Posterior-only Stabilization for Traumatic Thoracolumbar Burst Fractures

Abstract

BackgroundNo consensus exists for the management of unstable thoracolumbar (TL) burst fractures. Surgical options include anterior, lateral, or posterior stabilization (or a combination), depending on the fracture. The potential benefits of anterior reconstruction come with increased operative time and associated morbidity. A posterior-only approach can offer stable correction without increased operative risks but may result in loss of kyphotic correction over time.PurposeTo determine whether posterior-only stabilization is a viable treatment option for patients with traumatic TL fractures as opposed to anterior and combined approaches.MethodsWe performed a retrospective analysis of adult patients with TL burst fractures who underwent posterior­-only surgical intervention from 2005 to 2015. Operations were performed at two levels above and below the fractured segment using pedicle screw-rod fixation constructs with autograft and allograft. All patients received TL bracing for at least three months. Patients lost to follow­up were excluded.ResultsSixty-four consecutive patients with posterior­-only stabilization were identified, with 18 lost to follow­up. Of the remaining 46 patients, 93% (n=43) were male and 7% (n=3) were female, with a mean age of 36.8 years. All patients were followed for 12 months. The mean time until the removal of the brace was 3.54 months. No patients required additional surgical intervention for spinal stabilization. Three patients experienced postoperative complications, all of which were related to infection.ConclusionsOur data indicate that posterior­-only stabilization for traumatic TL burst fractures is a durable and effective option in select patients. The approach offers surgical intervention with a decreased perioperative risk as well as reduced morbidity and mortality, with a minimal increase in the risk of kyphotic deformity. Further prospective studies are necessary to validate these findings clinically.

Outcome of patients undergoing posterior spine fixation and decompression for posttraumatic thoracolumbar spine fractures and the factors predicting it

“…The mean age of presentation was 44.30+/-11.87yrs and most common age group of presentation was 30-50 yrs (59% patients) this again point to the fact that traumatic fractures mainly affects physically active age group and population (males). In a similar study done by Hariri O R et al between 2005 to 2015 among 46 patients, 93% patients were male and mean age of presentation was 36.8 years 9 . Another comparative study done by Petr V et al in thoraco-lumbar spine fractures among 35 patients, again had 28 male patients and mean age of presentation as 42.4years 10 .…”

Effect of Preoperative Embolization on the Intraoperative Bleeding during Posterior Stabilization in Thoracolumbal Fracture Cases at Prof. Dr. R. D Kandou Hospital Manado

“…Therefore, although the posterior radicular arteries were blocked selectively, the vertebrae could still get vascularized from the posterior spinal artery. [1][2][3][4][5][6][7][8][9][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] In the second patient, we performed the posterior stabilization procedure of the 4-5th lumbar vertebrae. The preoperative embolization was performed to block the 2nd of right posterior radicular artery with PVA of 250-355 micron using a micro catheter with a diameter of 1 fr up to 2.5 fr.…”

“…The possibility is the existence of the embolan escaped to a higher level, therefore, it reduced the vascularization to the spinal cord resulting in temporary muslce weakness, or the effects of trauma when the posterior stabilization procedure was performed. [1][2][3][4][5][6][7][8][9]34,35,[39][40][41][42][43][44][45][46][47][48][49] As for the third patient, we performed the posterior stabilization procedure of the 7th thoracal vertebra. The preoperative embolization was performed to block the right posterior radicular artery of the 5th thoracic vertebra and the left posterior radicular artery of the 9th thoracal vertebra using PVA of 250-355 micron in diameter and a micro catheter of 3.0 fr and distal of 2.4 fr (150 cm x 30 cm).…”