Relationships between Radiological Change of Fractured Vertebrae and Posterior Ligament Complex Injury in Thoracolumbar Fracture

OBJECTIVE: To investigate the relationships between posterior ligament complex injury and plain radiographic parameters in thoracolumbar spinal fractures. METHODS: Forty patients with thoracolumbar fractures who had operated from Jan 2006 to Dec 2007 were studied. For the evaluation of stability of injured vertebrae, we used the radiographic parameters which were wedge angle, Cobb's angle, compression rate measured on the plain radiographs, and the presence of posterior ligament complex injury on MRI. RESULTS: In the compression fracture group, the compression rate was statistically significant high in the posterior ligament complex injury patient(p=0.03). In the burst fracture group, the wedge angle, Cobb's angle and the compression rate were high in the posterior ligament complex injury patient, which were all statistically significant(p=0.02, 0.01, 0.01). CONCLUSIONS: The presence of a posterior ligament complex injury is important in the treatment of the thoracolumbar spine fracture. The status of the posterior ligament complex should be integrated into future classification schemes of thoracolumbar spine fractures.

Biomechanical Efficacy of Various Anterior Spinal Fixation in Treatment of Thoraco-lumbar Spine Fracture

PURPOSE: To evaluate the biomechanical results according to various anterior spinal fixation methodology in the treatment of thoracolumbar spine fracture. MATERIALS AND METHODS: The comparative analysis of fixation method was evaluated by three dimensional finite element model using the 1 mm reconstruction image of CT. Authors evaluated the flexion, extension, lateral bending, torsional stresses with 12 fixation methods for the compression and burst fracture. RESULTS: In biomechanical analysis, stiffness of body-fixation device was more stable in two-rod system in compression fracture and was stable in one-rod, two-rod system in burst fracture, but two-rod system was showed over-increase of stiffness. CONCLUSION: Authors recommend the usage of two-rod system in anterior fixation only and anterior one-rod system in anterior-posterior fixation.

Image Study of the Thoracolumbar Spine Fracture / 대한척추외과학회지

An accurate assessment of injuries to the spinal column and the neural tissues will facilitate the management of patients with injuries to the thoracic and lumbar spine. Routine radiological investigations are essential, but newer techniques are now available that define the extent of injuries in exquisite detail, providing a better understanding of not only the bony injuries, but also the extent of the soft tissue lesion, including the nervous system. The referring physician and the radiologist have many imaging techniques available for the diagnosis of the extent of thoracolumbar spine fracture. These include plain film radiography, computed tomography(CT), conventional polydirectional tomography, bone scan, magnetic resonance image(MRI), and myelography. These techniques are used alone or in combination to arrive at the correct diagnosis. It behooves the examining physician to be extremely thorough in identifying additional lession, not only for medicolegal reasons, but also to ensure that other potentially unstable lesions are not overlloked, since this could lead to neurological compromise if unsuspected. We describe the integrated use of multiple imaging techniques.

Neural Injury and Recovery of the Thoracolumbar Spine Fractures / 대한척추외과학회지

1. Evaluation of the Neural Injury For evaluation of neural injury from the thoracolumbar spine fracture, we should know the type and extent of injury. In case of the complete Spinal Cord Injury( SCI - Frankel classification A), they will not only lose the spinal cord function permanently distal to the injury site, but also show the probability 0~9% from Frankel A to D or E. But in case of the incomplete SCI, they will show sacral sparing and some kind of function will be recovered. The anticipation of recovery from the SCI depend on the results of neurologic examination after the spinal shock. If they have motor sparing, 86% of patients show the recovery of motor function during the first 6 month. The factor that influence to neurologic recovery are the initial kyphosis angle and canal compromising pattern, and do not influenced by treatmet methods. 2. The Factor of the Neural Injury Recovery 1) Conservative treatment in acute stage The inital pathophysiology of SCI is the mechanical injury, but secondary injury will be occur by impairment of blood supply and biochemical alteration, formation of free radial, release of glutamic acid, calcium influx, lipid peroxidation. Immediate methylprednisolone could minimize the spinal cord inury during the first 8 hours, and other GM-1 ganglioside, naloxone, TRH, spinal cord cooling, hyperbaric theraphy will be helpful. 2) Surgical treatment The factor influence the recovery of SCI (1) time interval injury to operation, (2)decompression of neural element, (3) reduction of fractured fragment. 3) Management of the Residual chronic stage Most common cause of death in SCI is urinary complication. We always should consider the improvement bladder function in SCI and the maintenance of low bladder pressure and feel free a bladder symptom.

