Harrington Rod Stabilization of Thoracic and Lumbar Fractures in Neurosurgery(Clinical Study)

Harrington Instrumentation to treat the unstable fracture (including the fracture dislocation) of the thraco-lumbar spine with neurologic deficits is a very effective method. This method provides rigid fixation and stability for thoracolumbar fracture, also offers the optimum condition for recovery of nerve roots, and decompresses the spinal canal with anatomical reduction. The principal advantage for this method of treatment is the early mobilization of the patient and enhanced rehabilitation. Authors, performed Harrington Instrumentation with a laminectomy experienced 20 cases of unstable thoraco-lumbar spine fracture(including the fracture-dislocation) with neurologic deficit from Aug. 1980 to Oct. 1984. The following results were obtained : 1) Of twenty patients, the patients at the age 20 to 49 were commonly injured and predominant cause of spinal injury was falling accident. 2) The thoraco-lumber fracure(including fracture-dislocation) were thoracolumbar junction, the commonest site among them was the lst lumber vertebra, and the commonest mechanism of spinal injury way flexon injury. 3) Most commonly, paraplegia was with twelve thoracic vertebra injury, and paraparesis was with lst lumbar vertebra. 4) Correction of the kyphotic deformity was 8 degree on the average, and the range of the correction was between 0 degree and 19 degree. 5) Neurological recoveries were gained from 14 patients(70%), and the 10 patients(50%) among them were completely recovered. 6) Average hospital periods were 78 days and after an average 21 postoperative days, ambulation was started. 7) In complication, three hook dislocations were occured. 8) Early operation (laminectomy for posterior decompression and Harrington Instrumentation for anterior decompression) was very effective in spinal cord injury.

Thoracolumbar Intramedullary Astrocytoma of the Spinal Cord: Report of 1 Case

The intramedullary glioma of spinal cord has occupied 22.5% of intraspinal neoplasm, and is the most common among the intramedullary spinal cord tumor, and the first successful operative removal was performed in 1907 by Elsberg. The intramedullary astrocytoma has frequent incidence in the thoracic and cervical region of the spinal cord, which has more frequent grade I astrocytoma. We experienced a case of intramedullary grade II astrocytoma of the thoracolumbar region which has associated a paraplegia as neurological deficit. A 26 year old Korean female has admitted to our clinic because of paraplegia with incontinence for 2 years. On admission, the neurological examination revealed a paraparesis below T12 level with urinary and fecal incontinence and then local tenderness from T10 to L1 level. The simple X-ray film of the thracolumbar spine has showed erosion of both pedicle, widening of interpeduncular distance and scalloping change of posterior vertebral margin from T12 to L1, which were similar to the picture of intramedullary spinal cord tumor. We performed a myelography by pantopaque through the lumbar and cisternal puncture for accurate site of lesion, and found a complete block at L1 level and T10 level on myelogram. Then the immediate total laminectomy from T8 to L1 was applied. The operative finding was a intramedullary mass with cystic fluid, which has compressed the spinal cord. After aspiration of cystic fluid, we removed the tumor mass incompletely because of intermingling with spinal cord but the decompression was enough. The neurological defict was improved gradually for post-operative 4 weeks, thereafter improvement was stopped and remained the paraparesis. The post-operative pathological diagnosis was grade II astrocytoma, which composed of anaplastic cell and radiotherapy has followed.