The phenomenon and efficiency of ligamentotaxis after dorsal stabilization of thoracolumbar burst fractures

Thirty-six consecutive patients with burst fractures of the thoracolumbar spine and with a fractured posterior vertebral surface dislocated into the spinal canal without neurological symptoms were treated with the AO internal fixator. Computed tomography-aided planimetry of the spinal canal was undertaken preoperatively and within 1 week postoperatively to elucidate the effect of kyphosis correction and distraction on spinal canal widening (ligamentotaxis). The stenosis of the spinal canal area (SCA) was reduced from 29% preoperatively to 19% postoperatively (+10%) of the estimated original area, and the stenosis of the mid-sagittal diameter (MSD) reduced from 31 to 23% (+8%). The widening of the SCA was greater at the level of L1/L2 (+13%) than at L3/L4 (+6%). High preoperative canal compromise was associated with greater absolute spinal canal widening. Large trapezoid-shaped fragments resisted reduction by ligamentotaxis. Even though the effect of ligamentotaxis after operative treatment with the internal fixator was proven, a certain stenosis of the spinal canal remains in most cases. Especially for patients with fracture-related neurological symptoms, ligamentotaxis alone does not seem sufficient for the requested spinal decompression. Even an exact analysis of preoperative CT scans under consideration of the fracture level will not always allow an exact prognosis of the expected effect of ligamentotaxis.     

Spinal canal decompression in traumatic thoracolumbar burst fractures: posterior distraction rods versus transpedicular screw fixation.

Although the benefit of spinal canal decompression of traumatic thoracolumbar burst fractures is controversial, it remains a desirable procedure, as many reports describe improved neurologic outcome with spinal canal reconstruction. The optimal type of posterior instrumentation for reconstructing the spinal canal is unclear. This study focused on the efficacy of posterior distraction rods versus transpedicular screw fixation implants in decompressing the spinal canal and on the relationship between the amount of canal decompression and subsequent neurologic recovery. A medical records review was conducted to identify all patients surgically treated for traumatic burst fractures of the thoracolumbar spine from January 1, 1987 to June 30, 1989. Sixty-seven patients were selected by this review, and, of these, 30 had had both preoperative and postoperative CT scans. We could find no bias among patients who received both preoperative and postoperative CT scans as compared to those who did not, therefore the 30 patients were considered to be a random sample of the total population of 67. A retrospective study was then conducted on the 30 patients with surgically treated burst fractures--15 treated with posterior distraction rods and 15 treated with AO Fixator Interne transpedicular screw fixation implants. Preoperative and postoperative spinal canal cross-sectional areas were measured directly from the scaled CT scans. The area of most severe compromise was compared with an internal standard defined as the next, caudal, uncompromised spinal level, and the percentage of preoperative and postoperative canal compromise was calculated.(ABSTRACT TRUNCATED AT 250 WORDS)     

The options of the three different surgical approaches for the treatment of Denis type A and B thoracolumbar burst fracture

Thoracolumbar fracture is a common traumatic condition; however, the management remains challenging. The aim of this study is to establish criteria for selection of the anterior, posterior and posterolateral approaches for open reduction and internal fixation of thoracolumbar fracture. A group of 64 patients with Denis type A and B thoracolumbar burst fracture were treated with anterior, traditional posterior and paraspinal approach reduction with or without decompression. The fracture was fixed with titanium mesh and Z-plate by anterior approach and screw rod system by posterior approach and paraspinal approach. Clinical evaluations showed operation duration, blood loss, average length of incision and postoperative ODI in the paraspinal group were less than the traditional posterior group and anterior group. The statistical significant differences were reached (P < 0.05). There is not statistical difference between the three approaches for relevant parameters of radiographs (Cobb angle). The anterior approach surgery should be limitedly used for severe Denis type B fracture with direct reduction. The posterior approach is familiar to the spine surgeons and is commonly applied to most Denis type A and B thoracic lumbar fractures with indirect reduction and has less complication compared to the anterior approach, but also has some shortcomings. Paraspinal muscle approach is the muscle gap approach, in line with the minimally invasive surgery , which is now advocated with the idea with indirect reduction, compared to traditional surgery can significantly relieve postoperative pain and is worthy of further research and promotion.     

