胸腰椎疾病治疗原则.pptVIP

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) 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 * * 1 Dangerous loading anticipated 4 Radiographic criteria Sagittal plane displacement 2.5mm (2pt) Relative sagittal plane angulation 5 degrees (2pt) 2 Spinal cord or cauda equina damage 2 Posterior elements destroyed or unstable to function 1 Disruption of costovertebral articulations 2 Anterior elements destroyed or unable to function Point Value * Point Element 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 *