Surgical treatment of Denis type B thoracolumbar burst fracture with neurological deficiency by paraspinal approach

Abstract

We aimed to describe the surgical technique and clinical outcomes of paraspinal-approach reduction and fixation (PARF) in a group of patients with Denis type B thoracolumbar burst fracture (TLBF) with neurological deficiencies. A total of 62 patients with Denis B TLBF with neurological deficiencies were included in this study between January 2009 and December 2011. Clinical evaluations including the Frankel scale, pain visual analog scale (VAS) and radiological assessment (CT scans for fragment reduction and X-ray for the Cobb angle, adjacent superior and inferior intervertebral disc height, and vertebral canal diameter) were performed preoperatively and at 3 days, 6 months, and 1 and 2 years postoperatively. All patients underwent successful PARF, and were followed-up for at least 2 years. Average surgical time, blood loss and incision length were recorded. The sagittal vertebral canal diameter was significantly enlarged. The canal stenosis index was also improved. Kyphosis was corrected and remained at 8.6±1.4o (P>0.05) 1 year postoperatively. Adjacent disc heights remained constant. Average Frankel grades were significantly improved at the end of follow-up. All 62 patients were neurologically assessed. Pain scores decreased at 6 months postoperatively, compared to before surgery (P<0.05). PARF provided excellent reduction for traumatic segmental kyphosis, and resulted in significant spinal canal clearance, which restored and maintained the vertebral body height of patients with Denis B TLBF with neurological deficits.

Postoperative loss of correction after combined posterior and anterior spinal fusion surgeries in a lumbar burst fracture patient with Class II obesity

“…[ 10 , 12 , 17 , 24 , 27 ] Even after posterior fusion without anterior support, favorable postoperative radiological results have been reported for thoracolumbar burst fractures. [ 6 , 28 ] However, in this case, we experienced an unexpected significant postoperative correction loss after combined posterior and anterior fusion surgery. Because the patient had Class II obesity (BMI: 36.9 kg/m 2 ), it is suggested that obesity is a factors influencing postoperative correction loss.…”

“…[ 12 ] The recent development of pedicle screws, including percutaneous screw systems, has enabled surgeons to treat patients with thoracolumbar fractures through the posterior approach easier than ever. [ 6 , 20 , 28 ]…”

“…When treating such patients with spinal fusion surgery, it is debatable whether anterior fusion should be performed only for the injured cranial level (single-level) or for cranial and caudal levels (two levels). [ 10 , 12 , 17 , 24 , 28 ] Surgeons should make an effort to reduce surgical risks; thus, the number of fusion levels should be carefully considered before surgery. On the other hand, sufficient stability with an adequate number of fixation levels is important to avoid postoperative loss of segmental kyphosis correction.…”

Modified Posterior Short-Segment Pedicle Screw Fixation at The Fracture Level for Treatment of Upper Lumbar Burst Fracture

“…Each of them has its own advantages and disadvantages, and there is still controversy over the approach selection. Posterior operation utilizing the tension of the posterior longitudinal ligament to restore the fracture block protruding in spinal canal has the advantages of easier exposure and operation, less trauma, shorter operation time, less bleeding, and better three-dimensional xation so on [15] . Its superiority is also con rmed by the study of Stancić et al [16] .…”

Beneficial effect of traditional Chinese medicine fumigation “Bone-healing Powder” in postoperative pain and recovery of neurological function of traumatic thoracolumbar spine fractures

“…[24] The sagittal vertebral canal diameter had been remarkably enlarged when para-spinal-approach reduction and fixation were used in order to treat Denis B type thoracolumbar burst fractures with deficiencies of neurological function. [25] Specifically, a previous study showed that TCM treatment could promote spinal movement and exercise as well as decreasing the Cobb angle, which is dually a simpler and more cost effective route than conventional treatment. [26]…”