A Study of Fracture Patterns and Preventive Strategies of Thoracolumbar Spine Injuries

Introduction: Thoraco-lumbar spine fractures form majorityof spine fractures and is an important cause of morbidity.However, comprehensive data regarding epidemiologicalpattern of trauma patients with spinal fractures are scarce.Many epidemiological reports about spinal fractures focus onosteoporosis as an etiologic factor. But in Indian populationmore important etiological factors are road traffic accidentsand falls from height. Studies concerning only operativelytreated patients with spinal fractures show selective andbiased data that might be useful for capacity planning inhospitals or evaluating results of operative treatment, but notfor epidemiological purposesMaterial and Methods: 86 consecutive patients with thoracicor lumbar fractures attending the out-patient department orEmergency department of Sree Gokulam Medical CollegeHospital, Trivandrum were enrolled in the study. All patientswith fractures of the thoracic or lumbar spine were enrolledin this study.Result: Distribution of fracture pattern in thoracolumbarspine injuries were studied. And the methods to prevent thosefractures are listed in this study.Conclusion: This study is a prospective cohort study of theepidemiological aspects and pattern of injury and treatment inthoraco-lumbar spine fractures at a tertiary care referral center.A total of 86 patients were enrolled in the study.The mostcommon fracture pattern seen in this study was compressionfractures (24.4%) which are stable. This was followed bystable burst fractures (23.2%, unstable burst fractures (18.6%),translational injuries (fracture-dislocations)(16.3%), flexiondistraction injuries(13.9%) and chance fractures(3.5%).

Comparison of the effects of injured vertebra pedicle fixation combined with vertebroplasty and vertebra pedicle screw fixation combined with vertebroplasty in the treatment of osteoporotic thoracolumbar burst fractures / 中国骨伤

OBJECTIVE@#To assess the curative effects of injured vertebra pedicle fixation combined with vertebroplasty and short-segment pedicle screw fixation combined with vertebroplasty in treatment of osteoporotic thoracolumbar burst fractures.@*METHODS@#Seventy patients with osteoporotic thoracolumbar burst fractures who met the inclusion criteria were collected in the study from January 2015 to December 2017. Among them, 35 patients were treated with injured vertebra pedicle fixation combined with vertebroplasty (group A), including 20 males and 15 females, aged from 55 to 74 years with an average of (64.03± 7.82) years. Twenty-six cases were type A3 and 9 cases were type A4 according to the AO typing;another 35 patients were treated with short segment pedicle screw fixation combined with vertebroplasty (group B), including 18 males and 17 females, aged from 54 to 72 years with an average of (62.78±6.40) years. Twenty-eight cases were type A3 and 7 cases were type A4 according to AO typing. Operation length, intraoperative bleeding volume, complication, imaging parameters and clinical effects were compared between the two groups.@*RESULTS@#All the patients were followed up for at least 12 months. There were no significant differences in gender, age, injury site, preoperative VAS, Cobb angle, and injured vertebral height before surgery. There were no significant differences in operation length, intraoperative bleeding volume between two groups. In terms of VAS scores before surgery, 1 week after surgery, and at the final follow up, group A was 5.5 ±2.5, 1.8 ±0.8, 0.9 ±0.4, group B was 5.4 ± 2.3, 1.7±0.6, 1.2±1.8, respectively;injured vertebral height was (40.4±8.8)%, (92.0±4.9)%, (87.1±3.8)% in group A, and (41.2±6.6)%, (93.2±4.6)%, (80.0±4.3)% in group B;Cobb angle was (18.4±6.9) °, (2.8±2.2) °, (4.2±2.6) ° in group A, and (16.8±7.2) °, (2.7±2.5) °, (6.0±2.4) ° in group B. There were significant differences in the 3 parameters above before the operation and at the final follow up in all groups (<0.05). There were significant differences in the Cobb angle and injured vertebral height between 1 week after operation and at the final follow up (<0.05). At the final follow up, injured vertebral height in group A was obviously better than that in group B (<0.05). Internal fixation failure occurred in 2 cases from the group A, and occurred in 4 cases from the group B. There were no neurological complications in both groups.@*CONCLUSION@#For osteoporotic thoracolumbar vertebral burst fractures, injured vertebra pedicle fixation combined with vertebroplasty and vertebra pedicle screw fixation combined with vertebroplasty can achieve good clinical effects. However, injured vertebra pedicle fixation combined with vertebroplasty is better at maintaining postoperative vertebral height and sagittal arrangement, and reducing internal fixation related complications. The treatment strategy is worthy of application and promotion.

