OBJECTIVE: To evaluate the early clinical outcomes of subtotal corpectomy and intervertebral bone grafting through posterior approach alone in the treatment of thoracolumbar burst fracture or thoracolumbar fracture-dislocation.
METHODS: Between January 2009 and December 2010, 20 patients with thoracolumbar burst fracture or thoracolumbar fracture dislocation were treated with subtotal corpectomy and intervertebral bone grafting through posterior approach alone. There were 14 males and 6 females, with an average age of 36.1 years (range, 19-47 years). Fractures were caused by falling from height in 12 cases, traffic accident in 6 cases, and crushing in 2 cases. According to AO classification, there were 10 cases of A3 type, 8 cases of B2 type, and 2 cases of C2 type. Single segment was involved in 8 cases, double segments in 12 cases. Twelve cases complicated by fracture dislocation and 6 cases by lateral displacement. All patients had bones occupancy in vertebral canal. The preoperative Cobb angle was (30.2 +/- 3.9) degrees. According to Frankel classification for neurological function, there were 4 cases of grade B, 9 cases of grade C, and 7 cases of grade D at preoperation. The mean time between injury and operation was 4.5 days (range, 1-12 days).
RESULTS: All incisions healed by first intention, and no infection occurred. Twenty patients were followed up 8-16 months (mean, 12 months). The interbody fusion time was 6-9 months (mean, 7 months). Neurological function recovered 1 to 3 grades: 1 case of grade C, 2 cases of grade D, 17 cases of grade E at last follow-up. The Cobb angle was (6.5 +/- 4.2) degrees at last follow-up, showing significant difference when compared with preoperative value (t = 2.39, P = 0.00). No breaking or loosening of screw and implant sinkage occurred.
CONCLUSION: A combination of subtotal corpectomy and intervertebral bone grafting through posterior approach alone has the advantages of complete decompression, restoration of spinal stability, restoration of vertebral body height, high bone healing rate, and good recovery of neurological function. However, this surgical technique has a relatively large amount of blood loss and high requirements for surgeons.
