle resection for decompression sickness,and to analyze the safety and effectiveness of this procedure.Methods:A retrospective analysis was performed on 13 patients(1 male and 12 female,aged(69.53±8.71)years old)with unilateral pedicle decompres-sion sickness prevertebral column reconstruction for stage Ⅲ Kummell's disease from September 2018 to January 2021.Preoperative X-rays,CT,and MR determined the presence of a vacuum sign(X-ray/CT)in the vertebral body or a fluid accumulation in the vertebral body(MR).In all patients,the lamina,articular process and pedicle were removed on the symptomatic or more severe side,and the pedicle screw was used on the opposite side to restore part of the height of the affected vertebrae,and the height of the affected vertebrae was fur-ther restored by intra-vertebral compression bone grafting and PEEK interbody fusion implant.At the same time,posterior pedicle screw system was used to fix the upper and lower vertebrae of the affected vertebrae,and intraoperative X-ray fluo-roscopy was used to determine the effective height of the affected vertebrae.Finally,the affected anterior midcolumn was reconstructed and the kyphotic deformity was corrected.The outcome measures included operative time,intraoperative blood loss,postoperative drainage volume,vertebral height of the affected vertebra,visual analogue scale(VAS)before and after surgery,Oswestry disability index(ODI),Cobb angle of the local sagittal plane of the affected vertebra.Results:All patients successfully completed the operation,no neurovascular injury,low back pain,lower limb pain and numbness symptoms were significantly improved.The operative time was(192.00±87.16)min,the intraoperative blood loss was(249.00±128.26)mL,and the postoperative drainage volume was(283.27±76.71)mL.Incision fat liquefaction occurred in 1 patient,which healed after debridement.1 patient developed lower extremity intermuscular venous thrombosis.12 patients were followed up completely,and 1 patient had cerebral infarction and limb movement disorder half a year after surgery,and was lost to follow-up.The duration was 8-11 months,with an average of 10.1 months.VAS scores and ODI scores were significantly improved from 6.46±1.32 and 68.16±4.43 to 1.18±0.59 and 15.35±7.64 respectively(F=16.556,P＜0.001;F=29.368,P＜0.001).The vertebral anterior margin height improved from(1.03±0.41)cm before surgery to(2.24±0.55)cm and(2.11±0.46)cm at the last follow-up 1 week after surgery,and the changes before and after surgery were statistically significant(F=11.578,P＜0.001).There was no significant change in postoperative follow-up(q=3.12,P=0.081).Local kyphosis improved from 28.72°±8.12° before and after surgery to 8.16°±3.27° and 9.32°±2.13° at the last follow-up.The changes before and after surgery were statistically significant(F=18.461,P＜0.001),while the changes after follow-up were not statistically significant(q=0.53,P=1.101).Conclusion:The treatment of stage Ⅲ Kummell's disease with unilateral pedicle resection can not only effectively relieve nerve compres-sion,correct sagittal kyphosis,restore spinal stability,but also reduce intraoperative trauma and postoperative complica-tions.The treatment of stage Ⅲ Kummell's disease with unilateral pedicle resection decompression sickness prevertebral column reconstruction has a good efficacy.
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