Posterior spinal canal decompression with screw fixation and reconstruction of three vertebral column for thoracolumbar burst fractures complicated with nerve injury / 中国骨伤

<p><b>OBJECTIVE</b>To explore the feasibility and clinical effect of posterior spinal canal decompression with pedicle screw fixation and reconstruction of anterior and middle vertebral column for thoracolumbar burst fractures complicated with nerve injury.</p><p><b>METHODS</b>A total of 36 patients with thoracolumbar burst fractures treated from March 2011 to April 2016 were enrolled in the retrospective study. There were 20 males and 16 females, aged from 21 to 52 years old with an average of 37.6 years. All the fractures were located on a single segment, 8 cases of T11₁₁, 10 cases of T₁₂, 12 cases of L₁, 6 cases of L₂. According to thoracolumbar injury classification and severity score(TLICS) system, the score was 7 to 9 points, with an average of 7.4 points. According to the America Spine Injury Association(ASIA) grade, 4 cases were type A, 10 cases were type B, 14 cases were type C, 8 cases were type D. All the patients underwent posterior spinal canal decompression with pedicle screw fixation and reconstruction of anterior and middle vertebral column. The recovery of nerve function was evaluated by ASIA grading. The correction of kyphosis(Cobb angle), the volume change of injuried spinal canal, the change of anterior border height of injury vertebra which can be observed by X-rays;the internal fixation loosening and breakage and all the information of bone fusion were recorded.</p><p><b>RESULTS</b>All the operations were successful, the mean operative time and intraoperative blood loss were(2.8±0.3) h (2.1 to 3.5 h) and (880±120) ml(550 to 1 350 ml), respectively. All the incisions got primary healing. All the patients were followed up for 12 to 28 months with an average of 18.4 months. All the patients obtained satisfactory bone fusion. No pseudoarticulation formation was found, and there was no loosening, breakage of pedicle screws or displacement of titanium mesh. Neurological function was improved in different degree, except in one patient with grade A and another one with grade B. According to the ASIA grade, there were 1 case of type A, 1 case of type B, 7 cases of type C, 10 cases of type D and 17 cases of type E, postoperatively. At 3 days after operative, the anterior border height of injury vertebra, Cobb angle and the volume changes of injury spinal canal were obviously improved(<0.05), and there was no significant difference between postoperative at 3 days and final follow-up(>0.05).</p><p><b>CONCLUSIONS</b>Spinal canal decompression with screw fixation and reconstruction of anterior and middle vertebral column through posterior midline approach is a safe and effective method in the treatment of thoracolumbar burst fractures with nerve injury, it is worthy to be popularized. It can complete the spinal canal decompression of 360 degree, reduction of fractures and reconstruction of vertebral three-column at the same time through a single posterior approach. The advantages includes less trauma, perfect decompression, good stability and etc.</p>

Spinal Canal Remodeling in Operated Cases of Thoracolumbar Fractures.

Introduction: Among trauma patients 6% have spinal column injury, half of which have spinal cord or nerve root injury. Road traffic accidents being the most common cause. Burst fractures account for more than half of the thoracolumbar fractures which are treated by various modalities of fixation and decompression. Aim: The aim of this study is to compare direct and indirect surgical decompression of the spinal canal in patients with thoracolumbar fractures with neurodeficit and to compare spinal canal remodeling. Materials and Methods: A total of 30 patients with thoracolumbar fractures were divided into two groups, Group 1 with direct and Group 2 with indirect decompression. Canal diameters were recorded before and after surgery and at follow-up. The patients were followed up at 3, 6, and 12 months. Both groups will be compared using Student’s paired t-test and Chi-square test. Results: Both groups were comparable in terms of age, sex, mode if injury, site of injury, and pre-operative canal diameters. After surgery, mean diameter for G1 1.2 cm (standard deviation [SD] ± 0.03) and G2 1.15 cm (SD ± 0.04) canal diameters improved in both groups with P < 0.05, however among both groups, the P < 0.05 showing that better canal clearance was achieved in G1 than in G2. Diameter at 1 year for G1 1.37 cm (SD ± 0.048) and G1 1.37 cm (SD ± 0.029), though the improvement in canal diameters from post-operative period to 1 year is significant in each group (P value in both groups <0.001), and among groups, the difference is not significant with P > 0.05. Conclusion: The neurological damage in thoracolumbar burst fractures occurs at the precise moment of injury. Furthermore, there is spontaneous remodeling potential of the spinal canal.

