Anterior fixation of thoracolumbar traumatic spinal injuries.

BACKGROUND: Traumatic spinal fractures require surgical treatment to restore the anatomical curvatures of the spine and release the nervous structures. However, uniform management guidelines have not been established and thus the literature includes papers focussing only on the posterior techniques as well as those assessing the anterior or anteroposterior approaches. This paper presents the outcomes of the treatment of spinal fractures with anterior and anteroposterior fixation. MATERIAL AND METHODS: The study enrolled 48 patients. The age of the patients at the time of injury was 36.8 years on average and the mean follow-up period was 3.8 years. All the fractures were unstable and caused stenosis of the spinal canal lumen. We used anterior or combined anterior and posterior approaches with a titanium implant in all the cases. Radiological assessment involved determination of the monosegmental and bisegmental Cobb angle, and the neurological status was evaluated according to the Frankel classification. RESULTS: The mean post-traumatic monosegmental angle was -17.1°, compared to -9.1° post-operatively and -9.2° at followup. The bisegmental angle was -12.7° at baseline, -7.9° post-operatively, and -8° in the follow-up period. Neurological assessment showed no neurological deficits in 27 patients while 2 persons had complete limb paralysis and the other 19 patients had various degrees of neurological deficits. The last follow-up examination did not show any improvement with respect to the neurological status of the patients with complete paralysis. However, an improvement of at least 1 Frankel group was noted in 15 patients with partial neurological deficits. CONCLUSIONS: 1. The most common causes of traumatic spinal injuries are falls from a height and road accidents. 2. fractures occur most often at the thoracolumbar junction of the spine. 2. Anteroposterior fixation with release of the spinal canal and spinal fusion is a beneficial treatment method. 3. Apart from vertebral body mesh, treating lumbar spine fractures requires the additional use of vertebral body screws or transpedicular posterior fixation. 4. Anterior fixation ensures the restoration of the physiological curvatures of the spine and stabilizes the spine until a complete bone union is achieved, preventing the loss of correction during the follow-up period.

Treatment of idiopathic scoliosis exceeding 100 degrees - comparison of different surgical techniques.

BACKGROUND: The treatment of scoliosis exceeding 100 degrees remains a challenge. Anterior fusion only may lead to low correction and screw plowing, posterior fusion only may cause the cranckshaft phenomenon in skeletally immature patients. Two-stage surgery is advocated, comprising anterior release and posterior fusion. MATERIAL AND METHODS: The aim of the paper is to compare treatment outcomes in patients with a >100% primary curve treated between 1984 - 2004 with one of the following techniques: halo-femoral traction with posterior fusion (Group I; n=124 patients), anterior release with halo-femoral traction and posterior fusion (Group II; n=32), single stage anterior release and posterior fusion (Group III; n=20), and posterior fusion only (Group IV; n=19). Correction and loss of correction were assessed radiologically. Additional surgical procedures and the presence of complications were also recorded. The fusion techniques were compared. Mean post-operative follow-up duration was 3.9 years, ranging from 2 to 15.3 years. RESULTS: Correction was highest in Group II and Group III (52.7% and 51.7%, respectively); vs. Group I and Group IV (45.8% and 38.7%, respectively). The loss of correction at final follow-up was lowest in Group II and Group III (2% and 3.3%), and highest in Group I and Group IV (6.4% and 15.6%, p<0.05). In all groups, the use of derotational instrumentation increased correction (59.7% C-D vs. 37% Wisconsin vs. 24.5% Harrington-Luque) and decreased loss of correction (4% C-D vs. 5% Harrington-Luque vs. 28% Wisconsin). Rates of neurological complications were similar in all groups; no persistent deficits were noted. CONCLUSIONS: Anterior release with halo traction and posterior fusion is the optimal treatment of severe scoliosis. If halo traction is contraindicated, single stage anterior release and posterior fusion should be performed. Contemporary instrumentation techniques result in higher correction rates and better curve stability.

Retrospective study of two-stage surgery in the treatment of scoliosis exceeding 100 degrees - assessment including spinal balance evaluation.

BACKGROUND: Scoliosis exceeding 100 degrees remains an important problem in spinal orthopaedics. The choice of an optimal surgical technique is crucial, not only because of the degree of correction needed, but also because of the need to minimize the number of complications and avoid imbalance after surgery. The aim of this work is to analyse the outcomes of a two-stage surgical regimen for scoliosis exceeding 100 degrees consisting of anterior release, cranio-femoral traction, and posterior fusion with derotational instrumentation. MATERIAL AND METHODS: Twelve patients with thoracic scoliosis (7 females and 5 males) were assessed retrospectively. The mean curve angle before surgery was 129 degrees. All patients underwent a two-stage procedure consisting of anterior release followed by 10-14 days of cranio-femoral traction and posterior fusion with derotational instrumentation. Mean age at surgery was 19 years. The mean follow-up period was 5 years. Radiological evaluation was based on postero-anterior and lateral radiographs. RESULTS: Mean curve correction was 44% and this result was stable during the follow-up period. Thoracic kyphosis did not change significantly after treatment, remaining at 61 degrees on average. Coronal decompensation was noted in 4 patients before surgery and one of the four after treatment. The Th1-midline distance improved significantly, as did the Th12-L2 angle on lateral radiographs. There were no neurological complications. CONCLUSION: Two-stage treatment of very severe scoliosis enables stable correction with some improvement of spinal balance in both the coronal and sagittal plane.