Epidemiological Features of Patients with Subdural Hygroma in a Prospective Case Series

Purpose To compare the efficacy and safety of the percutaneous screw fixation (PSF) and the open pedicle screw fixation (OPSF) on thoracolumbar (TL) fracture. Methods Sixty-four adult patients with TL vertebral fractures who underwent open or percutaneous posterior short-segment transpedicular screw fixation between January of 2013 and September of 2015 were retrospectively reviewed. All patients underwent clinical, radiological and quality of life follow-up for at least 18 months. Results There was no significant difference in age, gender, time between injury and surgery, and preoperative percentage of anterior column height, preoperative sagittal regional Cobb angle, or kyphotic angle of fractured vertebra between these two groups (p > 0.05). There was significantly less intraoperative blood loss in the PSF (87.6 24.6 mL) than in the OPSF group (271.4 142.6 mL) (p < 0.05). The mean surgery time was 62 minutes (range 42­130 minutes) for open and 58 minutes (range 35 to 128 minutes) for percutaneous screw fixation. The surgery time was shorter in the PSF group, but with no statistical significance (p > 0.05). The mean Oswestry disability index (ODI) scores after 18-months were 23.12 8.2 for the PSF and 24.12 9.2 for the OPSF group, without any statistical significance (p > 0.05). Conclusion Both open and percutaneous screw fixations are safe and effective. The percutaneous techniques significantly reduced the intraoperative blood loss compared with the open techniques.

Objetivo Comparar a eficácia e segurança das técnicas de fixação convencional e percutânea para fraturas toracolombares. Métodos Sessenta e quatro pacientes adultos com fraturas da transição toracolombar que foram submetidos a fixação pedicular curta por técnicas aberta convencional e percutânea entre janeiro de 2013 e setembro de 2015 foram retrospectivamente avaliados. Todos foram submetidos a avaliação clínica, radiológica e de qualidade de vida com no mínimo 18 meses do seguimento. Resultados Não houve diferença significativa na idade, sexo, tempo entre o trauma e o tratamento, porcentagem da redução da altura do corpo vertebral pré-operatório, angulo de Cob sagital na região da fratura, ou ângulo de de cifose da vértebra fraturada entre os dois grupos (p > 0,05). Houve uma menor perda sanguínea no grupo percutâneo (87,6 24,6 mL) em comparação com a técnica convencional (271,4 142,6 mL) (p < 0,05). O tempo médio da cirurgia foi 62 minutos (42 - 130 minutos) para a técnica convencional e 58 minutos (35 - 128 minutos) para a percutânea. Apesar de mais curto na técnica percutânea, não houve diferença estatisticamente significante no tempo cirúrgico entre os dois grupos (p > 0,05). Em relação ao índice de incapacidade de Oswestry após 18 meses do tratamento cirúrgico, também não houve diferença significante do ponto de vista estatístico entre os dois grupos, sendo 23,12 8,2 para a técnica percutânea e 24,12 9,2 para o grupo da técnica convencional (p > 0,05). Conclusão Ambas as técnicas mostraram-se eficazes e seguras para o tratamento de fraturas da transição toracolombar. A técnica percutânea apresentou uma taxa de perda sanguínea significativamente menor em comparação à técnica aberta convencional.

Open vs. Percutaneous Pedicle Screw Insertion for Thoracolumbar Traumatic A3 and A4 AO Fractures - 18-Months Follow-Up