Decision-Making Process in Patients with Thoracolumbar and Lumbar Burst Fractures with Thoracolumbar Injury Severity and Classification Score Less than Four

STUDY DESIGN: Cross-sectional. PURPOSE: To develop a strategy to determine a sound method for decision-making based on postoperative clinical outcome satisfaction. OVERVIEW OF LITERATURE: The ideal management of thoracolumbar and lumbar burst fractures (TLBF) without neurological compromise remains controversial. METHODS: This was a prospective study. Patients with thoracolumbar injury severity and classification score (TLICS) <4 were treated nonoperatively, with bed rest and bracing until the pain decreased sufficiently to allow mobilization. Surgery was undertaken in patients with intractable pain despite an appropriate nonoperative treatment (surgery group). The Oswestry disability index (ODI) measure was observed at baseline and at the last follow-up. Clinically success was defined at least a 30% improvement from the baseline ODI scores in both the conservative and surgery groups. All case records were assessed for gender, age, residual canal and angulations at the site of the fracture in order to determine which patients benefited from surgery or conservative treatment and which did not. RESULTS: In all 113 patients with T11-L5, TLBFs were treated. The patients' mean age was 49.2 years. Patients successfully completed either nonoperative (n=99) or surgical (n=14) treatment based on ODI. Clinical examinations revealed that all of the patients had intact neurology. The mean follow-up period was 29.5 months. There was a significant difference between the two groups based on age and residual canal. The mean ODI score significantly improved for both groups (p <0.01). According to the findings, a decision matrix was proposed. CONCLUSIONS: The findings confirm that TLICS <4, age, and residual canal can be used to guide the treatment of TLBF in conservative decision-making.

Percutaneous kyphoplasty in treating thoracolumbar osteoporosis vertebral burst fractures / 中国医师进修杂志

Objective To evaluate the feasibility of percutaneous kyphoplasty (PKP) in treating osteoporotic vertebral burst fractures (OVBF) without nerve injury, and observe the clinical therapeutic effect. Methods A total of 32 patients with primary OVBF without nerve injury were treated by PKP from January 2009 to January 2013. The volume of bone cement intraoperative injection and complications after operation were observed. The visual analog scale (VAS) and Oswesty disability index (ODI) before and after operation were metered to evaluate pain relief and improvement of life quality. The Beck index, Cobb angle and vertebral canal bones occupying rate were metered before and after operation to evaluate the recovery of vertebral body height, correction of kyphosis and change of intraspinal bone block position. Results There were no serious complication occurred. The operation time was (52.05± 7.60) min, the volume of bone cement intraoperative injection was (4.08 ± 1.50) ml. After operation for one day, the VAS decreased from (7.89±0.52) scores to (2.31±0.39) scores, the Cobb angle decreased from (19.15±3.20)°to (11.19±2.58)°, the Beck index increased from 0.46±0.06 to 0.61±0.07, there were significant differences (P<0.01 or<0.05). The rate of spinal bones occupying after operation for one day was not decreased obviously, but after operation for 3 months, it decreased from (17.89±5.03)%to (9.18±4.17)%, there was significant difference (P<0.05).The ODI before operation was (76.89± 6.72) scores, after operation for 3 months was (30.86± 7.25) scores, there was significant difference (P<0.01). Conclusions The pain could be relieved effectively, and the quality of life could be improved by the method of PKP in treating OVBF. Meanwhile, the vertebral body height and kyphosis could be corrected and the rate of spinal bones occupying could not be increased significantly.

