1、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 ChapterSpinal 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 Func
2、tions to house and protect spinal cordBiomechanical CharacteristicsThoracic 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 fle
3、xion/extension in lower thoracic spineLumbar 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 jointsChecklist for the Diagnosis of Clinical Instability in the Thor
4、acic and Thoracolumbar Spine (T11 to L1)Point Element Point Value *Anterior elements destroyed or unable to function 2Posterior elements destroyed or unstable to function 2Radiographic criteria 4Sagittal plane displacement 2.5mm (2pt)Relative sagittal plane angulation 5 degrees (2pt)Spinal cord or c
5、auda equina damage 2Disruption of costovertebral articulations 1Dangerous loading anticipated 1Modified 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 instabilityClinical Application Degenerative disorders Fracture Scoliosis Kyphosis Tumors Infection Fail back surgery syndromeIndications for Surgery Progressive myelopathy Lower-extremity weakness or paralysis Radicular pain refractory to conservative measures
