Posterior Direct Decompression and Fusion of the Lower Thoracic and Lumbar Fractures with Neurological Deficit

Abstract

Study DesignA retrospective study.PurposeTo analyze the treatment outcome of patients with lower thoracic and lumbar fractures combined with neurological deficits.Overview of LiteratureAlthough various methods of the surgical treatment for lower thoracic and lumbar fractures are used, there has been no surgical treatment established as a superior option than others.MethodsBetween March 2001 and August 2009, this study enrolled 13 patients with lower thoracic and lumbar fractures who underwent spinal canal decompression by removing posteriorly displaced bony fragments via the posterior approach and who followed up for more than a year. We analyzed the difference between the preoperative and postoperative extents of canal encroachment, degrees of neurologic deficits and changes in the local kyphotic angle.ResultsThe average age of the patients was 37 years. There were 10 patients with unstable burst factures and 3 patients with translational injuries. Canal encroachment improved from preoperative average of 84% to 9% postoperatively. Local kyphosis also improved from 20.5° to 1.5°. In 92% (12/13) of the patients, neurologic deficit improved more than Frankel grade 1 and an average improvement of 1.7 grade was observed. Deterioration of neurologic symptoms was not observed. Although some loss of reduction of kyphotic deformity was observed at the final follow-up, serious complications were not observed.ConclusionsWhen posteriorly displaced bony fragments were removed by the posterior approach, neurological recovery could be facilitated by adequate decompression without serious complications. The posterior direct decompression could be used as one of treatments for lower thoracic and lumbar fractures combined with neurologic injuries.

Posterior Decompression with Fusion & Fixation by Pedicle Screw and Rod of Thoraco Lumbar Spine: A Study of 15 Cases

“…It was evident that 13(86.66%) were male and 2(13.33%) were female. In previous study 10 patients sustained unstable burst fractures and 3 patients sustained translational injuries (fracture-dislocation) 16 . In our study 9(60%) were compressed fracture, 3(20%) ( Fig.…”

“…The depth gauge may be inserted into the cancellous bone of the vertebral body and the anterior cortex is not perforated. If there is doubt regarding the depth, take a lateral radiography and ensure that the depth gauge does not penetrate more than 80% of the AP body diameter, then the anterior cortex will not be perforated 16 .…”

“…In previous study the average age group were 37 years (± 11.7 years), there were 9(69%) male patients and 4(31%) female patients. The average follow-up period was 30 months (± 13.5 months) 16 . In our study the highest age group were 1-20 years and 21-40 years that was 6(40%).…”

Anterior Reconstruction via a Relatively Noninvasive Retroperitoneal Approach for Lumbar Burst Fracture

“…However, the optimal management of lumbar burst fractures remains controversial. Some authors recommend posterior reconstruction because of various advantages, including safety, less technically demanding and wide surgical field of view, whereas posterior reconstruction is reportedly associated with surgical failure with increased kyphotic deformity or unimproved neurologic deficits. Some authors recommend anterior reconstruction in patients who have sustained neurologic deficits or kyphotic deformity.…”

“…Some authors recommend posterior reconstruction because of various advantages, including safety, less technically demanding and wide surgical field of view, whereas posterior reconstruction is reportedly associated with surgical failure with increased kyphotic deformity or unimproved neurologic deficits. Some authors recommend anterior reconstruction in patients who have sustained neurologic deficits or kyphotic deformity. However, concerns with the anterior approach include an increased risk of surgery‐related soft tissue injury such as abdominal muscle dissection, greater blood loss and longer operative time and hospital stay.…”