Efficacy of percutaneous kyphoplasty for treating osteoporotic burst fractures and bone cement leaking pathway / 重庆医学

Objective To evaluate the clinical curative efficacy and to explore the leaking pathway of bone cement to verte‐bral canal through treating osteoporotic vertebral burst fractures (OVBF) by using percutaneous kyphoplasty(PKP) .Methods Ac‐cording to AO classification ,45 OVBF patients with 45 vertebras in the Erdos Central Hospital from October 2005 to May 2013 were treated by using PKP .The pathway of bone cement leaking to spinal canal and intervertebral space was determined by postop‐erative CT plain scan .The postoperative vertebral height ,Cobb angle and spinal stenosis improvement were measured .The change of VAS were compared between before and after operation .Results There were 2 cases of bone cement leaking to spinal canal .The leaking passway was mainly through basivertebral foramen .The leakage of bone cement to superior intervertebral space was higher than that to lower intervertebral space .The recovery of the vertebral height ,correction of Cobb angle and pre‐and post‐operative VAS scores had statistically significant differences (P0 .05) .Conclusion PKP for treating OVBF is not a contraindication .The main pathway of bone cement lea‐king to spinal canal is basivertebral foramen after the treatment of OVBF by using PKP ,the leakage to intervertebral space is relat‐ed with the endplate damage .

Radiological Outcome of Short Segment Posterior Instrumentation and Fusion for Thoracolumbar Burst Fractures

STUDY DESIGN: Retrospective study. PURPOSE: To evaluate the radiological outcome of the surgical treatment of thoracolumbar burst fractures by using short segment posterior instrumentation (SSPI) and fusion. OVERVIEW OF LITERATURE: The optimal surgical treatment of thoracolumbar burst fractures remains a matter of debate. SSPI is one of a number of possible choices, yet some studies have revealed high rates of poor radiological outcome for this SSPI. METHODS: Patients treated using the short segment instrumentation and fusion technique at the Spinal Injuries Center (Iizuka, Fukuoka, Japan) from January 1, 2006 to July 31, 2012 were selected for this study. Radiographic parameters such as local sagittal angle, regional sagittal angle, disc angle, anterior or posterior height of the vertebral body at admission, postoperation and final observation were collected for radiological outcome evaluation. RESULTS: There were 31 patients who met the inclusion criteria with a mean follow-up duration of 22.7 months (range, 12-48 months). The mean age of this group was 47.9 years (range, 15-77 years). The mean local sagittal angles at the time of admission, post-operation and final observation were 13.1degrees, 7.8degrees and 14.8degrees, respectively. There were 71% good cases and 29% poor cases based on our criteria for the radiological outcome evaluation. The correction loss has a strong correlation with the load sharing classification score (Spearman rho=0.64, p<0.001). CONCLUSIONS: The loss of kyphotic correction following the surgical treatment of thoracolumbar burst fracture by short segment instrumentation is common and has a close correlation with the degree of comminution of the vertebral body. Patients with high load sharing scores are more susceptible to correction loss and postoperative kyphotic deformity than those with low scores.

Predictive Factors for a Kyphosis Recurrence Following Short-Segment Pedicle Screw Fixation Including Fractured Vertebral Body in Unstable Thoracolumbar Burst Fractures

OBJECTIVE: The technique of short segment pedicle screw fixation (SSPSF) has been widely used for stabilization in thoracolumbar burst fractures (TLBFs), but some studies reported high rate of kyphosis recurrence or hardware failure. This study was to evaluate the results of SSPSF including fractured level and to find the risk factors concerned with the kyphosis recurrence in TLBFs. METHODS: This study included 42 patients, including 25 males and 17 females, who underwent SSPSF for stabilization of TLBFs between January 2003 and December 2010. For radiologic assessments, Cobb angle (CA), vertebral wedge angle (VWA), vertebral body compression ratio (VBCR), and difference between VWA and Cobb angle (DbVC) were measured. The relationships between kyphosis recurrence and radiologic parameters or demographic features were investigated. Frankel classification and low back outcome score (LBOS) were used for assessment of clinical outcomes. RESULTS: The mean follow-up period was 38.6 months. CA, VWA, and VBCR were improved after SSPSF, and these parameters were well maintained at the final follow-up with minimal degree of correction loss. Kyphosis recurrence showed a significant increase in patients with Denis burst type A, load-sharing classification (LSC) score >6 or DbVC >6 (p6, or DbVC >6.

