Thoracolumbar burst fractures: CT dimensions of the spinal canal relative to postsurgical improvement (original) (raw)
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JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA
Introduction: The relevant features in the treatment of thoracolumbar fractures vary in the literature. The classical surgical indications of burst fractures are loss of vertebral body height, kyphosis, neurological deficit and canal encroachment. Recent papers have attributed less importance to canal impingement as a surgical indicator in intact patients, irrespectively of the degree of encroachment. The several thoracolumbar fracture classifications have prompted efforts to guide the surgical indications. We analyzed the relevance attributed to the canal encroachment by thoracolumbar fracture classifications in the management of burst fractures without neurological deficit. Objective: To evaluate the relevance attributed by the thoracolumbar fractures classifications to the canal encroachment in the management of burst fractures without posterior ligamentous complex disruptions or neurological deficits. Methods: A literature search was performed by tracking the related articles of...
Bulletin (Hospital for Joint Diseases (New York, N.Y.)), 1996
Forty five patients (27 males and 18 females) aged 18 to 62 years, with thoracolumbar burst fracture treated between 1980 to 1994 were studied retrospectively. The purpose of the study was the identification of the existing correlation between the posttraumatic spinal canal stenosis and the initial neurological deficit. The presence of Dall and Stauffer type II fracture statistically constitutes an important factor, with negative involvement, in the diagnosis of the initial neurological status. In thoracolumbar spine, there is an inversely proportional relation with statistical importance between the level of injury and the post-traumatic spinal stenosis-as the burst fracture is sited higher, smaller canal encroachments by fragments will produce the same neurological deficit.
European Spine Journal, 1995
Burst fractures of the lower cervical spine (C3-7) are often associated with severe neurological injury. During the last 5 years (1987)(1988)(1989)(1990)(1991)(1992) we operated on 11 patients who had sustained burst fractures together with neurological deficit. The operations were performed through an anterior approach. The burst vertebra was excised, and the defect was filled with bone graft. Implants (plates and screws) were used in 10 cases. The preoperative examination was conducted by computed tomography and revealed that in 4 patients with complete tetraplegia (Frankel grade A) there was more than 50% spinal canal narrowing, whilst in the remaining 7 patients, with various levels of incomplete tetraplegia, there was less than 50% spinal canal narrowing, resulting in considerable improvement. The above results support the hypothesis that a correlation exists between the magnitude of the spinal canal encroachment, the initial neurological deficit and the final outcome.
Analysis of the independent risk factors of neurologic deficit after thoracolumbar burst fracture
Journal of orthopaedic surgery and research, 2016
The objective of this study is to identify the independent risk factors of neurologic deficit after thoracolumbar burst fracture. Traumatic fractures of the thoracolumbar spine are the most common type of spinal column fractures. Many studies have attempted to determine whether neurologic deficit in such fractures is related to spinal canal stenosis or other parameters observed on axial computed tomography. However, this relationship remains controversial. A review of the clinical data and axial computed tomography (CT) for 105 patients was performed. Neurologic deficit was classified according to the American Spinal Injury Association (ASIA) classification. Various preoperative CT parameters, including vertebral body compression, canal stenosis, sagittal alignment, and fragment reverse, were analyzed using ordinal logistic regression analysis. Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, canal volume, transverse canal diameter, median sagittal diameter, Cobb ang...
European Spine Journal, 1994
Thirty consecutive patients who had suffered unstable fractures and dislocations of the thoracolumbar spine mostly associated with neurologic impairment and bony encroachment on the spinal canal were treated either with Harrington distraction rods combined with sublaminar wires or with the Zielke-VDS device. These patients were subsequently assessed for neurologic outcome, spinal canal clearance, sagittal and coronal spinal deformity cmxection preoperatively and postoperatively with a minimum follow-up of 26 months. In the follow-up evaluation, the patients who underwent surgery with Harrington rods showed an overall improvement of their neurologic function of 90.9%, whereas all patients who underwent the Zielke operation improved. Preoperatively, positive correlations were found between the level of injury and Frankel grades; the cord lesion tended to demonstrate more severe neurologic deficit when compared with cauda equina ones (P < 0.001). Furthermore, dislocation accompanying the iniury resulted in a more severe neurological deficit (P < 0.05). Hmxington rods and Zielke device offer sufficient initial correction of the frontal spinal deformity but did not significantly either restore or maintain sagittal plane alignment. The Harrington series showed an overall improvement of the segmental kyphosis of 26% (NS), with a subsequent loss of correction of 7.38% (NS) on the follow-up observation. The Zielke device produced an immediate, much better correction of the segmental posttraumatic kyphosis of 45% (NS), but a toss of correction of 22.9% (NS) was measured in the follow-up evaluation. Correction of the anterior and posterior vertebral height was shown to be better for the Zielke patient group. The coronal deformity was completely corrected equally well by the Harrington and Zielke devices. There was no statistically significant correlation between the degree of bony encroachment of the spinal canal and the initial Frankel grade. Additionally, no statistically significant correlation was found between correction of the sagittal deformity, restoration of anterior and posterior Correspondence to: P. Korovessis, 65-67 Haralabi str., GR-26224 Patras, Greece vertebral height, coronal deformity correction, and clearance of the vertebral canal. Concerning neurological stares, no patient in either group was worse in the follow-up evaluation. A significant correlation was found between the age of the patient and the neurological improvement favoring young patients (P < 0.001).
