Unstable burst fractures of the thoraco-lumbar junction: treatment by posterior bisegmental correction/fixation and staged anterior corpectomy and titanium cage implantation

Nov 29, 2005Acta neurochirurgica

Treatment of unstable spine fractures at the middle-lower back using back surgery followed by front surgery with metal cage support

AI simplified

Regenerative Health on OpenScience ↗PubMed ↗DOI ↗

Abstract

The mean posttraumatic loss of anterior vertebral body height was 58% (45-70%).

Posttraumatic mean regional kyphosis was 16 degrees, which could be corrected to a mean lordosis of 2 degrees using the posterior approach.
A mean secondary loss of kyphosis correction of 3 degrees was observed over 24 months.
No hardware failures occurred, and construct stability was maintained in all 20 patients.
Surgical complications included one during the posterior approach and three transient complications from the anterior approach.
12 of the 14 patients with initial neurological deficits improved by an average of 1.5 grades on the ASIA scale.
At 24 months postoperatively, mean regional TL back pain was reported at 1.6 on a scale of 0-10, with anterior approach site pain at 1.2.

AI simplified

BACKGROUND: Controversy exists about the best treatment of unstable thoraco-lumbar (TL) burst fractures. Kyphosis correction and canal decompression in case of a neurological deficit are recognized treatment objectives, and various conservative and surgical strategies have been proposed. This prospective observational study evaluates the benefits and risks of a posterior bisegmental transpedicular correction/fixation and staged anterior corpectomy and titanium cage implantation in unstable TL junction burst fractures.

METHOD: 20 consecutive patients with a single-level traumatic unstable burst fracture at the TL junction were operated on by a bisegmental posterior correction/fixation, followed by anterior corpectomy and titanium cage implantation 7-10 days later. The radiological and clinical course is documented over a period of 24 months.

FINDINGS: The mean posttraumatic loss of anterior vertebral body height was 58% (45-70%). The posttraumatic mean regional kyphosis was 16 degrees and could be corrected by the posterior approach to a mean lordosis of 2 degrees. Mean secondary loss of the kyphosis correction was 3 degrees over 24 months. No hardware failure occurred, and construct stability was observed in all 20 patients. One surgical complication occurred during the posterior approach, and three transient surgical complications by the anterior approach. 12 of the 14 patients with an initial neurological deficit recovered an average of 1.5 grades on the ASIA scale. At 24 months postoperatively, the mean regional TL back pain on a VAS (0-10) was 1.6, and the mean pain at the anterior approach site was 1.2.

CONCLUSION: Posterior bisegmental transpedicular correction/fixation and staged anterior corpectomy and titanium cage implantation is a safe and reliable surgical treatment option in unstable TL junction burst fractures. The advantages of this technique are a complete kyphosis correction, immediate stability, maintenance of kyphosis correction, and complete spinal canal decompression in case of a neurological deficit. However, these advantages have to be carefully weighed against the double approach morbidity.

Full Text

Full text is available at the source.

View full text (PDF) ↗View full text (HTML) ↗View full text ↗

Unstable burst fractures of the thoraco-lumbar junction: treatment by posterior bisegmental correction/fixation and staged anterior corpectomy and titanium cage implantation

Abstract

Full Text

You found one interesting study. We’ll send the next 7.

what lands in your inbox each week:

Abstract

Full Text

Related papers

You found one interesting study. We’ll send the next 7.

what lands in your inbox each week: