皮質骨路徑合併骨水泥：在骨質疏鬆椎體經骨水泥增強後的替代固定方式

Cortical bone trajectory with bone cement: An alternative fixation option for treating patients with previously augmented osteoporotic vertebrae

腰薦椎脊柱融合是治療各種脊柱病變常用的手術方法。經椎弓螺釘固定是後路腰椎融合手術中最常用的方法。然而，傳統的經椎弓路徑可能會被經常用於治療骨質疏鬆性壓迫性骨折的骨水泥所阻擋。因此，我們建議皮質骨路徑（CBT）合併骨水泥，作為先前椎體經骨水泥增加後的替代固定方式。一名87 歲的女性在跌傷後，患有2個月的下背痛合供雙側下肢疼痛。在入院前兩年，曾接受過腰椎第三節骨質疏鬆壓迫性骨折的椎體成形術及腰椎第三四節和第四五節的椎間盤切除手術。核磁共振檢查發現，脊椎滑脫和復發性椎間盤造成神經根壓迫。然後，患者接受腰椎第三四節和第四五節經椎間孔腰椎椎體間融合，並使用CBT 合併骨水泥法，從腰椎第三至五節進行椎體螺釘固定。手術中，在X 透視下，完成CBT 路徑的穿刺。由於脊椎椎體是骨質疏鬆性，故在插入每個螺釘之前，注射0.5ml 聚甲基丙烯酸甲酯水泥。術中沒有發生骨水泥滲漏的現象。術後，先前的神經功能缺損逐漸恢復。手術後6 個月未發現鋼釘移位或鬆動情。我們的病例證明CBT 合併骨水泥，可能是骨質疏鬆患者先前接受椎體骨水泥增強術後的另一種固定選擇方式。

 

Fusion in the lumbosacral spine is a common surgical procedure for management of a variety of spinal pathologies. Transpedicular screw fixation is the most commonly used tech­nique for posterior lumbar fusion surgery. However, the traditional transpedicular path can become blocked by bone cement, which is frequently used to treat osteoportic compression fractures. Therefore, we introduced the cortical bone trajectory (CBT) with bone cement as an alternative fixation option for treating patients with previously augmented vertebrae. An 87-year-old woman presented with lower back pain with radiation to the left leg after a fall 2 months prior to presentation. She had undergone vertebroplasty at the L3 osteoportic ver­tebra and discectomies in the L3-4 and L4-5 vertebrae 2 years before admission. Progressive spondylolisthesis and recurrent discs with nerve root compression in previous surgical levels were diagnosed based on magnetic resonance images. The patient underwent transforaminal lumbar interbody fusion in L3-4 and L4-5 and screw fixation from L3 to L5 using CBT with bone cement. During surgery, CBT was approached under fluoroscopy. Because of the os­teoporotic vertebrae, 0.5 ml of polymethylmethacrylate cement was injected before insertion of each screw. No immediate cement leakage was observed. Postoperatively, the patient’s previous neurological deficits gradually recovered, and no displacement or loosening of in­struments was observed 6 months after surgery. Our case demonstrated that CBT with bone cement is an alternative fixation option for osteoporotic patients with previously augmented vertebrae.