Surgical treatment for the posterior rim separation of the lumbar and sacral vertebral boday

English Keywords:Lumbar vertebrae  Sacral vertebrae  Posterior rim separation  Surgery

English Abstract:

  【Abstract】 Objectives: To evaluate the therapeutical methods and clinical effects for posterior vertebral rim separation of lumbar and sacral vertebral boday. Methods: From February 2004 to June 2010, 34 patients underwent lumbar radiography, computed tomography (CT), and magnetic resonance imaging (MRI). All patients were operated on discectomy and removal of the bony fragments. First, doing disectomy and providing an evacuated interspace, a trench was created around the fragment at the interspace. The resection of bony fragments was proceeded using the laminectomy rongeur, curette and small chisel. Wide fenestration or hemilaminectomy was performed for 13 type Ⅲ lesions. For 11 typeⅠ, Ⅱ lesions that the nerve root symptoms were unilateral, wide fenestration or hemilaminectomy was applied to the trouble side；for 5 cases with bilateral symptoms, bilateral fenestration was applied to both sides；for 5 cases with large bony fragment, spinal canal stenosis and lumbar spondylolisthesis were treated with laminectomy, posterior lumbar interbody fusion(PLIF). JOA score was used to evaluate the short-term clinical results. Results: The follow-up period ranged from 11 months to 4.6 years (mean 2.7 years). The average lumbar JOA score of pre-operation and the last follow-up was 12.4 and 27.2, respectively. Satisfactory effect was achieved in all patients except one typeⅡand one type Ⅲ lesion, the satisfaction rate of the clinical results was 94%. There were no serious intra-operative or postoperative complications. Patients undergoing PLIF had bony fusion at final follow-up. Conclusions: Early operation should be applied to patients who got no effects by conservative treatment. Preoperative accurate diagnosis and understanding the type and location of the separated fragment are the essentials for surgical success.