Posterior Spinal Fusion using Autogenous Bone Graft Combined with Xenograft for the Treatment of Thoracolumbar Spine Fractures / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical outcome and reliability of mixed bone in the process of posterior spinal fusion for the treatment of thoracolumbar spine fractures. In order to eliminate donor site morbidity which is linked to the use of autogenous bone graft, a new surgical procedure mixing autogenous bone chips that were obtained from local decortication of the posterior element of the spine with highly purified calf bone (Lubboc) is studied. MATERIALS AND METHODS: We followed up 9 patients who had undergone autogenous bone graft and 9 patients who had undergone mixed bone graft for more than 12 months out of 33 patients who underwent posterior spinal fusion for thoracolumbar spine fractures between July 1993 and July 1997. RESULTS: Radiographic results indicated solid bony union in 17 of 18 cases regardless of the graft materials. Based on each follow-up evaluation, it was found that the increase in kyphotic angle was related to elapsed time rather than to the type of graft materials. CONCLUSIONS: It appears that the new surgical method of bone graft with highly purified calf bone can be a reliable alternative for achieving stable posterior spinal fusion as long as bone chips large enough to fill the interlamina space can be obtained.

Pedicle Screw Fixation and Posterolateral Fusion for Thoracolumbar Spine Fracture

From January, 1996 to December, 1997, 24 patients with unstable thoracolumbar spine fracture were treated with pedicle screw fixation and posterolateral fusion. The present study is a retrospective analysis on various clinical paramaters such as age, sex distribution, causes of injury, levels of injury and outcomes. The mean follow-up period was 17 months(range, 4-26 months) after their initial operation. Reduction and stabilization was attained without complications. Sixteen patients with Frankel Grade-C,D,E returned to full-time work, but 8 patients with Frankel grade-A, B were not significantly improved. Maximum neurologic recovery can be expected with prompt and adequate decompression, restoration of normal spinal alignment and rigid internal fixation.

Surgical Results of Stabilization of the Thoracolumbar Spine Fracture with the Internal Skeletal Fixation System

The thoracolumbar spine is frequently involved in spinal injuries, with more than 50% of all vertebral body fractures. This fractures may cause injuries to the spinal cord or nerve roots. Therefore the appropriate management, including surgery of that lesion, is very important and can determine the long-term outcome of the treatment. The authors analyzed the surgical results of twenty-nine thoracolumbar spine fractures treated with anterior or posterior internal skeletal fixation from August. 1990 to December, 1995. The indications for surgery were based on the neurological state and radiological findings of the patients. The selection of surgical approach(anterior or posterior) depended on the presence of neural or canal compression, the initial radiological findings, and the extent of reducibility of the fractures. Of twenty-nine patients, 21 cases were operated via the anterolateral route with Kaneda or Z-plate. The others were operated through the posterior approach with Diapason transpedicular system. They were grouped into one of three categories according to the radiological findings by Gertzbein's classification. A type fractures were most common(12 cases), B was 11, and C was 6 cases. Surgical results were evaluated by neurological recovery and achievement of stable reduction. Postoperative neurologic recovery rate was 76.2% in the case of anterolateral approach and 50.0% in the case of posterior approach. The reduction of kyposis and compression in types of A and B was prominent(P<0.01) but in type C it was not. The authors conclude that the operation with anterior and posterior internal skeletal fixation for the treatment of unstable thoracolumbar fractures can improve neurological recovery and normalize anatomical deformities.

