Ultrasound-Guided Spinal Fracture Repositioning, Ligamentotaxis, and Remodeling After Thoracolumbar Burst Fractures

Abstract

Ultrasound-guided fracture repositioning is an efficient method for spinal canal decompression of burst fractures with neurologic symptoms. The marked degree of widening of the spinal canal due to the effects of ligamentotaxis and remodeling may render the reposition of retropulsed fragments unnecessary in cases of fractures without a neurologic deficit.

Use of Intraoperative Ultrasound During Spinal Surgery

“…Intraoperative ultrasound has been reported to be useful in the resection of intervertebral disc herniations, the reduction of thoracolumbar burst fractures, the resection of ventrally located extradural tumors, and to determine whether posterior decompression alone is adequate for treatment of spinal canal stenosis due to ossification of the posterior longitudinal ligament. 19 , 22 , 41 – 51 Anterior approaches to the ventral spinal canal can provide a better corridor for direct visualization of this region; however, transthoracic, thoracoabdominal, and retroperitoneal approaches are associated with increased blood loss, operative time, and surgical morbidity. These disadvantages can be avoided by using a posterior approach with ultrasound guidance to maneuver angled instruments beneath the thecal sac without the need to retract the thecal sac, spinal cord, or nerve roots.…”

Thoracolumbar fracture reduction by percutaneous in situ contouring

“…Posterior wall fragments could be reduced using ligamentotaxis through percutaneous in situ contouring. Remodeling of the spinal canal may be observed after thoracolumbar burst fractures [24,25]. Leferink et al [23] stressed the importance of intraoperative reduction because this would trigger the amount of remodeling over time.…”

Avaliação da redução por ligamentotaxia nas fraturas toracolombares tipo explosão

“…A taxa de 79% dos pacientes do sexo masculino coincide com a literatura (72%) 11 . O mecanismo mais comum de fratura é a queda de altura 12,13 , representando 68% dos nossos casos.…”

“…O estreitamento médio do canal em 47% do seu diâmetro também está de acordo com a literatura médica, sendo encontrado um estreitamento de 37% no trabalho de Avanzi 12 e de 45% no estudo de Mueller 11. A remodelação no diâmetro do canal vertebral encontrada foi de 40%. No trabalho de Muller, foi de 56% 11 , no de Garcia 14 50%, e de 34% no trabalho de Kuner 13 , com uma remodelação de 48% nos estudos de Sjostrom 15 .…”