Modified surgery for acute thoracolumbar fractures: a prospective report

Abstract

Objectives The treatment of acute thoracolumbar fractures is a demanding and fine surgical challenge. Conventional procedures are not always satisfactory enough because of postoperative complications of failure of posterior instrumentation or lumbodorsal pain etc. This prospective outcome study was undertaken to investigate the improvement of the surgical treatment effect on acute thoracolumbar fractures by performing modified surgeries. Methods Nineteen patients with acute thoracolumbar fractures and associated incomplete neurologic deficit, subjected to the methods of transpedicular intracorporeal hydroxyapatite grafting and pedicle screw fixation through paraspinal approach, were reviewed after a minimum follow-up of 2 years. Nineteen patients all suffered from a single thoracolumbar fracture. The mean preoperative ratio of the height of the anterior border was 57.2%, kyphosis degree was 21.6°, and occupancy of canales spinalis was 30.5%. The radiographic parameters were evaluated, and clinical records were reviewed. Results The average operating time was 112.4 min, and the mean blood loss was 123.7 ml. The neurologic function of all 19 patients was improved by at least one American Spine Injury Association grade, with 17 (89.5%) having complete neurologic recovery. The mean height of injured spine was corrected from 57.2% to 88.4% at the most recent follow-up, and the kyphosis was corrected from 21.6°to 4.8°. There was only one patient (5.3%) who complained that the operative area was a little painful, and the remaining patients did not claim pain in waist and back. Conclusions Transpedicular intracorporeal hydroxyapatite grafting and pedicle screw fixation through paraspinal approach could provide reliable neurologic improvement in patients with incomplete neurologic deficit, and could prevent the development of kyphosis. Furthermore, it has the obvious advantages of less invasion and blood loss, and decreases the risks of postoperative lumbodorsal pain.

Treatment of thoracolumbar fracture-dislocation with a trauma limitation strategy: a technical report and 2-year follow-up

“…After the thorough decompression of the spinal canal was performed, the dissection was performed again, and the dislocation and recovery of the spine sequence were corrected by the principle of leverage to achieve the same surgical effect as that of conventional open surgery. Thoracic and lumbar vertebrae fracture-dislocation without obvious height loss of the vertebral body can be implanted at the intervertebral and posterior lateral attachments; if the height of the combined vertebral body is lost, the "shell effect" can occur after the internal xation of the injured vertebrae [19] . When the anterior middle column is insu cient following injury, the internal xation will bear substantial stress.…”