Application of modified posterior decompression for the treatment of thoracolumbar burst fractures / 中国骨伤

ABSTRACT

<p><b>OBJECTIVE</b>To study therapeutic effects of self-designed canal decompressor in the posterior surgical treatment of thoracolumbar burst fractures, and provide evidence for widespread application.</p><p><b>METHODS</b>From January 2008 to December 2008, the self-designed canal decompressor was used in 43 patients (30 males and 13 females, ranging in age from 22 to 49 years) with thoracolumbar burst fractures. According to Denis classification, there were 12 cases of type A, 24 cases of type B, 6 cases of type D and 1 case of type E. Affected segment: 16 patients in T12,19 patients in L1 and 8 patients in L2. The index of intra-operative blood loss, postoperative 24 h wound drainage volume, and operative time were compared with those of 16 patients who undergone traditional operation. The preoperative and postoperative vertebral canal volume, Cobb angles, residual vertebral body height, neurological outcome, and back pain were evaluated and compared.</p><p><b>RESULTS</b>All the patients healed without wound infection, neurological symptoms and other complications. Forty-three patients were followed up ranging from 12 to 24 months, with a mean of (16.5 +/- 2.5) months. Compared with traditional posterior operation, the blood loss and operative time in modified posterior approach group had statistically significant difference, but the postoperative 24 h wound drainage had no significant difference between the two groups. CT scan indicated that applying the canal decompressor allowed efficient restore of canal volume from preoperative (49.4 +/- 16.7)% to postoperative (12.8 +/- 4.2)%. The X-ray showed Cobb angles reduced from preoperative (30.1 +/- 2.4)degrees to postoperative (5.1 +/- 0.6) degrees. Mean vertebral height was restored to (81.5 +/- 5.5)% after operation. Follow-up evaluation indicated that neurological recovery presented in 33 patients,with an average improvement of 0.87 Frankel grades. Neurological deterioration was not observed.</p><p><b>CONCLUSION</b>Applying the canal decompressor enables efficient and safe spinal decompression, restore the height of the injured vertebrae, reconstruction of the anterior-middle column stability,and prevention of postoperative vertebral height and Cobb angle lost.</p>