Direct and Indirect Reduction of the Retropulsed Fragments in Thoracolumbar and Lumbar Burst Fractures / 대한척추외과학회지

ABSTRACT

STUDY DESIGN: Thirty-eight patients with thoracolumbar and lumbar burst fractures were evaluated according to the treatment methods of the retropulsed fragments. OBJECTIVE: To confirm the pure effect of ligamentotaxis according to the approaching methods to tile involved area. SUMMARY OF BACK GROUND DATA Retropulsed fragments were effectively treated by indirect posterior reduction. Regardless of size of the retropulsed fragments, remodelling process of the retropulsed fragments was progressed during follow-up period. METHODS: 38 patients with burst fractures of thoracolumbar and lumbar spine were divided into two groups according to tile reduction method of the retropulsed fragments ; the one group consisted of 18 cases which were treated by posterior instrumentation and indirect reduction(Group I ligamentotaxis) and the other groups consisted of 20 cases which were treated by posterior instrumentation and posterior direct reduction(Group II). Change of neural canal compromise rate, neurologic status, remodelling process of the retropulsed fragments were measured using pre-, post-operative and follow-up radiographs and CT. RESULTS: Comparing the two groups, neural canal compromise rates were decreased at postoperative period but, there were no significant differences in both groups. There were no correlation of neurologic status and neural canal compromise rate. We could confirm the remodelling process of the retropulsed fragments, but there were no significant changes according to the size of the retropulsed fragments between two groups. CONCLUSIONS: Indirect reduction by posterior instrumentation( ligamentotaxis ) could effectively treat the retropulsed fragments in burst fractures of thoracolumbar and lumbar spine without directs posterior reduction.