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 function2 Posterior elements destroyed or unstable to function2 Radiographic criteria4 Sagittal plane displacement > 2.5mm (2pt) Relative sagittal plane angulation > 5 degrees (2pt) Spinal cord or cauda equina damage2 Disruption of costovertebral articulations1 Dangerous loading anticipated1 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