胸腰椎疾病治疗原则
高振兴
Chief, Spine Surgery, CHI-MEI Hospital, Taiwan
Honor President, TMISS
Chairman, SAS Taiwan Chapter
Spinal Functional Units
• Two vertebral bodies
• Intervertebral disc
– Functions to provide flexibility for the
spinal column and as a weight-bearing
structure
• Facet joint/posterior elements
– Functions to house and protect spinal
cord
Biomechanical Characteristics
Thoracic spine
• Least mobile region of spine because of stability
provided 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 Spine
• Less still thoracic spine in flexion/extension-trend that
continues as one moves toward sacrum
• Minimal rotation
• Primarily constrained anatomically by more
coronally oriented facet joints
Checklist for the Diagnosis of Clinical Instability in
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 Application
•
•
•
•
•
•
•
Degenerative disorders
Fracture
Scoliosis
Kyphosis
Tumors
Infection
Fail back surgery syndrome
Indications for Surgery
• Progressive myelopathy
• Lower-extremity weakness or
paralysis
• Radicular pain refractory to
conservative measures