Reduction of the intracanal fragment in experimental burst fractures

An experimental investigation was carried out to create burst fractures and to evaluate the mechanisms and degree of reduction of the intracanal fragment with posterior instrumentation techniques in multisegmental human cadaver specimens. Reduction of the spinal fragment through kyphosis correction and distraction was evaluated using CT imaging. With kyphosis correction alone there was no decrease in canal compromise; in some cases there was a slight increase in canal compromise. Distraction, whether applied before or after kyphosis correction was the effective mechanism in reducing the fracture fragment. Kyphosis correction applied after distraction did not reduce the fragment further. Posterior devices that are used to treat burst fractures of the thoracolumbar spine with intracanal fragments should provide some form of distraction.     

Intraoperative ultrasonography for reduction of thoracolumbar burst fractures

The purpose of this study was to determine the efficacy of intraoperative ultrasound monitoring in the reduction and stabilization of thoracolumbar burst fractures of the spine. Thirty-one patients underwent a posterior approach for reduction and stabilization of a thoracolumbar burst fracture, with complete follow-up available on 26. Intraoperative real-time sonography was used for monitoring retropulsed fragments during distraction and fracture impaction. Computed tomography was used to compare preoperative canal compromise and postoperative reduction. Average canal compromise preoperatively was 66.5%, and the average canal compromise postoperatively was 18.7%. Neurologic function was not changed in 16, improved in ten, and worsened in none. Average hospital stay was 21.6 days. No complications were directly attributable to the use of the ultrasound. The authors believe that ultrasonography provides a safe and accurate method of intraoperatively evaluating reduction of burst fracture of the thoracolumbar spine from the posterior approach.     

Treatment of acute thoracolumbar burst fractures with kyphoplasty and short pedicle screw fixation: Transpedicular intracorporeal grafting with calcium phosphate: A prospective study

Background:

In the surgical treatment of thoracolumbar fractures, the major problem after posterior correction and transpedicular instrumentation is failure to support the anterior spinal column, leading to loss of correction and instrumentation failure with associated complaints. We conducted this prospective study to evaluate the outcome of the treatment of acute thoracolumbar burst fractures by transpedicular balloon kyphoplasty, grafting with calcium phosphate cement and short pedicle screw fixation plus fusion.

Materials and Methods:

Twenty-three consecutive patients of thoracolumbar (T₉ to L₄) burst fracture with or without neurologic deficit with an average age of 43 years, were included in this prospective study. Twenty-one from the 23 patients had single burst fracture while the remaining two patients had a burst fracture and additionally an adjacent A1-type fracture. On admission six (26%) out of 23 patients had neurological deficit (five incomplete, one complete). Bilateral transpedicular balloon kyphoplasty with liquid calcium phosphate to reduce segmental kyphosis and restore vertebral body height and short (three vertebrae) pedicle screw instrumentation with posterolateral fusion was performed. Gardner kyphosis angle, anterior and posterior vertebral body height ratio and spinal canal encroachment were calculated pre- to postoperatively.

Results:

All 23 patients were operated within two days after admission and were followed for at least 12 months after index surgery. Operating time and blood loss averaged 45 min and 60 cc respectively. The five patients with incomplete neurological lesions improved by at least one ASIA grade, while no neurological deterioration was observed in any case. The VAS and SF-36 (Role physical and Bodily pain domains) were significantly improved postoperatively. Overall sagittal alignment was improved from an average preoperative 16° to one degree kyphosis at final followup observation. The anterior vertebral body height ratio improved from 0.6 preoperatively to 0.9 (P<0.001) postoperatively, while posterior vertebral body height improved from 0.95 to 1 (P<0.01). Spinal canal encroachment was reduced from an average 32% preoperatively to 20% postoperatively. Cement leakage was observed in four cases (three anterior to vertebral body and one into the disc without sequalae). In the last CT evaluation, there was a continuity between calcium phosphate and cancellous vertebral body bone. Posterolateral radiological fusion was achieved within six months after index operation. There was no instrumentation failure or measurable loss of sagittal curve and vertebral height correction in any group of patients.

