ABSTRACT
Objective To explore surgical treatment through posterior approach to reduce the fracture and dislocation complicated with longitudinal ligaments and intervertebral disc rupture in the thoracic or lumbar spine. Methods Eighteen cases suffered from the fracture and dislocation complicated with longitudinal ligaments and intervertebral disc rupture in the thoracic or lumbar spine between January 2001 and May 2004, retrospectively were reviewed all the patients are male, aged from 19 to 58 years old (average 38 years). All the patients are paraplegia. The involved vertebrae are T11 to L 3. All the lateral X-ray films showed the fractured vertebra taking on wedged shape. The posterior vertebral body-height was decreased in six patients. The fractured vertebra lost its height by 1/4 to 3/4 of normal height. The upper vertebral dislocation extent was from 25% to 100%. Two cases complicated with lateral displacement. All the patients were operated on within posttraumatic 10 days. One of the two posterior surgical techniques was used for a given patient: 1) One technique is implantation of pedicle-screws in upper and lower vertebrae just adjacent to fractured vertebra. 2) Another technique is implantation of pedicle-screws both in fractured vertebra and its adjacent upper and lower vertebrae. Results All the patients were followed up 3 months to 3 years (average 18 months). 8 cases were treated with two-vertebrae 4 pedicle-screws implantation technique, the height of fractured vertebral body was not improved in 5 cases, partially improved in 3 cases. The dislocation of the upper vertebra adjacent to fractured vertebra was partially improved in 6 case, not changed in 1 case, got worse in 1 case. 10 cases were treated with three-vertebrae 6 pedicle-screws implantation technique, the height of fractured vertebral body was all improved by 80% to 100%. The dislocation of the upper vertebra was corrected completely in all the ten cases. Conclusion The procedure of three-vertebrae 6 pedicle-screws implantation is practical, effective and useful for treatment of the fracture and dislocation comlicated with longitudinal ligaments and intervertebral disc rupture in the thoracic or lumbar spine.