Purpose To compare the efficacy and safety of the percutaneous screw fixation (PSF) and the open pedicle screw fixation (OPSF) on thoracolumbar (TL) fracture. Methods Sixty-four adult patients with TL vertebral fractures who underwent open or percutaneous posterior short-segment transpedicular screw fixation between January of 2013 and September of 2015 were retrospectively reviewed. All patients underwent clinical, radiological and quality of life follow-up for at least 18 months. Results There was no significant difference in age, gender, time between injury and surgery, and preoperative percentage of anterior column height, preoperative sagittal regional Cobb angle, or kyphotic angle of fractured vertebra between these two groups (p > 0.05). There was significantly less intraoperative blood loss in the PSF (87.6 24.6 mL) than in the OPSF group (271.4 142.6 mL) (p < 0.05). The mean surgery time was 62 minutes (range 42­130 minutes) for open and 58 minutes (range 35 to 128 minutes) for percutaneous screw fixation. The surgery time was shorter in the PSF group, but with no statistical significance (p > 0.05). The mean Oswestry disability index (ODI) scores after 18-months were 23.12 8.2 for the PSF and 24.12 9.2 for the OPSF group, without any statistical significance (p > 0.05). Conclusion Both open and percutaneous screw fixations are safe and effective. The percutaneous techniques significantly reduced the intraoperative blood loss compared with the open techniques.

Objetivo Comparar a eficácia e segurança das técnicas de fixação convencional e percutânea para fraturas toracolombares. Métodos Sessenta e quatro pacientes adultos com fraturas da transição toracolombar que foram submetidos a fixação pedicular curta por técnicas aberta convencional e percutânea entre janeiro de 2013 e setembro de 2015 foram retrospectivamente avaliados. Todos foram submetidos a avaliação clínica, radiológica e de qualidade de vida com no mínimo 18 meses do seguimento. Resultados Não houve diferença significativa na idade, sexo, tempo entre o trauma e o tratamento, porcentagem da redução da altura do corpo vertebral pré-operatório, angulo de Cob sagital na região da fratura, ou ângulo de de cifose da vértebra fraturada entre os dois grupos (p > 0,05). Houve uma menor perda sanguínea no grupo percutâneo (87,6 24,6 mL) em comparação com a técnica convencional (271,4 142,6 mL) (p < 0,05). O tempo médio da cirurgia foi 62 minutos (42 - 130 minutos) para a técnica convencional e 58 minutos (35 - 128 minutos) para a percutânea. Apesar de mais curto na técnica percutânea, não houve diferença estatisticamente significante no tempo cirúrgico entre os dois grupos (p > 0,05). Em relação ao índice de incapacidade de Oswestry após 18 meses do tratamento cirúrgico, também não houve diferença significante do ponto de vista estatístico entre os dois grupos, sendo 23,12 8,2 para a técnica percutânea e 24,12 9,2 para o grupo da técnica convencional (p > 0,05). Conclusão Ambas as técnicas mostraram-se eficazes e seguras para o tratamento de fraturas da transição toracolombar. A técnica percutânea apresentou uma taxa de perda sanguínea significativamente menor em comparação à técnica aberta convencional.

The Concept of Evolution of Thoracolumbar Fracture Classifications Helps in Surgical Decisions

Since Boehler's sentinel description, a universally acceptable thoracolumber fracture classification has eluded spine surgeons. The concept of the stability of a thoracolumbar injury changed continuously from the two column concept of Holdsworth to the three column theory of Denis. With the advent of sophisticated imaging techniques, improved biomechanical understanding, and in order to meet the high expectations of patients, several classification systems have been forwarded by the stalwarts in the field. Each successive system has contributed significantly to the understanding and prediction of treatment outcome. Load sharing classification by McCormack attempted to rationalize the use of short segment posterior instrumentation. Magerl et al. developed a comprehensive classification system based on progressive morphological damage determined by three fundamental forces: compression, distraction, and axial torque. Vaccaro et al. devised the thoracolumbar injury severity score based on three independent variables: the morphology of the injury, posterior ligamentous complex (PLC) integrity, and neurological status at the time of injury. But, there are limitations to the classification system, especially when magnetic resonance imaging yields a PLC status as indeterminant. In the absence of a universally acceptable classification system, it is important to understand the underlying concepts of the fractures. The author concisely reviews the subject from its inception in the year 1929 to the present day.

Effects of Zoledronic Sodium on Thoraco-lumbar Spine Fracture / 中国药房

OBJECTIVE:To investigate the effects of zoledronic sodium on fracture healing in patients with thoraco-lumbar spine fracture(TLSF). METHODS:82 patients with TLSF were randomly divided into observation group and control group with 41 cases in each group. All applied pedicle screw fixation. After operation,control group received conventional therapy as calcium supplement,and observation group was additionally given intravenous injection of zoledronic sodium 5 mg on the basis of control group. The change of Imaging parameters 6 months after operation were compared between 2 groups,and the changes of serum PINP,β-CTX and lumbar spine bone mineral density,and fracture healing time were compared 3,6,12 months after operation. RESULTS:The vertebral height,sagittal index,Cobb’s angle of 2 groups were improved 6 months after operation,compared with before operation,with statistical significance (P0.05);the levels of β-CTX and PINP in observation group were lower than that in control group 3,6,12 months after operation, there was statistical significance 3 month after operation(P<0.01);BMD of observation group was higher that of control group 3, 6,12 months after operation,with statistical significance(P<0.05);the fracture healing time of observation group was(13.25± 1.23)weeks,which was shorter than that of control group(14.54±1.49)weeks,with statistical significance(P<0.01). CONCLU-SIONS:For patients with TLSF,postoperative treatment of zoledronic sodium can increase lumbar spine bone mineral density and promote healing.

Incidence of Vascular Complications Arising from Anterior Spinal Surgery in the Thoraco-Lumbar Spine

STUDY DESIGN: Modern biomaterials and instrumentation have popularised surgery of the thoraco-lumbar spine through an anterior route. The advantage of anterior surgery is that it allows for a direct decompression of the compromised spinal canal. However, the potential for devastating long-term sequelae as a result of complications is high. PURPOSE: The aim of this study was to give a general overview and identify the incidence of vascular complications. OVERVIEW OF LITERATURE: There is limited literature describing the overall incidence and complications of anterior spinal surgery. METHODS: A retrospective review of a prospective database of 1,262 consecutive patients with anterior surgery over a twelve-year period. RESULTS: In our study, 1.58% (n=20) of patients suffered complications. Injury to a major vessel was encountered in 14 (1.11%) cases, of which nine involved an injury to the common iliac vein. In six cases, the original procedure was abandoned due to a life-threatening vascular injury (n=3) and unfavourable anatomy (n=3). CONCLUSIONS: The incidence of vascular and other complications in our study was relatively low. Nevertheless, the potential for devastating long-term sequelae as a result of complications remains high. A thorough knowledge and awareness of normal and abnormal anatomy should be gained before attempting such a procedure, and a vascular surgical assistance especially should be readily accessible. We believe use of access surgeons is mandatory in cases with difficult or aberrant anatomy.

The therapeutic effects of UPASS-Ⅱ percutaneous pedicle screws internal fixation treating thoracolumbar fracture / 重庆医学

Objective To observe the therapeutic effects of UPASS-Ⅱ minimally invasive spinal system percutaneous pedicle screws internal fixation treating thoracolumbar fracture .Methods From May 2011 to December 2012 ,26 patients(observing group) were sufferred from thoracolumbar fracture without neural impairment were treated with UPASS-Ⅱ minimally invasive spinal sys-tem percutaneous pedicle screws internal fixation ,and were compared with other 26 cases(control group) adopted the treatment of conventional open pedicle screws internal fixation in the same period .Results All patients were followed up more than 6 months (mean 9 .2 months) ,the comparison of Cobb′s angle ,anterior vertebra height ,VAS ,JOA score and ODI between pre and post oper-ation were all significantly different in both group(P<0 .01) ,but the operation time and length of stay in the hospital in observing group were significantly shorter than that in control group (P<0 .05) ,moreover ,the amount of operative bleeding and drainage of post operation in observing group decreased obviously than that in control group (P<0 .01) .Conclusion This study shows that UPASS-Ⅱ minimally invasive spinal system percutaneous pedicle screw internal fixation treating thoraco-lumbar fracture is a safe and effective treatment strategy in selected patients .

Usefulness of Chest Radiographs for Scoliosis Screening: A Comparison with Thoraco-Lumbar Standing Radiographs

PURPOSE: The purposes of this study were to evaluate the usefulness and limitations of chest radiographs in scoliosis screening and to compare these results with those of thoraco-lumbar standing radiographs (TLSR). MATERIALS AND METHODS: During Korean conscription, 419 males were retrospectively examined using both chest radiographs and TLSR to confirm the scoliosis and Cobb angle at the Regional Military Manpower. We compared the types of spinal curves and Cobb angles as measured from different radiographs. RESULTS: In the pattern of spinal curves, the overall matching rate of chest radiographs using TLSR was about 58.2% (244 of 419 cases). Cobb angle differences between chest radiographs and TLSR with meaningful difference was observed in 156 cases (37.2%); a relatively high proportion (9.5%) of Cobb angle differences more than 10 degrees was also observed. The matching rate of both spinal curve types and Cobb angle accuracy between chest radiographs and TLSR was 27.9% (117 among 419 cases). Chest radiographs for scoliosis screening were observed with 93.94% of sensitivity and 61.67% of specificity in thoracic curves; however, less than 40% of sensitivity (38.27%, 20.00%, and 25.80%) and more than 95% of specificity (97.34%, 99.69%, and 98.45%) were observed in thoraco-lumbar, lumbar, and double major curves, respectively. CONCLUSION: The accuracy of chest radiographs for scoliosis screening was low. The incidence of thoracic curve scoliosis was overestimated and lumbar curve scoliosis was easily missed by chest radiography. Scoliosis screening using chest radiography has limited values, nevertheless, it is useful method for detecting thoracic curve scoliosis.

Modified minimally invasive percutaneous pedicle screws osteosynthesis (mMIPPSO) for the treatment of thoraco-lumbar fracture without neural impairment / 中国矫形外科杂志

[Objective]To explore the feasibility and effect of modified minimally invasive percutaneous pedicle screws osteosynthesis for the treatment of thoraco-lumbar vertebra compression fracture.[Method]Twelve cases of thoraco-lumbar fracture without neural impairment were enrolled who did not need laminotomy decompression from June 2005 to June 2007.With the help of C-arm image intensifier,the pedicle screws were inserted through four small longitudinal incisions(1-1.5 cm)and modified surgical instruments.Perioperative parameter,postoperative imaging index,visual analog scale(VAS)and Oswestry Disability Index(ODI)were compared with the treatment of conventional open pedicle screws osteosynthesis in other 18 cases.[Result]All cases were followed up from 8 to 25 months(mean 13.2 months).The operation time and length of stay in minimal invasive group were significantly shorter than that in conventional group,the amount of operative bleeding and drainage of postoperation decreased obviously(P

Discussion of operative management of posterior marginal bone block in thoraco-lumbarvertebral burst fracture / 中国矫形外科杂志

[Objective]To discuss the surgical treatment,the proper application,and the respective effect of the therapy of burst fracture in the posterior marginal vertebral bone block and the thoraco-lumbar vertebra.[Method]Thirty-eight patients with thoraco-lumbar burst fracture induced by high energy injury were hospitalized from July 2002 to June 2006.Through the were assessed application of section and ORIF(open reduction internal fixation),decompression of vertebral canal by bone grafting and fusion,the clinical effect of therapy by rechecking the postoperative thoracic-lumbar function and radiographic information.[Result]All the 38 patients were followed up for 12-18 months(average 14.4 months).The fracture were all healed and lumbar pain disappeared,the vertebral height restored,and well-fused.According to Frankel ranking,the neurological function recovered,with the degree varying from 1 to 3.[Conclusion]It's a good method to apply the open and reduction,decompression of spinal canal with bone grafting and fusion operation.This kind of operation can get perfect treating effect by providing good fixation and reducing the complications.

Treatment of thoraco-lumbar spinal tuberculosis with kyphotic deformity with surgical techniques of Z-plate-Ⅱ~(TM) internal fixation apparatus system / 中国矫形外科杂志

[Objective]To evaluate the short-term and long-term effectiveness of the surgical technique of one-stage one-step surgical techniques of Z-plate-Ⅱ~(TM) internal fixation apparatus system and anterior debridement and autograft bone graft fusion in the treatment thoraco-lumbar spinal tuberculosis with kyphotic deformity.[Method]The outcome of sixty eight cases suffered from thoraco-lumbar spinal tuberculasis with kyphotic deformity between July 1998 and March 2004 managed by the surgical techniques of Z-plate-Ⅱ~(TM) internal fixation apparatus system and anterior debridement and antograft bone graft fusion through posteroiateral costotransversectomy or kidney incision was analyzed.All cases wer given a longitudinal study follow-up for a mean of 3.3(2.2~6.3)years postoperatively.[Result]All patients showed successful autograft bone graft fusion.Among 45 cases accompanied with neurotic symptom of Potts paraplegia,25 were completely recovered,15 were partly recovered,total the ratio of recovery was 88.89% at the end of postoperative follow-up.The average immediate postoperative correction of kyphosis angle was 28.9?,the average loss of correction was only 2.7? at final follow-up.[Conclusion]The surgical technique of one-stage one-step Z-plate-Ⅱ~(TM) internal fixation apparatus system and anterior debrideraent and autograft bone graft fusion is found helpful in strengthening the stability of the spine in thoraco-lumbar spinal tuberculosis with kyphotic deformity,providing successful interbody fusion and recovery of Potts paraplegia,correcting the kyphosis,and preventing progress of kyphosis.

Short Segment Pedicle Screw Fixation with Augmented Intra-Operative Vertebroplasty in Unstable Thoraco-Lumbar Fracture: Preliminary Report

OBJECTIVES: Since vertebroplasty has been introduced, we performed short segment pedicle screw fixation with augmented intra-operative vertebroplasty in patients with unstable thoraco-lumbar fracture. Our intentions are to demonstrate the efficacy and indication of this new technique compare to conventional methods. MATERIAL AND METHODS: The surgery comprised of pedicle screw fixations on one level above and below the fracture site, and the fractured level itself, if pedicle is intact, and intra-operative vertebroplasty under the fluoroscopic guide with in-situ postero-lateral bone graft. Also, in cases of bone apposition, we removed those with small impactor through a transfascetal route. During the last 2 years, we performed in seven(7) unstable thoraco-lumbar fracture patients who consisted of two different characteristics, those four(4) with primary or secondary osteoporosis and three(3) of young and very healthy. All patients were followed clinically by A.S.I.A. score and radiography. RESULTS: Mean follow up period was 14 months. We observed well decompressed state via transfascetal route in cases of bone fragments apposition and no hardware pullout in osteoporotic cases, no poly-methyl-methacrylate (PMMA) leakage through the fracture sites into the spinal canal, and no kyphotic deformities in both cases during follow-up periods. All patients demonstrated solid bony fusion except one following osteoporotic compression fracture on other sites. CONCLUSIONS: In the management of unstable thoraco-lumbar fracture, we believe that this short segment pedicle screw fixation with augmented intra-operative vertebroplasty reduce the total length or levels of pedicle screw fixation without post-operative kyphotic deformity.