Conclusions:

Balloon kyphoplasty with calcium phosphate cement secured with posterior short fixation in the thoracolumbar spine provided excellent immediate reduction of posttraumatic segmental kyphosis and significant spinal canal clearance and restored vertebral body height in the fracture level.     

后路伤椎上间隙融合双节段固定治疗Denis B型椎体爆裂性骨折

目的 探讨后路伤椎上间隙融合双节段固定治疗Denis B型椎体爆裂性骨折的临床疗效.方法 2009年7月至2011年1月收治8例Denis B型椎体爆裂性骨折患者,男5例,女3例;年龄20～68岁,平均42岁.采用后路伤椎上间隙融合双节段固定,比较术前、术后Frankel分级变化、术前、术后及末次随访时伤椎前缘高度比值...     

胸腰椎Chance骨折和屈曲过伸型损伤的手术治疗

目的：观察胸腰段Chance骨折和屈曲过伸型损伤伴神经损伤的手术疗效。方法：全组11例,男8例,女3例,年龄15-48岁,平均34岁,神经功能FrankelA级2例,B组2例,C级2例,D级4例和E级1例。手术内固定器械分别使用了Harrington、浓RF和CD内固定系统,随访时间1-9年,平均3年8个月。结果：全组病例脊柱后柱分离得到明显恢复,脊柱前柱压缩亦得到改善。除2例外FrankelA级患者神经功能无 变化外,8例不全截瘫均有Frandel1级以上的改善。结论：手术治疗可及时恢复脊柱的稳定性,促进神经功能康复。     

The natural history of burst fractures at the thoracolumbar junction

Conservative management of 54 patients with thoracolumbar (T12 and/or L1) burst fractures was investigated. The fractures were subdivided according to the Denis classification and a modification was suggested. Most type A and B fractures showed good results regarding reduction and neurological improvement. However, severe type B (with anterior column compression and spinal canal narrowing exceeding 50%), D, and E fractures were to a large extent complicated by intractable low back pain, neurological involvement, and signs of instability. This study suggests predictors for complications in patients with burst fractures in the thoracolumbar junction. These are (a) compression rate of the anterior column exceeding 50%, (b) narrowing of the spinal canal exceeding 50%, (c) signs of rotational malalignment in fracture level, and (d) level of the injury (L1 fractures).     

Evaluation of surgical treatment for burst fractures

The authors instituted a prospective, randomized study of patients presenting with acute burst fractures of the thoracolumbar and lumbar spine. Patients were alternately treated by posterior distraction using pedicle instrumentation (AO fixateur interne) or anterior decompression and instrumentation (Kostuik-Harrington device). Forty patients are presented with a mean follow-up of 20 months. Preoperatively, there was significant canal compromise in 39 patients. This measured 44.5% in those patients undergoing posterior surgery and 58% in those patients undergoing anterior surgery. Postoperatively, this was reduced to 16.5% and 4%, respectively. There is a statistically significant difference between these two groups (P less than 0.0001). The mean preoperative kyphotic deformity was 18.7 degrees in those patients treated by anterior surgery and 18.2 degrees in the group treated by posterior surgery. At last follow-up, the mean improvement in kyphotic deformity was 9.3 degrees in the anterior group and 11.3 degrees in the posterior group. There is no statistically significant difference between these two groups. There were two implant failures of the anterior Kostuik-Harrington construct and two implant failures of the AO fixateur interne. Blood loss was significantly higher in the patients undergoing anterior surgery, but there were no complications from thoracotomy and anterior decompression of the dural sac. This study supports the hypothesis that posterior distraction instrumentation can effectively decompress the canal and correct kyphosis in patients sustaining burst-type injuries. Anterior surgery, however, results in a more complete and reliable decompression of the canal.     

