In situ contouring technique in the treatment of thoracolumbar fractures

Abstract

Burst fractures typically occur at T12 or L1 and create a sagittal deformity by a compression mechanism. This posttraumatic kyphosis is evaluated preoperatively by measuring the sagittal index of Farcy. Posterior instrumentation using in situ contouring is based on a bilateral insertion of rods which take the shape of the spine first. The rods are placed in a perpendicular position to monoaxial pedicular screws and then bent in situ, which makes the spine follow the movements of the rods. This principle makes it possible to correct the posttraumatic kyphosis at the level of the fractured vertebra and the overlying disk, which will open progressively using a ligamentotaxis mechanism. An additional anterior approach is indicated if the sagittal correction through the disk represents less than 50% compared to the total correction (in other words, if the correction of the traumatic deformity is obtained more in the disk than in the bone (>50%), an additional anterior approach is performed: more through the disk than the vertebral body (>50%)). This reliable technique meets the requirements of sagittal posttraumatic kyphosis correction, and provides a solid construct which avoids bracing.

Percutaneous three column osteotomy for kyphotic deformity correction in congenital kyphosis

“…To correct the sagittal imbalance, a variety of techniques including closing wedge and opening osteotomies, as well as combined anterior/posterior approaches have been advocated [11,12,19]. The advantages, associated with minimally invasive surgery (MIS) [5], namely less blood loss, less soft tissue trauma leading to intact muscles and osteoligamentous fixation, have recently been used in adult spinal deformity correction [8,10].…”

Influence of the Shape of Back on the Thoraco-lumbar Fractures

“…There is no elongation stress on the spine, just a correction of the lordosis. Before locking the implants, the frontal balance of the construct must be improved (implants on the same vertebra forming a perpendicular line with the rod) by compressiondistraction maneuvers [1,2]. The sub-laminar hook is locked in compression on the screw that it protects.…”

“…Thoraco-lumbar fractures are the most frequent spinal injuries [1][2][3]. The traumatic injury first leads to a kyphotic deformity [4] noted and measured as previously described by several authors [5][6][7][8].…”

“…We conducted a prospective and observative study of 80 thoracolumbar fractures, operated on by the same surgeon. Reduction was performed by the in situ contouring technique described by Jackson [22] and Steib [2].…”

Thoracolumbar fracture reduction by percutaneous in situ contouring

“…In situ contouring has been described for open surgery [7,8]. The principle of this technique consists of first giving the rods the shape of the spine, and then to bend the rods inside the patient.…”