以三度空間電腦斷層影像評估術後腰椎

Three-Dimensional Computed Tomography in Evaluation of Operated Lumbar Spine

本研究試圖以電腦斷層的三度空間重組影像，應用於19位曾接受腰椎手術而在術後罹患背部症狀的病人。結果發現：三度空間重組影像能理想地表現出手術後的變化，包括先前減壓手術的方式及其範圍、椎板及小面關節被切除的程度、骨融合的立體性，和骨融合與橫突及小面關節的結合情形。此外，對於手術後無法解釋其復發或持續背痛的病人，三度空間重組影像能發現從X光素片和二度空間的電腦斷層軸狀面上難以看出的異常－尤其是癒合不全的裂縫或假關節形成。矢狀面分割的三度空間重組影像，則能更清楚地展示側隱窩與神經孔的大小及形態，和其狹窄的程度及原因。脊椎骨外科醫師如能據此判斷先前手術是否恰當和造成不穩定性的原因及位置，便可因而改進其術前及術後的評估計畫。

Three-dimensional (3-D) reconstructions from computed tomographic (CT) scans were applied in 19 patients with back symptoms after the operation for lumbar spine. The 3-D reconstructed images optimally demonstrate the postoperative changes, including the type and extent of prior decompressions, the extent of laminae and facet joints resected, the solidity of spinal fusion, and the incorporation of fusion mass with transverse processes and facet joints. In addition, for the patients with unexplained recurrent or persistent back pain after surgery, the 3-D reconstructed images discover some abnormalities not appreciated on plain radiographs and two-dimensional axial CT images, especially the gaps of nonunion and/or pseudoarthrosis. The sagittally split 3-D reconstructed images excellently display the size and shape of neural foramen and lateral recess, and the degree and causes of their stenosis. Accordingly, the spinal orthopedic surgeons are able to judge the adequacy of prior surgery and to identify the causes and points of instability, thus improving the pre-and postoperative planning.