Complications following Harrington instrumentation for fractures of the thoracolumbar spine

The purposes of using Harrington instrumentation for the treatment of thoracolumbar fractures are to reduce the fracture, decompress the spinal canal, create stability at the fracture site, and shorten the hospitalization period. However, technical problems or the injudicious use of Harrington-instrumentation systems can also complicate the management of these fractures. We have studied forty patients (forty-five Harrington-instrumentation stabilization procedures) who had significant complications. Twenty-six of the thirty patients who were followed for more than two years required additional spinal reconstructive surgical procedures. Five patients had neurological deterioration (one died), nine patients had an inadequate reduction of translational displacement of a vertebral fracture, sixteen patients had dislodgment or disengagement of the Harrington components with resultant loss of fixation, six patients had a deep wound infection, three patients had a complete wound dehiscence with exposure of metal, and sixteen patients had persistent unrecognized neural compression. Several factors were associated with these failures of Harrington instrumentation: translational (flexion-rotation) injuries of the osteoligamentous middle column; failure to obtain either myelographic or computed tomographic studies, or both, postoperatively; failure to identify persistent neural compression; wound dehiscence; the use of distraction rods for high thoracic kyphosis; and instrumentation across the lumbosacral joint.     

经伤椎与跨节段固定治疗无脊髓损伤的胸腰段A3型骨折

目的 比较经伤椎固定与跨节段固定治疗无脊髓损伤胸腰段A3型骨折的疗效.方法 回顾性分析无脊髓损伤的AO分型为A3型的52例胸腰段单椎体爆裂性骨折患者的临床资料,并按固定方法不同分为A、B两组.A组23例为2005年1月至2006年12月采用后路经伤椎椎弓根钉固定的患者,其中男性18例,女性5例;平均年龄(35.3±8.3)岁;伤椎分布:T_(11)1例、T_(12)9例、L_111例、L_2 2例.B组29例为1999年1月至2004年12月采用传统后路跨节段经椎弓根固定的患者,其中男性20例,女性9例;平均年龄(37.3±6.8)岁;伤椎分布:T_(11)1例、T_(12)7例、L_120例、L_2 1例.分别于术前、术后即刻、术后2年对患者临床疗效与影像学指标进行对比分析.结果 患者均获随访,随访时间24～84个月,平均(37.4±10.9)个月.A、B两组比较,术前、术后即刻、术后2年JOA、VAS平均评分差异均无统计学意义;术后即刻Cobb角平均矫正度分别为13.7°±7.7°、8.8°±5.0°,术后2年平均矫正丢失度分别为2.9°±1.5°、5.0°±2.9°,差异均有统计学意义(P<0.01);术后即刻伤椎前缘高度平均矫正度分别为(29.4±6.0)%、(21.7±6.9)%,术后2年平均矫正丢失度分别为(3.1±0.8)%、(6.6±3.0)%,而术后即刻伤椎后缘高度平均矫正度分别为(8.5±3.2)%、(6.1±1.8)%.术后2年平均矫正丢失度分别为(2.0±0.8)%、(3.4±1.0)%,两组伤椎前、后缘高度术后即刻平均矫正度及术后2年平均丢失度差异均有统计学意义(P<0.01).A组术后即刻CT显示11例(47.8%)椎管内骨折块完全复位、12例(52.2%)复位后矢状径狭窄<1/3,复位效果优于B组(P<0.01).术后未出现神经损伤及与伤椎置钉有关的并发症.B组出现2例螺钉断裂.结论 经伤椎固定治疗胸腰段A3型骨折能获得更好的初期复位,术后2年矫正丢失较跨节段固定少.     