Journal of Clinical Neuroscience, 2020
Background: Thoracolumbar burst fractures (TLBFs) are the most common spinal trauma; however, their appropriate management has not yet been determined. In this study, we aimed to compare the clinical and radiological results of percutaneous pedicle screw fixation (PPSF) following posterior decompression technique versus anterior corpectomy and fusion technique for the treatment of TLBFs. Methods: A total of 46 patients (2002-2015) with TLBFs were included in this study. The inclusion criteria were a single-level Magerl type A3 burst fracture of the thoracolumbar junctional spine (T12-L2). The patients were divided into two groups; Group A (22 patients) underwent anterior corpectomy and fusion, and Group B (24 patients) underwent PPSF after posterior decompression. Anterior corpectomy and fusion surgery were performed in 22 cases before April 2009, and PPSF following posterior decompression technique was used in 24 cases since then. For radiological assessment, the kyphosis angle was measured preoperatively, early postoperatively, and at the last follow-up using the Cobb angle. Mean correction of the Cobb angle after surgery, and loss of correction between the immediate postoperative and final Cobb angle were calculated accordingly. All neurological deficits were identified in the initial evaluation and graded using the American Spinal Injury Association (ASIA) grading system. Perioperative parameters including operation time, amount of blood loss, and mean hospital stay were also evaluated. Results: The patients comprised 17 males and 5 females in Group A and 13 males and 11 females in Group B. In terms of the involved levels, there were three cases of T12, twelve L1, and seven L2 in Group A and one case of T12, thirteen L1, and ten L2 in Group B. The mean follow-up duration was 44.9 months in Group A and 14.7 months in Group B. The kyphotic angle was significantly corrected after surgery by 6.4°in Group A (p = 0.001) and 9.2°in Group B (p < 0.001). Among patients with neurological deficit, 11 of 15 in Group A and 20 of 23 in Group B demonstrated improvement by at least one ASIA grade at the final observation. However, there was no significant difference in neurological improvement between the two groups (p = 0.13). Mean operation time was significantly shorter (p < 0.001) and mean blood loss was significantly less (p < 0.001) in Group B than in Group A. Mean hospital stay was also significantly shorter in Group B (p < 0.001). Conclusions: Spinal canal decompression through small laminectomy followed by PPSF in the treatment of TLBFs with neurological deficits offers excellent clinical and radiological improvement as well as biomechanical stability. Furthermore, this can be a safe and effective surgical option with the advantage of less invasiveness in the treatment of TLBFs.
Spinal Cord, 1997
The wide spread availability of computerized tomography has added a new dimension to the anatomical evaluation of vertebral fractures. This diagnostic modality has shown that in these fractures, the protrusion of bone spicules into the spinal canal is often encountered. The clinical signi®cance of this ®nding and its relation to the need of establishing indications for surgery in these patients is controversial. The neurological outcome of patients with postraumatic bony encroachment of the spinal canal is not well documented in the literature, and therefore the adequate therapeutic approach is neither clear nor is it unanimous. Whether treatment should be aggressively surgical with decompression and/or segmental fusion, or conservative, the goal has to be prevention of secondary injury to the spinal cord. This presentation is a mean 4 year follow up study of 38 consecutive patients with spinal fractures and spinal canal narrowing, who were treated conservatively. The results demonstrate that the initial neurological ®ndings have a very signi®cant prognostic value for the neurological outcome, regardless of the spinal segment involved, the type of injury and spinal canal narrowing as demonstrated by computerized tomograms. We conclude that in trauma patients with vertebral fractures and spicules in the spinal canal without evidence of an initial neurological de®cit, a favorable neurological prognosis can be predicted, following conservative management.
