Cotrel-Dubousset instrumentation in the treatment of unstable thoracic and lumbar spine fractures

Abstract

The use of computed tomography and developments in spinal biomechanics have led to a better understanding of vertebral fractures. The disappointing results achieved with conservative treatment have led to an increasing popularity of surgical treatment in the last 15 years. The results of 20 unstable thoracic or lumbar spine fractures treated surgically with Cotrel-Dubousset instrumentation at the First Clinic of Orthopaedics and Traumatology of the Ankara Social Security Hospital between December 1988 and June 1991 were evaluated in this study. The mean follow-up was 31.9 months. The mean sagittal index angle was 23.7 degrees +/- 6.8 degrees preoperatively and was corrected by 67.1 +/- 29.9%, and the thoracolumbar junction angle was brought within physiological limits in 65% of the cases. Postoperatively, the neurological status improved in 15% of the patients and remained unchanged in the rest. It was concluded that the Cotrel-Dubousset instrumentation established vertebral stability in unstable vertebral fractures by forming a rigid frame and restored physiological thoracic and lumbar postural contours due to its highly corrective effect in the sagittal plane.

The Successful Short-term Treatment of Flexion-distraction Injuries of the Thoracic Spine Using Posterior-only Pedicle Screw Instrumentation

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] The current study is one of the largest to our knowledge in the English literature reported on P/TPS in the treatment of FDI of the thoracic spine. Aside from its limitations, our data supports that FDI of the thoracic spine may be amendable to a uniform surgical approach that allows for the reduction and restoration of the posterior tension band with a biomechanically rigid pedicle screw construct.…”

“…There is limited data reporting the results of the treatment of purely thoracic (T1-T10) FDI. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Various classification schemes have been devised in an attempt to define the mechanism of injury and treatment guidelines. [20][21][22][23] Denis' 3 column theory describes FDI as a failure of the middle and posterior columns under tension, and a possible failure of the anterior column under compression when the flexion force in association with an axis in the anterior column is generated.…”

“…In severe fractures, conservative treatment results in progressive kyphosis that correlates with neurologic deterioration and pain at follow-up. 15,16 Residual or progressive deformity of >17-degree focal kyphosis has been reported to carry a poor clinical prognosis. [24][25][26] The goal of operative intervention is to stabilize the spine, correct any focal kyphosis, prevent progression of the corrected kyphosis, and when indicated, decompress the neural elements.…”

Torakolomber Vertebra Kırıklarında Posterior Stabilizasyon Uygulanan Hastalarımızda Geç Dönem Sonuçlarımız

“…Benzer kırıklara koruyucu tedaviden, erken cerrahi tedaviye kadar çok çeşitli tedavi yöntemleri tanımlanmıştır [2]. Son 50 yıldır, vertebra kırıklarında, posterior ve/veya anterior yaklaşımla posterior, anterior veya kombine enstrümantasyon uygulamaları tedavide kullanılmakta olup, her üç seçenek ile elde edilen çok başarılı sonuçlar bildiren çalışmalar yayımlanmıştır [3,4,5,6,7,8,9,10]. Diğer taraftan hala herkesçe kabul edilebilir, geçerliliği ve güvenirliliği kanıtlanmış, bir torakolomber bölge kırık sınıflaması olmaması, cerrahi tedavide en çok başvurulan nörolojik yaralanma üzerinde cerrahi veya konservatif tedavinin benzer değişimlere yol açması, "spinal instabilite" kavramı konusunda hali hazırda bir kesinlik ve netlik olmaması torakolomber bölge kırıklarının tedavisi konusundaki karmaşanın sürmesine yol açmaktadır.…”