间接复位治疗胸腰椎爆裂型骨折术后椎管重塑形

目的观察后路椎弓根螺钉间接复位术后椎管形态面积的变化,探讨间接复位效果及术后椎管重塑形现象。方法 2003年5月～2010年9月,同组医师采用后路椎弓根螺钉间接复位治疗胸腰椎爆裂型骨折27例,其中L113例,L29例,L34例,T121例。美国脊髓损伤学会（American Spinal Injury Association,ASIA）分级D级13例,E级14例。术前、术后1周及术后1年取内固定行CT检查,测量伤椎平面的椎管面积及伤椎相邻上下椎管平均面积,计算伤椎椎管骨块占位率。比较术前、术后1周及术后1年椎管骨块复位程度。结果 27例患者均获得随访,13例术前D级患者均恢复到E级。术后1周CT复查显示椎管骨块占位率由术前（30.9±13.8）%减至（10.4±6.4）%,差异有统计学意义（P〈0.05）;术后1年椎管骨块占位率减至（6.3±3.9）%,与术后1周相比差异有统计学意义（P〈0.05）。结论后路椎弓根螺钉间接复位治疗胸腰椎爆裂型骨折能明显有效减少椎管内骨块占位率,经过术后1年重塑形椎管面积接近正常水平。     

采用椎弓根螺钉经伤椎固定与不经伤椎固定治疗下腰椎骨折疗效对比分析

目的：对比分析采用跨伤椎固定与经伤椎固定治疗下腰椎骨折的疗效。方法：回顾性分析2009年1月～2010年12月分别采用椎弓根螺钉经伤椎固定与不经伤椎固定治疗的56例下腰椎骨折,其中男41例,女15例;年龄21~46岁,平均41．5岁。损伤部位：L3 27例,L4 16例,L5 13例。按AO分型：A1．2型6例,A3．1型29例,A3．2型9例,A3．3型12例。载荷评分5-8分,平均6-3分。脊髓神经损伤按ASIA分级：B级3例,C级4例,D级8例。采用椎弓根螺钉不经伤椎固定27例,经伤椎固定29例,两组患者均选择性进行单节段植骨融合。对比两组患者术前、术后和最后随访时的Cobb角、伤椎前缘高度恢复及椎管占位情况的变化。随访过程中过程中观察植骨融合和马尾神经恢复情况。采用Denis评分比较两组患者局部疼痛和工作状态的恢复差异。结果：所以患者获随访12—48个月,平均25．8个月。不经伤椎固定1例于术后3个月出现棒松动,其余未出现内松动或断裂现象。在术后Cobb角矫正、椎体前缘高度恢复、椎管占位率恢复及最后随访时椎体前缘高度恢复和椎管占位保持方面两组差异无统计学意义（P〉0．05）。术后两组患者矫正度均存在丢失现象,不经伤椎固定组最后随访时的Cobb角与术后比较差异的统计学意义（P〈0．05）,经伤椎固定组最后随访时的Cobb角与术后比较差异无统计学意义（P〉0．05）,两组间Cobb角矫正度丢失率差异有统计学意义（P〈0．05）。不经伤椎固定组植骨融合21例（78％）,经伤椎固定组植骨融合27例（93％）（P〈0．05）。在局部疼痛评分上,经伤椎固定组优于不经伤椎固定组（P〈0．05）,而在工作状态的恢复方面两组差异无统计学意义（DO．05）。结论：相对不经伤椎固定,经伤椎固定治疗下腰椎骨折能够获得较高的植骨融合率,同时能更好的维持脊柱矫正度,是下腰椎骨折后路治疗的较好选择。     

Mechanical principle and clinical application of the combined spinal rod-plate and transpedicular screws fixation system

Twenty-one patients with unstable burst fractures of the lower thoracic and lumbar spine were treated with a combined spinal rod-plate and transpedicular screws (CSRP-TPS) fixation system. This system is a new device for disorders of the lower thoracic and lumbar spine. In treatment of spinal fractures, it provided three-column axial distraction and stabilized the injured vertebra in a lordotic position-this maximized the reduction and indirectly achieved a neurologic decompression by ligamentotaxis. This "indirect" neurologic decompression was more successful in cases treated early after injury as the spinal canal area (measured by pre- and postoperative CT) increased 35% in cases treated within one week after injury; 25% in cases treated 7-14 days after injury; and there was little improvement in cases treated more than two weeks following injury. All patients had a minimum follow-up of 12 months. There were no infections, iatrogenic neurologic deficits or instrumentation failures. The CSRP-TPS system gave more improved results over conventional Harrington and segmental spinal instrumentation systems and only required fixation and fusion of three vertebral levels.     

Analysis of 75 operated thoracolumbar fractures and fracture dislocations with and without neurological deficit

Seventy-five surgically treated patients with thoracolumbar fractures and fracture dislocations, operated on between 1978 and 1982 at the Orthopedic Department of the University of Basel, were analyzed. The follow-up ranged from 18 months to 6 years. There were 45 men and 21 women, and 60% of the patients were not more than 30 years old. Additional injuries were common: 30% of the patients had craniocerebral injuries and 20% were polytraumatized. Ninety-six percent of all patients reached a hospital within 6 h, but only 23% initially presented at a center for spinal surgery. Sixteen patients had anterior surgery (fusion alone or with plating), and two of these had laminectomy as a second operation. Fifty-seven patients had posterior surgery, in 34 cases combined with a laminectomy. The Harrington instrumentation was used 45 times (29 distraction, 14 compression, and two combinations of distraction and compression rods). Luque rods with segmental sublaminar wiring was used seven times, the locking-hook distraction-rod system of Jacobs twice, and miscellaneous procedures five times. A total of 24 patients (greater than 30%) presenting neurological deficits improved postoperatively. None of the 18 patients with normal neurological findings deteriorated during the operation. Neurological improvement was seen more frequently after early than after delayed surgery, but the difference was not statistically significant. Laminectomy had no statistically significant effect on postoperative neurological status. Twenty-two patients required reoperation because of insufficient or failed instrumentation. Luque instrumentation had the highest rate of reoperations. Anterior surgery did not prove superior to posterior procedures. Hospitalization and immobilization time was significantly reduced with surgery for the neurologically normal or minimally damaged patients, but not for completely or incompletely paraplegic patients. Postoperative back pain occurred in 22 patients, of whom 14 had nonanatomic postoperative reductions. Complications directly due to the surgery were rare. It is our conclusion that the instrumentation used in this series was not good enough to be proposed for standardized use. These technically unsatisfactory results induced the development of the internal fixator system in the senior author's (E.M.) department.     

Analysis of 75 operated thoracolumbar fractures and fracture dislocations with and without neurological deficit

Summary Seventy-five surgically treated patients with thoracolumbar fractures and fracture dislocations, operated on between 1978 and 1982 at the Orthopedic Department of the University of Basel, were analyzed. The follow-up ranged from 18 months to 6 years. There were 45 men and 21 women, and 60% of the patients were not more than 30 years old. Additional injuries were common: 30% of the patients had craniocerebral injuries and 20% were polytraumatized. Ninety-six percent of all patients reached a hospital within 6h, but only 23% initially presented at a center for spinal surgery. Sixteen patients had anterior surgery (fusion alone or with plating), and two of these had laminectomy as a second operation. Fifty-seven patients had posterior surgery, in 34 cases combined with a laminectomy. The Harrington instrumentation was used 45 times (29 distraction, 14 compression, and two combinations of distraction and compression rods). Luque rods with segmental sublaminar wiring was used seven times, the locking-hook distraction-rod system of Jacobs twice, and miscellaneous procedures five times. A total of 24 patients (>30%) presenting neurological deficits improved postoperatively. None of the 18 patients with normal neurological findings deteriorated during the operation. Neurological improvement was seen more frequently after early than after delayed surgery, but the difference was not statistically significant. Laminectomy had no statistically significant effect on postoperative neurological status. Twenty-two patients required reoperation because of insufficient or failed instrumentation. Luque instrumentation had the highest rate of reoperations. Anterior surgery did not prove superior to posterior procedures. Hospitalization and immobilization time was significantly reduced with surgery for the neurologically normal or minimally damaged patients, but not for completely or incompletely paraplegic patients. Postoperative back pain occurred in 22 patients, of whom 14 had nonanatomic postoperative reductions. Complications directly due to the surgery were rare. It is our conclusion that the instrumentation used in this series was not good enough to be proposed for standardized use. These technically unsatisfactory results induced the development of the internal fixator system in the senior author's (E.M.) department.     