Clinico-radiologic Findings of the Whole Spine in Patients with Chronic Low Back Pain

OBJECTIVE: The purpose of this study was to evaluate the whole spine of the patients with chronic low back pain. METHOD: The cervico-thoraco-lumbar spine were evaluated in 128 patients with chronic low back pain. We analyzed radiologic and clinical findings of the cervico-lumbar spine and electrodiagnostic findings. RESULTS: Most of all cases showed abnormal findings in plain radiography and electrodiagnostic study. The radiologic findings were as follow: cervical X-ray with straightening of cervical lordotic curve in 85 cases; thoracic X-ray with scoliosis in 55 cases; lumbar X-ray with disc space narrowing in 85 cases. The electrodiagnostic study revealed lumbosacral radiculopathy in 87 cases. There were significant positive relationship between increased lumbosacral angle and straightening of cervical lordotic curve, and between lumbar scoliosis and thoracic scoliosis. CONCLUSION: Cervico-thoracic spinal abnormalities were shown in most of the patients with chronic low back pain. Therefore, The evaluation of whole spine would be needed comprehensive rehabilitation approach for the patients with chronic low back pain.

Effects of Environmental Sea Water Factors on the Isolation of Vibrio vulnificus in the Western Coastal Area of Korea / 대한피부과학회지

BACKGROUND: Vibrio vulnificus(V. vulnificus) is a pathogenic, marine, halophilic, Gram negative bacillus which causes fulminant infection in humans through skin wounds. or the ingestion of raw seafoods or Most cases are reported sporadically in summer in the south-western coastal area of Korea. OBJECTIVE: We studied the distribution of V. vulnificus in sea water, fishes, shellfish and sea mud from May to October in 1996 and the relationship between regional distribution and environmental factors. METHODS: We collected the sea water, sea mud, fishes and seafoods from May to October in Kunsan, Daechun, Moochangpo, Puan, Youngkwang and cultured it in Thiosulfate-Citrate-Bile salt-Sucrose(TCBS) agar, Cellobiose-Polymyxin B-Colistin(CPC) agar, and Sodium dodecyl sulfate- Polymyxin B-Sucrose(SPS) agar. At the same time we investigated environmental factors such as temperature, pH, salinity, turbidity, dissolved oxygen(DO), NO3 of sea water. RESULTS: Twelve strains(2.17%) of V. vulnificus were isolated from a total of 552 specimens. The V. vulnificas isolation rate from sea mud was higher than in sea water and shellfish. Areas where V. vulnipcus was isolated were Kunsan and Daechun. It was isolated during June, July and August. The Isolation rate was higher with CPC agar than TCBS, SPS agar. When V.vulnificus was isolated at Kunsan, the environmental factors of sea water noted were as follows: temperature, 25.3C; turbidity, 121Formazine turbidity units; salinity, 12.2%; DO, 7.3mg/L; pH, 7.37 and NO3, 1.18mg/L. CONCLUSION: CPC agar is the best medium of the three above used for the isolation of V. vulnificus from environmental samples. V. vulnificus was highly isolated in the Kunsan area because of the high water temperature and turbidity, low salinity and weak alkali state of the sea water in comparision with other areas. We suggest that high temperature and turbidity, low salinity and weak alkalinity of sea water are very important environmental factors for the growth of V. vulnificus.

Six Cases of Thoraco-lumbar Tuberculosis Treated by Anterior Decompression and Fusion with or withought Instrumentation

The anterior decompression and fusion have been the choice of surgical treatment for spinal tuberculosis since 1960. From April 1995 to April 1996, we operated on six patients of thoraco-lumbar tuberculosis. The procedure consisted of anterior decompression through corpectomy, stabilization with anterior instrument and bone graft with or without Titanium MESH. MRI provides a valuable information about the extent of the disease in multiple planes, thereby helping surgeons in planning of the operation. The thoracic spine was involed in four patients, the lumbar spine in two. On average, two vertebral bodies were involved. Anterior and middle column of spine were involved in all patients, but posterior column was intact in all patients. Disc space involvement was seen in all patients. Paraspinal abscess was observed in three patients. Epidural compression of the spinal cord or cauda equina was noted in all patients. Four patients showed neurological improvements and relief of pain. However, the recovery of two remaning paraplegic patients was not remarkable. There was no single case associated with persistence or recurrence of infection after instrumentation.

