P27。神经外科医生单节段胸腰椎切除术和椎体置换术的多中心回顾性研究

IF 2.5 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-07-01 DOI:10.1016/j.xnsj.2025.100651

Mohammad Khalil Al-Barbarawi MD, MBBS

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引用次数: 0

摘要

背景：椎体置换术（VBR）是解决骨折和肿瘤损害脊柱稳定性的关键干预措施。传统的方法通常涉及广泛的肌肉解剖和外科医生的协助，导致较长的恢复时间。极端外侧椎体间融合（XLIF）入路由神经外科医生独家执行，无需外科医生介入，提供了一种微创的替代方法，可能改善患者的预后并减少并发症。目的评价由神经外科医生进行的椎体置换术（VBR）的临床和影像学结果，评估其在减轻疼痛、改善神经功能和恢复骨折或肿瘤患者脊柱稳定性方面的疗效。研究设计/背景：这是一项在单一神经外科中心进行的回顾性临床研究，分析了2018年至2023年间由神经外科医生使用极外侧体间融合（XLIF）技术进行的单节段椎体置换术（VBR）的结果。患者样本：该研究包括2018年至2023年间使用XLIF技术接受单节段椎体置换术（VBR）的23例连续患者。样本包括需要前柱重建的椎体骨折或肿瘤患者。临床结果采用视觉模拟量表（VAS）评估疼痛和美国脊髓损伤协会（ASIA）分类评估神经状态。放射学结果包括术前和术后区域成角和脊柱稳定性的CT测量。并对并发症进行记录和分析。方法回顾性分析2018 - 2023年采用XLIF技术行单节段椎体置换术（VBR）的23例患者。临床结果采用视觉模拟量表（VAS）疼痛评分和美国脊髓损伤协会（ASIA）神经功能分类进行评估。放射学评估包括术前和术后CT扫描，以测量区域成角和脊柱稳定性。分析疼痛减轻、神经系统改善和并发症发生率的数据。结果患者表现出显著的临床改善，VAS疼痛评分中位数从8分降至2分，82.6%的病例神经系统改善（ASIA E分类）。放射学结果显示背部稳定后中位后凸角矫正5°，腹侧稳定后中位后凸角矫正9°。8.7%的病例出现并发症，包括胸膜损伤和感觉减退，主要发生在胸椎VBR和骨质疏松患者。总的来说，XLIF技术提供了实质性的疼痛缓解、神经恢复和脊柱稳定性。结论经XLIF的svbr是治疗椎体骨折和肿瘤的一种很有前景的技术，具有显著的疼痛缓解、神经恢复和脊柱稳定性。尽管有一些并发症，但该手术在临床和放射学上都有显著的益处，强调了其对复杂脊柱病变的疗效。FDA器械/药物状态本摘要不讨论或包括任何适用的器械或药物。

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P27. A multicenter retrospective study on single-level thoracolumbar corpectomy and vertebral body replacement done by neurosurgeons

BACKGROUND CONTEXT

Vertebral body replacement (VBR) is a crucial intervention for addressing fractures and tumors that compromise spinal stability. Traditional methods often involve extensive muscle dissection and the assistance of access surgeons, leading to longer recovery times. The eXtreme Lateral Interbody Fusion (XLIF) approach, performed exclusively by neurosurgeons without the need for access surgeons, offers a minimally invasive alternative, potentially improving patient outcomes and reducing complications.

PURPOSE

To evaluate the clinical and radiological outcomes of vertebral body replacement (VBR) using the eXtreme Lateral Interbody Fusion (XLIF) technique performed exclusively by neurosurgeons, assessing its efficacy in reducing pain, improving neurological function, and restoring spinal stability in patients with fractures or tumors.

STUDY DESIGN/SETTING

This is a retrospective clinical study conducted in a single neurosurgical center, analyzing outcomes of single-level vertebral body replacement (VBR) performed exclusively by neurosurgeons using the eXtreme Lateral Interbody Fusion (XLIF) technique between 2018 and 2023.

PATIENT SAMPLE

The study included 23 consecutive patients who underwent single-level vertebral body replacement (VBR) using the XLIF technique between 2018 and 2023. The sample consisted of patients with vertebral fractures or tumors requiring anterior column reconstruction.

OUTCOME MEASURES

Clinical outcomes were assessed using the Visual Analog Scale (VAS) for pain and the American Spinal Injury Association (ASIA) classification for neurological status. Radiological outcomes included preoperative and postoperative CT measurements of regional angulation and spinal stability. Complications were also recorded and analyzed.

METHODS

A retrospective analysis was conducted on 23 patients who underwent single-level vertebral body replacement (VBR) using the XLIF technique between 2018 and 2023. Clinical outcomes were evaluated using Visual Analog Scale (VAS) scores for pain and the American Spinal Injury Association (ASIA) classification for neurological function. Radiological assessments included preoperative and postoperative CT scans to measure regional angulation and spinal stability. Data were analyzed for pain reduction, neurological improvement, and complication rates.

RESULTS

Patients demonstrated significant clinical improvements, with a median reduction in VAS pain scores from 8 to 2 and neurological improvement in 82.6% of cases (ASIA E classification). Radiological outcomes showed a median kyphotic angle correction of 5° post-dorsal stabilization and 9° post-ventral stabilization. Complications were noted in 8.7% of cases, including pleural injuries and hypoesthesia, primarily in thoracic VBR and osteoporotic patients. Overall, the XLIF technique provided substantial pain relief, neurological recovery, and spinal stability.

CONCLUSIONS

VBR via XLIF is a promising technique for treating vertebral fractures and tumors, offering substantial pain relief, neurological recovery, and spinal stability. Despite some complications, the procedure demonstrates significant clinical and radiological benefits, underscoring its efficacy in complex spinal pathologies.