Treatment of Complete Fracture-dislocation of Thoracolumbar Spine

Abstract

Although difficult, satisfactory reduction of complete lumbar fracture-dislocation can be achieved through pedicle instrumentation. Intraoperative traction is necessary for the reduction procedure. Preoperative duration should be not >3 weeks. For the patient who cannot receive spine surgery in a few days after injury, preoperative traction should be applied. Covering dura sac by autologous fat graft is recommended for all the patients.

Management of traumatic double-level spondyloptosis of the thoracic spine with posterior spondylectomy: case report

“…20 However, posterior spondylectomy seems a safe and useful alternative, which appears to obviate the need for staged surgery in irreducible cases. 3,19 Preoperative application of pelvic traction and its continuation during surgery to facilitate reduction have been advised in patients with irreducible injury. Preoperative traction may ameliorate spinal column shortening and prevent soft-tissue contraction around the lesion and facilitate its open reduction.…”

Letter to the Editor: Thoracic fracture-dislocations

“…The degree of subluxation in the sagittal and coronal planes is variable and ranges from mild to total spondyloptosis. 8 Surgical management of these fractures is always pursued with the goals of achieving reduction, realignment, and stabilization.…”

“…We found that even in severe cases involving total spondyloptosis of one vertebral body over the other in the coronal, sagittal, or both planes, reduction can be achieved through various means, one of which would be the application of reduction pedicle screws using distractive forces and the removal of the superior articular facets in certain instances. 6,8 Ultimately these fractures will relocate as they are highly unstable, especially with the aid of intraoperative neuromuscular blockade (Fig. 1).…”

“…The reported chance of neurological improvement in these fractures is grim but is not nil. 6,8 Spinal shortening, especially at the level of the thoracic spinal cord, would probably render the potential chances for recovery even lower. Moreover, while the spinal alignment following this procedure is anatomical, a potentially deformed and buckled spinal cord or dural sac would still be associated with a higher risk of posttraumatic syrinx formation with time.…”

“…Realignment through the application of reduction pedicle screws using distractive forces and the removal of the superior articular facets is certainly useful in the acute phase. 5 According to Wang and Zhu, 8 "deformity correction was completely achieved in all the fracture-dislocations that were subjected to surgery within 3 weeks and was partly achieved in those subjected to surgery after 3 weeks." In the subacute phase, the injury is more rigid because of some degree of fracture healing.…”