Spine Journal, 2004
BACKGROUND CONTEXT: Conventional transpedicular decompression of the neural canal requires a considerable amount of lamina, facet joint and pedicle resection. The authors assumed that it would be possible to remove the retropulsed bone fragment by carving the pedicle with a high-speed drill without destroying the vertebral elements contributing to spinal stabilization. In this way, surgical treatment of unstable burst fractures can be performed less invasively. PURPOSE: The purpose of this study is to demonstrate both the possibility of neural canal decompression through a transpedicular approach without removing the posterior vertebral elements, which contribute to spinal stabilization, and the adequacy of posterior stabilization of severe vertebral deformities after burst fractures. STUDY DESIGN: Twenty-eight consecutive patients with complete or incomplete neurological deficits as a result of the thoracolumbar burst fractures were included in this study. All patients had severe spinal canal compromise (mean, 59.53%Ϯ14.92) and loss of vertebral body height (mean, 45.14%Ϯ7.19). Each patient was investigated for neural canal compromise, degree of kyphosis at fracture level and fusion after operation by computed tomography and direct roentgenograms taken preoperatively, early postoperatively and late postoperatively. The neurological condition of the patients was recorded in the early and late postoperative period according to Benzel-Larson grading systems. The outcome of the study was evaluated with regard to the adequate neural canal decompression, fusion and reoperation percents and neurological improvement. METHODS: Modified transpedicular approach includes drilling the pedicle for removal of retropulsed bone fragment under surgical microscope without damaging the anatomic continuity of posterior column. Stabilization with pedicle screw fixation and posterior fusion with otogenous bone chips were done after this decompression procedure at all 28 patients included in this study. RESULTS: Twenty-three of 28 patients showed neurological improvement. The percent of ambulatory patients was 71.4% 6 months after the operation. The major complications included pseudarthrosis in five patients (17.8%), epidural hematoma in one (3.5%) and inadequate decompression in one (3.5%). These patients were reoperated on by means of an anterior approach. Of the five pseudarthrosis cases, two were the result of infection. CONCLUSION: Although anterior vertebrectomy and fusion is generally recommended for burst fractures causing canal compromise, in these patients adequate neural canal decompression can also be achieved by a modified transpedicular approach less invasively. Ć 2004 Elsevier Inc. All rights reserved.
Management of unstable thoracolumbar spinal injuries by posterior short segment spinal fixation
International Orthopaedics, 2007
Fifty patients with thoracolumbar fractures were treated operatively between July 2000 and December 2001. The average age of the patients was 33.6 years (range: 20-50 years), 36 were males and 14 were females and the follow-up averaged 59 months (range: 49-68 months). A fall from a height, usually a tree, was the most common cause of injury. Twenty six patients had unstable burst fractures and 13 had translational injury. There were 15 patients with complete neurological deficit, 17 had partial neurological lesions, while 18 had no neurological deficit. All patients were treated by posterior short segment fixation (Steffee VSP). The average pre-operative kyphotic angle was 21.48°, which improved to 12.86°in the immediate post-operative period. The loss of kyphosis averaged 3.46°(0-26°) at the final follow-up. The average pre-operative anterior vertebral body height was 44.7% (range: 36-90%), which improved to 72.0% (range: 55-97%) in the immediate post-operative period. The loss of body height averaged 3.0% (range: 1-15%) at the final follow-up. No neurological deterioration was seen, and in 24 cases a one grade or better improvement was observed. The mean pain score was 1.6, and the mean functional score was 2.8. We found that the application of posterior instrumentation resulted in a reasonable correction of the deformity with a significant reduction in recumbency-associated complications; there were, however, significant other complications. Résumé Cinquante patients présentant une fracture thoracolombaire ont été traités entre juillet 2000 et décembre 2001. L'âge moyen était de 33.6 ans (20 à 50). Il s'agissait de 36 hommes et 14 femmes. Le suivi moyen était de 59 mois (49 à 68). La chute d'une hauteur habituellement d'un arbre était la cause la plus connue. Vingt-six patients avaient une fracture instable et 13 un traumatisme avec translation. Quinze patients avaient un déficit neurologique complet, 17 un déficit neurologique partiel et 18 aucun déficit neurologique. Tous les patients ont été traités par une fixation postérieure (Steffee VSP). L'angulation sans cyphose préopératoire a été de 21.48°en moyenne, celle-ci s'est améliorée de 12.86°en postopératoire immédiat. La perte de cyphose a été de 3.46°(0-26) au suivi final. La hauteur vertébrale de 44.7% (36-90) s'est améliorée à 72% (55 à 97) en postopératoire immédiat. La perte de hauteur du corps vertébral a été de 3%