Anterior Interbody Fusion Using Kaneda Device in Unstable Thoracolumbar Spinal Lesions

Recently anterior spinal device in the treatment of the unstable thoraco-lumbar spine has been used. We have experienced 11 patients of the unstable thoraco-lumbar spine, which were composed of 8 patients with burst fracture and 3 patients with tuberculous spondylitis. The 11 patients with neurological deficit were treated with an one stage anterior operation consisting of anterior decompression through vertebrectomy, realignment with Kanedae device. No patient showed neurologic deterioration after surgery. The anterior spinal instrumentation with Kaneda device afford enough stability to enable early ambulation with good alignment and solid fusion.

Treatment of Unstable Fracture of the Thoraco / 대한정형외과학회잡지

The spinal injuries were classified into bursting fracture, fracture-dislocation, seat-belt injury, compression fracture according to the three column theory by Denis. The bursting fracture and fracture-dislocation required the most careful planning. So, myelography, computerized tomography enabled us to diagnose the spinal fracture including retropulsed bony fragment into the spinal canal. There was much controversy as to appropriate treatment af unstable thoraco-lumbar fractures. The frequent surgical treatment of thoraco-lumbar spinal fractures was still posterior spinal instrumentation including Harrington rod system. Since 1964, the use of anterior spinal instrumentation had been started by Dwyer, Dunn, Kostrik, Slot, and Zielke used anterior spinal instrumentation in unstable thoraco-lumbar spinal fractures, but not popular. This study suggested the experience to accomplish the decompression of the neural elements and stabilization of the spine by using Kandea device in unstable thoraco-lumbar spinal fractures. 12 patients treated with this Kaneda device in unstable thoraco-lumbar spinal fractures were analyzed from Dec. 1988 to May, 1989 at the Department of Orthopaedic Surgery, Ewha Womans University Hospital. We obtained the following conclusions. The results were as follows. 1. The common injury mechanism was falling down in 5 cases, the frequent injury site was 1st lumbar vertebra. 2. According to Denis classification, the bursting fractures were in 8 cases(68% ), the fracture-dislocations were in 4 cases(33%). 3. The average preoperative kyphotic angulation was 24.5 degrees(range 8 to 45) and postoperative angulation was 5 degrees(range 2 to 15), the correction rate was 79.6% and correction degree was average 19.5 degrees. 4. The advantages were the fixation of one level above and below the injury site, sufficient neural decompression, firm spinal stabilization, early mobilization with a brace and elimination of the 2nd posterior procedure. 5. The fixation of vertebral plate was difficult due to the invariable size of vertebral plates, especially, in upper thoracic spinal fracture and children's fracture.

Segmental Spinal Instrumentation in the Management of Fracture and Fracture-Dislocation of the Thoraco-Lumbar Spine / 대한정형외과학회잡지

Segmental Spinal Instrumentation(S.S.I.) is more effective means of managing unstable thoraco-lumbar spine fractures than traditional Harrington Rod Instrumentation as an operative procedure which afforded rigid internal fixation with stability and needed minimal external immobilization. Early return to normal activity and successful rehabilitation are facilitated by efficient stabilization with S.S.I. Fifty-nine patients with fractures and fracture-dislocations of thoraco-lumbar spine were treated by Harrington Rod Instrumentation (29 patients) and S.S.I. (30 patients) at this hospital from June 1979 to July 1984. We have analysed the results of these treatment and obtained following conclusions: 1. S.S.I. is more rigid internal fixation than Harrington Rod Instrumentation. a) no or minimal external immobilization b) early ambulation and rehabilitation c) lowered complications 2. There was no significant difference in correction rate, loss of correction, and neurologic recovery between Harrington Rod Instrumentation and S.S.I.