Comparison of two Types of Surgery for Thoraco-Lumbar Burst Fractures: Combined Anterior and Posterior Stabilisation vs. Posterior Instrumentation Only

Summary  This retrospective study compares clinical outcome following two different types of surgery for thoracolumbar burst fractures. Forty-six patients with thoracolumbar burst fractures causing encroachment of the spinal canal greater than 50% were operated on within 30 days performing either: combined anterior decompression and stabilisation and posterior stabilisation (Group 1) or posterior distraction and stabilisation using pedicle instrumentation (AO internal fixator) (Group 2). We evaluated: neurological status (Frankel Grade), spinal deformities, residual pain, and complications. The average follow-up was 6 years. There were no significant differences between the patients in both groups concerning age, sex, cause of injury and the presence of other severe injuries. Neurological dysfunction was present in 39% of all cases. Bony union occurred in all patients. Loss of reduction greater than 5 degrees and instrumentation failure occurred significantly more often in Group 2 compared to Group 1, but the kyphosis angle at late follow-up did not differ between groups, due to some degree of overcorrection initially after surgery in Group 2. The clinical outcome was similar in both groups, and all but one patient with neurological deficits improved by at least one Frankel grade.  Indirect decompression of the spinal canal by posterior distraction and short-segment stabilisation with AO internal fixator is considered appropriate treatment for the majority of unstable thoracolumbar burst fractures. This is a less extensive surgical procedure than a combined anterior and posterior approach.     

The effect of posterior instrumentation of the spine on canal dimensions and neurological recovery in thoracolumbar and lumbar burst fractures

A prospective study was designed to determine whether posterior instrumentation of the spine in thoracolumbar and lumbar burst fractures produces indirect decompression of the spinal canal leading to better remodeling and neurological recovery. The study was conducted in Kasturba Medical College Manipal, India. Sixty-eight consecutive cases of thoracolumbar and lumbar burst fractures were treated by posterior instrumentation, and approval from the hospital ethical committee was obtained. The degree of initial spinal canal compromise, indirect decompression, and remodeling were assessed from the computed tomography scans. The neurological status at the time of presentation and at final follow-up was assessed by the American Spinal Injury Association’s modified Frankel’s grading. The median canal compromise in patients with and without neurological deficit was 47.32 and 39.33%, respectively. The overall mean canal compromise at the time of admission, post-operative, and final follow-up were 47.37, 26.58 and 14.85%, respectively (P = <0.001). The median canal compromise in patients who recovered was 44.5% and in those with no neurological recovery was 55.85%. The median percentage of canal decompression achieved in patients who recovered was 22.15%, whereas it was 22% in those who did not recover. The median remodeling in recovered and non-recovered groups was 64.50 and 80%, respectively. None of these differences was statistically significant. This study shows that posterior instrumentation of the spine produces significant indirect decompression of the spinal canal and better remodeling. However, these factors may not improve the neurological recovery.     

后路短节段器械复位内固定治疗胸腰椎脊柱脊髓损伤86例报告

目的：本报告后路短节段器械复位内固定治疗胸腰椎脊柱脊髓损伤。方法：对86例胸腰椎脊柱脊髓损伤患行脊柱后路椎管减压，根据不同的损伤节段选用不同的短节段内固定器。结果：随访10－24个月，所有伤椎的高度在术后都有不同程度的恢复，神经功能恢复好转率为78．9％。结论：后路短节段器械复位内固定治疗胸腰椎脊柱脊髓损伤是有效的，并且操作简便，创伤小，并发症少。