The Clinical Effect Observation in Balloon Kyphoplasty for Aged Osteoporotic Thoracolumbar Burst Fractures / 昆明医科大学学报

Objective To evaluate the possibility and safety of balloon kyphoplasty for the aged osteoporotic thoracolumbar burst fractures. Methods From October 2007 to December 2012, 78 patients with aged osteoporotic thoracolumbar burst fractures were treated by balloon kyphoplasty. The inflatable balloon was inserted through pedicle of vertebal arch to make fracture reduction, then the centrum was stuffed with bone cement. The whole procedure was pinpointed and detected by C-arm x-ray machine. Results All operations were completed successfully. The lumbar and back pain of the patients relieved obviously. The quality of patients' life was significantly improved. Imaging examinations revealed that the vertebrae altitude was recovered and the kyphosis was corrected obviously. Conclusion Balloon kyphoplasty is effective to treat the aged osteoporotic thoracolumbar burst fractures. But the operation had certain risk, we must do a good job in preoperative preparation, strictly handle surgical indication and accurately operate.

Clinical Efficacy of Implant Removal after Posterior Spinal Arthrodesis with Pedicle Screw Fixation for the Thoracolumbar Burst Fractures / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical efficacy of implant removal by analyzing the radiological changes after posterior spinal stabilization in patients with thoracolumbar burst fractures. MATERIALS AND METHODS: Fifty-eight patients, who received surgical treatment after a thoracolumbar burst fracture with at least a two year follow-up, were enrolled in this study. An evaluation of the clinical results was based on the VAS score to examine degree of pain and discomfort. The evaluation of the radiological results was performed by measuring the changes in the kyphotic angle of the fractured vertebral bodies and the severity of the collapse of the anterior vertebral height taken after the injury, after fusion and after metal removal on the plain lateral radiograph. RESULTS: The VAS score on pain and discomfort after removing the implants showed a significant decrease from 6.5 to 3.2 and from 5.6 to 2.8, respectively. Overall, the kyphotic angle after removing the implants increased by 3.7 degrees, whereas the anterior height of the fractured vertebral body after removing the implant decreased by 1.5% in correction. CONCLUSION: The removal of implants after posterior arthrodesis in thoracolumbar burst fractures can be performed effectively to relieve the pain and restore flexibility but can result in the progression of kyphosis. However careful consideration should be made before removing an implant in cases of severe initial damage.

Treatment of thoracolumbar burst fractures / 中国矫形外科杂志

Thoracolumbar burst fractures account for more than half of all thoracolumbar fractures,which often result in neurologic deficit,kyphosis deformity and significant disability.The management of thoracolumbar burst fractures differ with the types.Nowadays,the accepted methods of treatment of thoracolumbar burst fractures include conservative therapy,posterior reduction and instrumentation,anterior decompression and instrumentation,combined anterior-posterior approach and minimally invasive approach.Howerer,the optimal technique is not always evident.There is no precise classification system to determine which surgical procedure is the best.The following review summarizes the recent advances in treatment of thoracolumbar burst fractures.Recent clinical evidence shows that there is no significant difference between conservative therapy and surgical treatment for thoracolumbar burst fractures without neurologic deficit,and that surgical treatment should be considered for unstable fractures with neurological injuries.Some other clinical evidence shows that short segment combined fractured vertebra plasty with various manners has gained popularity,because it can reconstruct anterior column and decrease the failure of internal fixation and the occurrence of long-term spinal kyphosis deformity.In accordance with the principles of biomechanics and taking into account the occurrence of degeneration of adjacent segment,surgeons gradually applied non-fusion technology in clinical practice,and yet its long-term results need to be confirmed by further studies.

