Single-stage operation for traumatic thoracolumbar fractures with severe dislocation via a posterior approach alone: a case series

Abstract

AIm: This study reports a technique for treating severe thoracolumbar fractures with single-stage decompression, reduction, reconstruction, and stabilization via an entirely posterior approach. mAterIAl and methOds:The cases of 11 patients with severe traumatic thoracolumbar fractures/dislocations that were managed with single-stage decompression, reduction, reconstruction, and stabilization via an entirely posterior approach were included. Data on age, sex, mechanism of injury, associated trauma, neurological status, surgical technique, and clinical outcome were reviewed retrospectively. results: Of the 11 patients, two presented with primarily coronal displacement and nine with sagittal displacement. Coronal displacement was corrected from 19% preoperatively to 4.0% at the last follow-up evaluation. Sagittal displacement was reduced from 73.0% preoperatively to 3.0% at the last follow-up evaluation. After a mean follow-up period of 20.7 (range 16-30) months, no patient complained of local pain and no significant loss of correction or hardware failure was observed.COnClusIOn: Our experience proves that the single-stage posterior approach is safe and biomechanically reliable for treating severe thoracolumbar fractures/dislocations. Therefore, the presented technique is an alternative approach for this rare injury.KeywOrds: Thoracolumbar fracture, Severe dislocation, Single-stage, Posterior approach ÖZ AmAÇ: Bu çalışma, tamamen posterior bir yaklaşımla tek evreli dekompresyon, redüksiyon, rekonstrüksiyon ve stabilizasyon ile şiddetli torakolumber kırıkları tedavi etmek için bir tekniği bildirmektedir. yÖntem ve GereÇler: Tamamen posterior yaklaşımla tek evreli dekompresyon, redüksiyon, rekonstrüksiyon ve stabilizasyonla tedavi edilen şiddetli travmatik torakolumber kırık/dislokasyonu olan 11 vaka dahil edilmiştir. Yaş, cinsiyet, yaralanma mekanizması, ilgili travma, nörolojik durum, cerrahi teknik ve klinik sonuçlarla ilgili veriler retrospektif olarak gözden geçirilmiştir.BulGulAr: 11 hasta içinde ikisi primer koronal displasman ve dokuzu sajital displasmanla gelmiştir. Sajital displasman preoperatif olarak %19'dan son takip değerlendirmesinde %4,0'a düzeltilmiştir. Sajital displasman preoperatif olarak %73,0'dan son takip değerlendirmesinde %3,0'a düzeltilmiştir. Ortalama 20,7 (aralık 16-30) aylık takip süresiyle hiçbir hasta yerel ağrıdan yakınmamış ve düzeltmede önemli bir kayıp veya donanımla ilgili başarısızlık gözlenmemiştir. sOnuÇ: Deneyimimiz tek evreli posterior yaklaşımın şiddetli torakolumber kırıklar/dislokasyonlar tedavisinde güvenli ve biyomekanik olarak uyumlu olduğunu göstermiştir. Bu nedenle sunulan teknik bu nadir yaralanma için alternatif bir yaklaşımdır.

Clinical and radiological outcome of non-surgical management of thoracic and lumbar spinal fracture-dislocations — a historical analysis in the era of modern spinal surgery

“…Traumatic thoracolumbar spine dislocations are secondary to high-energy trauma, and these injuries are surgically treated in most, if not all spinal trauma centers around the world. [1][2][3][4][5][6][7][8][9] However, as far as we know, there is no modern study comparing the results of surgical versus non surgical management of these injuries. Because of this, the current studied aimed to report the treatment outcomes of patients treated non-operatively after an AOSpine C Type Thoracolumbar injury.…”

“…1 Many modern series reported the results of surgical treatment of traumatic thoracic and lumbar spinal dislocations with improvement in neurological status, avoiding late spinal deformity and decrease post-operative pain. [5][6][7][8][9] However, no recent comparative study of surgical versus non-surgical management of type C injuries exists attesting to the superiority of surgical treatment.…”

Posterior-only Stabilization for Traumatic Thoracolumbar Burst Fractures

“…TL fractures are a common form of spinal trauma, comprising 15% to 20% of traumatic spinal fractures, with an overall incidence of 64 per 100,000 people per year [ 6 - 7 ]. A majority occur secondary to high-energy trauma in younger patients, while in older patients, the more common etiology is ground-level trauma to an osteoporotic spine [ 8 ].…”

Surgical Management of an Unstable Lumbar Fracture-Dislocation—A Case Report

“…Annually, approximately 160,000 patients sustain spinal column injuries in the United States [1]. The lumbar spine is the most common sites for fractures because of the high mobility of the lumbar spine [2].…”

“…Fracture of the lumbar spine can occur whenever forces applied to the lower spinal column exceed the strength and stability of the spinal column unit. Common injuries resulting in fractures of the lumbar spine include fall from a height, motor vehicle and pedestrian accidents, and penetrating trauma, including gunshot wounds and stabbings [1] [3]. Accidents are the fourth leading cause of death in the United States after heart disease, cancer, and stroke, annually accounting for about 50 deaths per 100,000 populations [4].…”