Surgical Management of Thoracolumbar Spinal Injuries General Principles and Controversial Considerations

Jacobs, Rae R.; Casey, Michael P.

doi:10.1097/00003086-198410000-00004

Cited by 76 publications

(25 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[12][13][14] In general, surgery is indicated for any patient who presents with neurologic deficit and unstable spinal burst fracture. 8 Thoracic or lumbar burst fractures can be surgically managed via anterior, posterior, or combined approaches.…”

Section: Discussionmentioning

confidence: 99%

Single-Stage Posterior Corpectomy and Expandable Cage Placement for Treatment of Thoracic or Lumbar Burst Fractures

Sasani

Özer

2009

Spine

107

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Single-Stage Posterior Corpectomy and Expandable Cage Placement for Treatment of Thoracic or Lumbar Burst Fractures

Sasani

Özer

2009

Spine

107

View full text Add to dashboard Cite

show abstract

“…Severe posttraumatic vertebral deformity has been shown to correlate with residual local symptoms (Day andKokan 1977, Harkonen et al 1979). Reduction and internal fixation are probably more efficient than nonoperative management for restoring the vertebral anatomy, and stabilization of the fractures prevents additional neural damage and allows earlier mobilization (Jacobs and Casey 1984). However, there are few detailed reports on the ultimate radiographic results achieved by Harrington instrumentation in different types of unstable vertebral fractures.…”

mentioning

confidence: 99%

Recurrence of deformity after removal of Harrington's fixation of spine fracture: Seventy-six cases followed for 2 years

Myllynen

Böstman

Riska

1988

Acta Orthopaedica Scandinavica

View full text Add to dashboard Cite

“…3 In the treatment of thoracolumbar fractures involving all the columns, on which rotational forces have a greater impact, the most effective spinal canal decompression is attained by an anterior approach. [4][5][6][7] Conversely, in these cases with disruption of all 3 columns, performing anterior and posterior approaches (staged or simultaneously) is another choice of treatment. 8 Although a posterior approach alone can provide good stabilization, its potential failure to provide full reduction of fragments in the vertebral canal, particularly when posterior longitudinal ligament unity is disrupted, is well known.…”

Section: Discussionmentioning

confidence: 99%

Total L1 Vertebrectomy With T12-to-L2 Fusion in a Case of Burst Fracture

Özveren¹,

Erol

Kaplan

et al. 2005

Neurosurgery Quarterly

View full text Add to dashboard Cite

Objective: To present a novel technique aiming at fusion of the upper and lower vertebrae by removal of the anterior and posterior elements of a lumbar vertebra.Methods: A 26-year-old male patient presented with a posttraumatic L1 vertebra fracture and total paraplegia. Three weeks after corpectomy plus otogenic bone grafting plus instrumentation by an anterolateral approach, the patient, who had 3-column injury, developed a treatment-resistant deep wound infection. In the fourth week of antibiotic treatment after the onset of the infection, there was no improvement, and the vertebral stabilization provided by the instrumentation was disrupted. Thus, the fixators and autograft were removed, the L1 posterior elements were totally excised, and compressive posterior instrumentation was performed.Results: Fusion stabilization was achieved in the patient with treatment-resistant postoperative deep wound infection after anterior instrumentation through a total vertebrectomy plus a posterior instrumentation technique.A pproximately 2.1% to 8.5% of patients undergoing spinal instrumentation have wound infection as a postoperative complication. 1 The wound infection, a real nuisance for the patient and surgeon, usually requires at least long-term antibiotic treatment. In cases with hard-to-manage and resistant infections, removal of instrumentation may be the last resort. 2 This choice renders the treatment more difficult and prolongs hospitalization time. 1 This report presents the management of a patient who developed a postoperative deep wound infection and underwent a novel surgical technique in our clinic. To our knowledge, the relevant English literature does not present any case treated with aforementioned technique. CASE REPORTA 26-year-old male patient was transferred to our hospital after a motorcycle accident. On examination, paraplegia of the lower extremities, a sensory defect involving the T11 level and below, urinary retention, and anal sphincter tonus loss were detected. Direct radiography revealed a burst fracture on the L1 vertebra (Fig. 1A). On magnetic resonance imaging (MRI), the L1 vertebra posterior wall was seen to intrude into the vertebral canal and the spinal cord was extensively damaged (see Fig. 1B). In light of these findings, the patient had a stabilization procedure with anterior instrumentation and iliac autograft placement after an L1 corpectomy by the anterolateral approach (Fig. 2). In the third week of follow-up, a purulent discharge was observed at the wound site. Culture of the drainage demonstrated Klebsiella pneumonia growth. Treatment with antibiotics was instituted based on the results of the antibiogram. Despite 4 weeks of antibiotic treatment, the infection could not be controlled. The graft and instruments were noted to have moved, leading to destabilization (Fig. 3). Furthermore, the infection had advanced, and a thoracic computed tomography scan showed empyema development in the left lobe of the lower lungs. The patient was then operated on again using an anterolateral appro...

show abstract

Surgical Management of Thoracolumbar Spinal Injuries General Principles and Controversial Considerations

Cited by 76 publications

References 0 publications

Single-Stage Posterior Corpectomy and Expandable Cage Placement for Treatment of Thoracic or Lumbar Burst Fractures

Single-Stage Posterior Corpectomy and Expandable Cage Placement for Treatment of Thoracic or Lumbar Burst Fractures

Recurrence of deformity after removal of Harrington's fixation of spine fracture: Seventy-six cases followed for 2 years

Total L1 Vertebrectomy With T12-to-L2 Fusion in a Case of Burst Fracture

Contact Info

Product

Resources

About