Anterior approach for treatment of thoracolumbar burst fractures by decompression and bone graft / 中国矫形外科杂志

[Objective]To discuss the clinical effect of the anterior approach for the treatment of thoracolumbar burst fractures by decompression and bone graft.[Method]A total of 34 patients underwent anterior approach for the treatment of thoracolumbar burst fractures were retrospectively analyzed from September 2003 to September 2005.According to the Denis classification system,there were 6 type A,16 type B,6 type C,4 type D,and 2 type E.Preoperative and postoperative neurologic changes,spinal canal decompression,segmental angulation,and arthrodesis rate were evaluated.[Result]The average preoperative canal compressopm decreased from 66.5% to 2.0%.Mean preoperative segmental kyphosis improved from 22.10? to 2.30?.There was neurologic deterioration.Twenty-six(86.7%) of 30 patients with neurologic deficits had an improvement by at least one modified Frankel grade.All patients went on to apparently stable arthrodesis.[Conclusion]Types of anterior spinal instrumentation and reconstruction techniques allow direct anterior decompression of neural elements,improvement in segmental angulation,and acceptable rates of arthrodesis without the need for supplemental posterior instrumentation.

Evaluation of pedicle screws applied in the affected vertebra for the treatment of thoracolumbar burst fracture / 中国矫形外科杂志

[Objective]To investigate curative effect for thoracolumbar burst fractures by the method of vertebral pedicle screw fixation applied in the with transpedicular bone graft,and consider its indications.[Method]Thirty cases of thoracolumbar burst fractures were treated by vertebral pedicle screw fixation combining transpedicular bone graft.Among them 22 were male and 8 were famale,age ranged 18-64.All of cases were single segment fractures.The average height of anterior border was 35% before the operation,the average of Cobb's angle was 26?,the percentage of midsagital diameter was 55%.According to Frankel's neurological function classification,preoperative neurological function was Grade A in 4 cases,B in 8,C in 5,D in 6,E in 7.[Result]All cases were followed up for 6 to 30 months.All patients' pain relieved distinctly,the average height anterior border was increased to 97%,the average of Cobb's angle was 3.5?,the percentage of midsagital diameter was 92% postoperatively,showing significant difference(P

The Effect of Pedicle Screw Instrumentation on Fractured Vertebrae in Unstable Thoracolumbar Burst Fractures with Canal Encroachment and Clinical Result / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the canal encroachment of fractured bony fragments and neurological deficits of pedicle screw instrumentation for the treatment of unstable thoracolumbar burst fractures with pedicle screws inserted into the fractured vertebrae. MATERIALS AND METHODS: The authors evaluated 18 patients treated surgically with posterior fusions using pedicle screws for unstable thoracolumbar burst fractures, from March 2000 to September 2004. The ratios of the areas occupied by the fractured bony fragments in the canals were analyzed, before and after pedicle screw insertion, by computed tomography scans of the fractured vertebrae. The kyphotic angles, anterior vertebral heights, and neurological deficits were evaluated. RESULTS: The areas occupied by the fractured fragments in the canals were improved significantly after surgery and there were no neurological complications resulting from the placement of pedicle screws or fragment displacements. The kyphotic angles and anterior vertebral heights at the last follow-up visits were improved significantly compared with the preoperative radiographs. The neurological deficits were not aggravated after pedicle screw insertion. CONCLUSION: Our results suggest that pedicle screw instrumentation in fractured vertebrae is safe and effective for the treatment of unstable thoracolumbar burst fractures.

Anterior decompression and stabilization with anterior or posterior instrumentation for treatment of the serious thoracolumbar burst fractures / 中国矫形外科杂志

[Objective]To evaluate the clinical effect for the treatment of severe thoracolumbar vertebral burst fracture by the method of anterior vertebral decompression and fusion combining anterior or posterior fixation,and investigate its indications in different conditions.[Method]At the standard of Denis,twenty-eight cases were treated by anterior vertebral decompression and fusion combining anterior or posterior fixation.In a total of 28 cases,25cases were single vertebral fractures,2 cases were two adjacent vertebral fractures and 1 case was two vertebral fractures comparted by one unfractured centrum,the level of vertebral destruction was ruled by LSC scale of McCormack.[Result]26 cases were reviewed,all patients' pain were relieved obviously after the operation,(VAS scale improved),the height and shape of the fractured centrums recovered obviously(Cobb's angle improved 14.5? in average).After an average of 21.5 months follow-up,the pain all disappeared,the intervertebral grafted bone reached bony union,no Cobb's angle increased and no apparent implication occurred in all cases.[Conclusion]Application of anterior vertebral decompression and fusion combining anterior or posterior fixation can increase the stability of the anterior column of the spine,decompress completely,the intervertebral bone graft with kinds of interbody fixation enables the patients to move as early as possible,it is an effective method in treatment of severe thoracolumbar vertebral burst fracture.