Surgical Results of Stabilization of the Thoracolumbar Spine Fracture with the Internal Skeletal Fixation System

The thoracolumbar spine is frequently involved in spinal injuries, with more than 50% of all vertebral body fractures. This fractures may cause injuries to the spinal cord or nerve roots. Therefore the appropriate management, including surgery of that lesion, is very important and can determine the long-term outcome of the treatment. The authors analyzed the surgical results of twenty-nine thoracolumbar spine fractures treated with anterior or posterior internal skeletal fixation from August. 1990 to December, 1995. The indications for surgery were based on the neurological state and radiological findings of the patients. The selection of surgical approach(anterior or posterior) depended on the presence of neural or canal compression, the initial radiological findings, and the extent of reducibility of the fractures. Of twenty-nine patients, 21 cases were operated via the anterolateral route with Kaneda or Z-plate. The others were operated through the posterior approach with Diapason transpedicular system. They were grouped into one of three categories according to the radiological findings by Gertzbein's classification. A type fractures were most common(12 cases), B was 11, and C was 6 cases. Surgical results were evaluated by neurological recovery and achievement of stable reduction. Postoperative neurologic recovery rate was 76.2% in the case of anterolateral approach and 50.0% in the case of posterior approach. The reduction of kyposis and compression in types of A and B was prominent(P<0.01) but in type C it was not. The authors conclude that the operation with anterior and posterior internal skeletal fixation for the treatment of unstable thoracolumbar fractures can improve neurological recovery and normalize anatomical deformities.

Surgical Planning for Thoracolumar Spine Fracture

Many of the thoracolumbar spine fracture may be managed conservatively by postural reduction. But postural reduction alone cannot treat all the patient with thoracolumbar spine fracture properly. Recently, more patients with thoracolumbar spine fracture are managed surgically with the advance of surgical technique and instrument. Surgery may be performed by either anterior or posterior approach according to many factors. Generally initial management of patient with thoracolumbar spine fracture is conservative and surgery is delayed for spinal fusion, but early surgery with decompression of spinal cord and fusion of the vertebral body seems to be more proper in unstable fracture with compression of spinal cord by bony fragment and incomplete neurological deficit. Authors analyzed 52 cases of thoracolumbar spine fracture and made a proper management plan and proper surgical approach.

Operative Treatment of Dorsolumbar Fractures and Fracture Dilocations: Clinical Experiences / 대한정형외과학회잡지

Since the introduction of Holdsworth's new classification on fracture-dislocations of spine with particular emphasis on the role of posterior ligmaent complex, operative reduction and spinal fusion is considered to be an established procedure in treating unstable injuries of the thoracolumbar spine.By stabilizing unstable fractures,nursing, and rehabilitation become much easier. Among the various methods and devices, Harrington instrumentation and posterior spinal fusion have been used and found to be acceptable in our series. Twenty five consecutive patients with unstable fractures and fracture-dislocations' of thoracolumbar spine were treated by open reduction and spinal fusion with Harrington rod fixation at the Department of Orthopedic Surgery, Kang Nam General Hospital Public Corporation from the period of 1982 to 1985. The following results were obtained from analysis of the cases. l. Among 25 cases, 15 (60%) were due to flexion-rotation violence, 5 pure flexion,3 vertical compression, 1 shear fracture respectively. 2. Among 16 cases with neurologic deficit, 15 cases showed considerabel improvement after surgery. 3. Most of the cases showed satisfactory bony fusion, and average postoperative kyphotic angle was 14.4 after 3 months. 4. Although no particular external fixation was adopted, permitting mobility in bed, postoperative correction was relatively well maintained.