Pedicle screw fixation in spinal disorders: a European view.
Pedicle screw fixation in spinal disorders: a European view.
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DOI：
10.1007/bf01676569
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发表时间：
1997-01-01
期刊：
影响因子：
--
通讯作者：
Webb, J K
中科院分区：
文献类型：
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作者：
Boos, N;Webb, J K
由于安全性和有效性问题，这些设备的上市缺乏政府批准，这加剧了美国对椎弓根固定使用的持续争议。同时，这些植入物已成为欧洲脊柱器械的宝贵组成部分。关于北美的观点，缺乏从欧洲角度考虑椎弓根螺钉系统的历史演变、应用原理和临床结局的全面综述。该文献综述表明，椎弓根固定是一种相对安全的手术，与非椎弓根内固定相比，并发症风险并不显著升高。椎弓根螺钉固定提供了短而刚性的节段稳定，允许在缺乏完整后部结构的情况下保留运动节段和脊柱稳定，这是非椎弓根器械无法实现的。胸腰椎骨折治疗的融合率和临床结局似乎优于其他形式的治疗。对于脊柱畸形的矫正（即，脊柱侧凸、脊柱后凸、脊椎滑脱、肿瘤），椎弓根固定提供了通过后路入路进行刚性节段固定和促进畸形矫正的理论受益，但迄今为止临床相关性仍未知。在腰痛疾病中，对5，600例采用不同技术进行腰椎融合的文献分析显示，椎弓根螺钉固定可以提高融合率，但不能提高临床结果。文献中最引人注目的发现是放射学和临床结果的大范围。对于每一种融合技术，都描述了不良和良好的结果。本综述认为，欧洲脊柱外科医生应该开始通过前瞻性对照临床试验来支持椎弓根螺钉系统对特定脊柱疾病的明显益处。这可能会阻止即将到来的医疗许可机构限制椎弓根螺钉器械的使用，并在不久的将来在欧洲规定脊柱手术的实践。
Continuing controversy over the use of pedicular fixation in the United States is promoted by the lack of governmental approval for the marketing of these devices due to safety and efficacy concerns. These implants have meanwhile become an invaluable part of spinal instrumentation in Europe. With regard to the North American view, there is a lack of comprehensive reviews that consider the historical evolution of pedicle screw systems, the rationales for their application, and the clinical outcome from a European perspective. This literature review suggests that pedicular fixation is a relatively safe procedure and is not associated with a significantly higher complication risk than non-pedicular instrumentation. Pedicle screw fixation provides short, rigid segmental stabilization that allows preservation of motion segments and stabilization of the spine in the absence of intact posterior elements, which is not possible with non-pedicular instrumentation. Fusion rates and clinical outcome in the treatment of thoracolumbar fractures appear to be superior to that achieved using other forms of treatment. For the correction of spinal deformity (i.e., scoliosis, kyphosis, spondylolisthesis, tumor), pedicular fixation provides the theoretical benefit of rigid segmental fixation and of facilitated deformity correction by a posterior approach, but the clinical relevance so far remains unknown. In low-back pain disorders, a literature analysis of 5,600 cases of lumbar fusion with different techniques reveals a trend that pedicle screw fixation enhances the fusion rate but not clinical outcome. The most striking finding in the literature is the large range in the radiological and clinical results. For every single fusion technique poor and excellent results have been described. This review argues that European spine surgeons should begin to back up the evident benefits of pedicle screw systems for specific spinal disorders by controlled prospective clinical trials. This may prevent forthcoming medical licensing authorities from restricting the use of pedicle screw devices and dictating the practice of spinal surgery in Europe in the near future.