Transpedicular fixation combined w ith vertebral plasty in treatment of thoracolumbar burst fractures / 中华创伤骨科杂志

0.05).Conclusion Transpedicular fixation and verteb ral plasty of intracorporeal grafting combined with decompression is an alternative method in the treatment of thoracolu mbar burst fractures to restore the h eight of injured vertebra and preven t collapse of vertebral body postoperatively.[

Relationship between Traumatic Spinal Canal Stenosis and Neurologic Deficits in Thoracolumbar Burst Fractures / 대한정형외과학회잡지

In the assessment of thoracolumbar burst fractures, computed tomography(CT) is superior to other imaging modalities, especially when a more definitive assessment of the posterior elements of the spine or the nueral canal is desired. A few authors have reported the relationship between traumatic spinal canal stenosis and neurologic deficits. Authors analysed 64 patients with thoracolumbar burst fractures about the relationship between traumatic spinal canal stenosis and neurologic deficits using plane x-ray findings and CT scans. The results were as follows; 1. There was no difference of kyphotic angle and anterior vertebral height loss between neurologic deficit group on lateral plane x-ray findings. 2. The incidence of injury of the superior endplate was 100%(64/64); of the inferior endplate 53%(36/64); of the posterior element 45.3%(29/64). 3. Twenty(69.0%) of 29 patients with disruption of posterior element had neurologic deficits, while fourteen(40.0%) of 35 patients without disruption had neurologic deficits. 4. Spinal canal ratio of 35.3% or more at the epiconus level, 56.0% or more at the conus medullaris level, and 65.3% or more at the cauda equine level were significant factors for neurologic deficits in thoracolumbar burst fractures. Spinal canal ratio of 22.0% or less at the epiconus level, 34.5% or less at the conus medullaris level, and 43.1% or less at the cauda equine level were not accompanied with neurologic dieficit in thoracolumbar burst fractures. 5. Fifteen(68%) of 22 patients with neurologic deficit in epiconus and conus medullarsis level had the horsehoe or crescent shape of patient spinal canal, eight (66.7%) of 12 patients with neurologic deficit in cauda equine level had the horsehoe or crescent shape of spinal canal.

Clinical Evaluation of the Thoracolumbar Burst Fractures: Results of Anterior Decompression and Stabilization with Kaneda Derice

The authors report clinical results of twenty-three traumatic thoracolumbar burst fractures treated by internal fixation with Kaneda device after anterior decompression during recent three years. Thoracolumbar injuries made up 28.9% of total spinal injuries and the burst fractures treated by anterior decompression and stabilization with Kaneda device constituted 19.0% of all spinal injuries. The burst fractures occurred most frequently at the age of twenties and thirties. The main causes of injury were fall and vehicle accident. Superior end-plate fracture type was most common according to the types of burst fracture. The first and the second lumbar vertebrae were frequently involved. No patient showed neurological deterioration after surgery. Conus medullaris lesions in burst fractures of the thoracolumbar junction have a high potentiality for functional recovery because the lesions are not due to discontinuity or severe crush injury but due to simple compression by bony fragments. The Kaneda device offered enough stability to enable early ambulation with good alignment and solid fusion.

Clinical Evaluation of the Thoracolumbar Burst Fractures: Results of Anterior Decompression and Stabilization with Kaneda Derice

The authors report clinical results of twenty-three traumatic thoracolumbar burst fractures treated by internal fixation with Kaneda device after anterior decompression during recent three years. Thoracolumbar injuries made up 28.9% of total spinal injuries and the burst fractures treated by anterior decompression and stabilization with Kaneda device constituted 19.0% of all spinal injuries. The burst fractures occurred most frequently at the age of twenties and thirties. The main causes of injury were fall and vehicle accident. Superior end-plate fracture type was most common according to the types of burst fracture. The first and the second lumbar vertebrae were frequently involved. No patient showed neurological deterioration after surgery. Conus medullaris lesions in burst fractures of the thoracolumbar junction have a high potentiality for functional recovery because the lesions are not due to discontinuity or severe crush injury but due to simple compression by bony fragments. The Kaneda device offered enough stability to enable early ambulation with good alignment and solid fusion.