Results of Non-fusion Method in Thoracolumbar and Lumbar Spinal Fractures / 대한척추외과학회지

STUDY DESIGN: A retrospective study of surgically managed patients. OBJECTIVES: To evaluate the results of posterior stabilization of a thoracolumbar fracture, without fusion, followed by the removal of metal implants within an appropriate period. Changes in the sagittal alignment and the restoration of segmental motion were also investigated. SUMMARY OF LITERATURE REVIEW: In managing unstable thoracolumbar and lumbar fractures, posterior fusion, using a transpedicular screw system, has been the treatment of choice, but results in the permanent loss of segmental motion. MATERIALS AND METHODS: Twelve patients with thoracolumbar and lumbar spine fractures, under 40 years of age (mean 28.4 years), were managed using this non-fusion method. Implants were removed at mean 9.2 months after the initial fixation of the fracture. For metal-fixed segments, the sagittal alignment, such as the angle of kyphosis, height of body, recovered motion range in flexion-extension and right-left bending view, were measured radiologically and compared with a control group. Clinical aspects, such as gross deformity and functional ability, were also investigated. RESULTS: The average sagittal angle at the time of injury was average 17.2 degrees, but became 1.7 degrees post-fixation, which increased after removal of the implants, reaching 9.8 degrees at the final follow up. The height of the fractured body was maintained until the final follow-up. The mean segmental motion measured in the sagittal and coronal planes were 11.7 and 9.5 degrees, respectively. Most patients were satisfied with the final gross appearance and functional outcomes. Only one patient showed considerable development of kyphotic angulation, but the functional outcome was good. CONCLUSION: The author's non-fusion method seems to be effective in achieving stability and sagittal alignment, as well as in regaining segmental motion of the fixed segments. The non-fusion method seems to be an effective method for managing thoracolumbar fractures, especially for young active persons.

Differences of Fracture Types and Associated Injuries in Thoracolumbar Fractures Caused by Fall from Height and by In-Car Accident

PURPOSE: To evaluate the differences of associated factors in thoracolumbar fractures according to the mechanism of injury, level and type of the fracture, associated injuries were investigated for comparison between injuries by fall from height and by in-car accident injury. MATERIALS AND METHODS: Medical records and X-ray findings of 249 patients with fractures of thoracolumbar spine were reviewed retrospectively. Among them, 169 patients were injured by the two main causes. McAfee classification was adopted to determine the type of fracture. Associated injuries were classified as head and neck, chest and abdomen, pelvis, proximal and distal extremity, and neurologic deficit. Statistical analysis using Chi-square method was used for comparison between the two groups. RESULTS: In overall patients, the most common cause of thoracolumbar fracture was fall from height (44.6%) followed by in-car accident (23.3%) and fall down (16.9%). In fall-from height gruoup, burst fracture was the most common (44.1%) while flexion-distraction injury was the most popular (39.7%) in in-car accident group (p=0.05). Comparison according to height of fall showed significant increase of multiple fractures (p=0.0326). Associated injuries of distal lower and upper extremities and pelvis were common in fall-from-height group, while injuries of head and neck, proximal part of upper extremity, chest and abdomen were common in in-car accident patients. CONCLUSION: Type of fracture and distribution of associated injuries were significantly different between the two main causes of thoracolumbar injury, which seemed to be useful for understanding the mechanical events of injury and detecting associated injuries in each victim.