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