Quantitative selection of indications for combined anteroposterior surgery for thoracolumbar fractures / 中华创伤杂志

ABSTRACT

Objective To discuss the value of thoracolumbar injury classification and severity score (TLICS) and load-sharing scores in guiding selection of the indications of combined anteroposterior surgery for thoracolumbar fractures. Methods A total of 216 patients with thoracolumbar fractures treated surgically from January 2006 to January 2008 were involved in the study. Combined anterior and posterior surgery was carried out in 48 patients including 32 males and 16 females (at average age of 39 years, range 18-55 years). Segments involved T11 in two patients, T12 in eight, L1 in 20 and L2 in 18. According to the classification of Magerl, there were 20 patients with type B1 fractures, 15 with type B2, four with type C1 and nine with type C2. Neurologic status based on ASIA classification was at grade A in five patients, grade B in 16, grade C in 16, grade D in nine and grade E in two. All patients were operated in lateral position at one stage within 14 days after injury, with posterior laminectomy and pedicle fixation, anterior corpectomy, reduction and strut graft. Forty-five patients were followed up for 14-38 months. Plain X-ray radiographs and reconstruction CT were taken to observe the bone healing. Local kyphosis and vertebral canal were also measured. All the patients were evaluated with TLICS and load-sharing scores. Results Lumbar physical lordosis was reconstructed, with no evident correction loss,pseudoarthrosis or implant failure noted during follow-up. The patients treated with combined surgery had TLICS score ≥5 points, load-sharing scores ≥7 points and were combined with posterior ligamentous complex injury, so the fracture could not be sufficiently decompressed and reconstructed with single anterior or posterior surgery. Of all, 45 patients were followed up for 14-38 months (mean 25 months), which showed that all the combined surgeries were performed successfully, with bone fusion and neurological status improved for at least one ASIA grade. No complications like implant breakage, loosening, titanium mesh displacement or subsidence were observed. Conclusions LICS is basically helpful for guiding selection of combined surgery, but does not well evaluate the canal compromise, to which the load-sharing scores can supplement. These two evaluation systems should be applied together. The anteroposterior surgery can be recommended when the patients are with TLICS≥5 points, load-sharing score ≥7 points and combined with ligament complex injury.