胸腰椎疾病治疗原则

高振兴高振兴

Chief, Spine Surgery, CHI-MEI Hospital, TaiwanHonor President, TMISSChairman, SAS Taiwan Chapter

Spinal Functional UnitsSpinal Functional Units

• Two vertebral bodies

• Intervertebral disc– Functions to provide flexibility for the sp

inal column and as a weight-bearing structure

• Facet joint/posterior elements– Functions to house and protect spinal cor

d

Biomechanical CharacteristicsBiomechanical Characteristics

Thoracic spine• Least mobile region of spine because of stability provi

ded by costovertebral articulations and rib cage• Lateral bending evenly distributed between vertebral

segments• More axial rotation in upper thoracic spine• More flexion/extension in lower thoracic spine

Lumbar SpineLumbar Spine• Less still thoracic spine in flexion/extension-trend tha

t continues as one moves toward sacrum• Minimal rotation• Primarily constrained anatomically by more coronall

y oriented facet joints

Checklist for the Diagnosis of Clinical Instability in Checklist for the Diagnosis of Clinical Instability in the Thoracic and Thoracolumbar Spine (T11 to L1)the Thoracic and Thoracolumbar Spine (T11 to L1)

Point Element Point Value *

Anterior elements destroyed or unable to function 2

Posterior elements destroyed or unstable to function 2

Radiographic criteria 4

Sagittal plane displacement > 2.5mm (2pt)

Relative sagittal plane angulation > 5 degrees (2pt)

Spinal cord or cauda equina damage 2

Disruption of costovertebral articulations 1

Dangerous loading anticipated 1

Modified from White AA III, Panjabi MM: Clinical biomechanics of the spine, ed 2, Philadelphia, 1990: JB Lippincott.*A point value total of 5 or more indicates clinical instability

Clinical ApplicationClinical Application

• Degenerative disorders

• Fracture

• Scoliosis

• Kyphosis

• Tumors

• Infection

• Fail back surgery syndrome

Indications for SurgeryIndications for Surgery

• Progressive myelopathy

• Lower-extremity weakness or paralysis

• Radicular pain refractory to conservative measures