不安定性を示す80歳以上の高齢者頚椎疾患に対するinstrumentation手術

抄録

  Objective : The use of spinal instruments in the elderly remains controversial because of the potential fragility of their bones. The purpose of this article is to show our views about spinal instrumentation surgery for unstable cervical lesions in elderly patients over the age of 80 years.

  Methods : 31 patients underwent a total of 32 spinal instrumentation surgeries. The vertebral plate system was used in most cases of unstable subaxial cervical spine lesions. Posterior screw fixation system was used for subluxation or dislocation in the upper cervical spine. For odontoid fracture odontoid screw was inserted anteriorly. Bone fusion was evaluated by dynamic plain radiographs 3 months after surgery.

  Results : The patients underwent surgery for spinal injury in 18 cases, cervical spondylosis in 12 cases and spinal tumors in one case. In 25 of 31 case initial fixation remained intact during follow-up period and bone fusion was confirmed. Bony fusion could not be evaluated in 3 cases because of bed-rest following postoperative complications and in one case of cervical metastatic tumor. In two patients, instrumentation failure were occurred. In one case, anterior vertebral plate system placed for vertebral dislocation broke down three weeks after surgery. In this case, an instrument could not support vertebral column that had been destroyed entirely. In another case, bony union was not achieved because of unskillful odontoid screwing. Complications occurred in a total of 6 cases. Respiratory failure was most frequent and occurred in 4 cases, 3 of there died. Confusion or other mental complication, occurred in 2 cases, were transient.

  Conclusion : Spinal instrumentation is a safe and useful method for unstable cervical spinal lesions in elderly patients when the surgical strategy is strict and instrument devices are used with precision.