Thoracolumbar burst fractures with a neurological deficit treated with posterior decompression and interlaminar fusion

Study Design: Retrospective study. Objective: The aim of this study is to evaluate the clinical, neurological, and radiological outcomes of posterior vertebral column resection (PVCR) technique for treatment of thoracic and thoracolumbar burst fractures. Methods: Fifty-one patients (18 male, 33 female) with thoracic/thoracolumbar burst fractures who had been treated with PVCR technique were retrospectively reviewed. Preoperative and most recent radiographs were evaluated and local kyphosis angle (LKA), sagittal and coronal spinal parameters were measured. Neurological and functional results were assessed by the American Spinal Injury Association (ASIA) Impairment Scale, visual analogue scale score, Oswestry Disability Index, and Short Form 36 version 2. Results: The mean age was 49 years (range 22-83 years). The mean follow-up period was 69 months (range 28-216 months). Fractures were thoracic in 16 and thoracolumbar in 35 of the patients. AO spine thoracolumbar injury morphological types were as follows: 1 type A3, 15 type A4, 4 type B1, 23 type B2, 8 type C injuries. PVCR was performed in a single level in 48 of the patients and in 2 levels in 3 patients. The mean operative time was 434 minutes (range 270-530 minutes) and mean intraoperative blood loss was 520 mL (range 360-1100 mL). The mean LKA improved from 34.7° to 4.9° (85.9%). For 27 patients, the initial neurological deficit (ASIA A in 8, ASIA B in 3, ASIA C in 5, and ASIA D in 11) improved at least 1 ASIA grade (1-3 grades) in 22 patients (81.5%). Solid fusion, assessed with computed tomography at the final follow-up, was achieved in all patients. Conclusion: Single-stage PVCR provides complete spinal canal decompression, ideal kyphosis correction with gradual lengthening of anterior column together with sequential posterior column compression. Anterior column support, avoidance of the morbidity of anterior approach and improvement of neurological deficit are the other advantages of the single stage PVCR technique in patients with thoracic/thoracolumbar burst fractures.

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Functional Outcome of Thoracolumbar Burst Fractures Without Neurological Deficit

Journal of Orthopaedic Trauma ◽

10.1097/00005131-199611000-00006 ◽

1996 ◽

Vol 10 (8) ◽

pp. 541-544 ◽

Cited By ~ 114

Author(s):

W. J. Kraemer ◽

E. H. Schemitsch ◽

J. Lever ◽

R. J. McBroom ◽

M. D. McKee ◽

...

Keyword(s):

Functional Outcome ◽

Neurological Deficit ◽

Thoracolumbar Burst Fractures ◽

Burst Fractures

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Operative versus Nonoperative Treatment of Thoracolumbar Burst Fractures without Neurological Deficit: 15- to 20-Year Follow-up

The Spine Journal ◽

10.1016/j.spinee.2012.08.082 ◽

2012 ◽

Vol 12 (9) ◽

pp. S23

Author(s):

Kirkham B. Wood ◽

Christopher C. Harrod ◽

Amir A. Mehbod ◽

Glenn R. Buttermann

Keyword(s):

Neurological Deficit ◽

Nonoperative Treatment ◽

Thoracolumbar Burst Fractures ◽

Burst Fractures

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Single Screw-Rod Anterior Instrumentation for Thoracolumbar Burst Fractures with Incomplete Neurological Deficit

Journal of Orthopaedic Surgery ◽

10.1177/230949901302100119 ◽

2013 ◽

Vol 21 (1) ◽

pp. 71-76 ◽

Cited By ~ 7

Author(s):

Siddhartha Sharma ◽

Dara Singh ◽

Manjeet Singh ◽

Arvind Kohli ◽

Gurjit Singh ◽

...

Keyword(s):

Neurological Deficit ◽

Anterior Instrumentation ◽

Thoracolumbar Burst Fractures ◽

Single Screw ◽

Burst Fractures

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CT scan prediction of neurological deficit in thoracolumbar burst fractures

Journal of Bone and Joint Surgery - British Volume ◽

10.1302/0301-620x.74b5.1527112 ◽

1992 ◽

Vol 74-B (5) ◽

pp. 683-685 ◽

Cited By ~ 37

Author(s):

WP Fontijne ◽

LW de Klerk ◽

R Braakman ◽

T Stijnen ◽

HL Tanghe ◽

...

Keyword(s):

Ct Scan ◽

Neurological Deficit ◽

Thoracolumbar Burst Fractures ◽

Burst Fractures

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Lesión dural asociada a fracturas de charnela toracolumbar y lumbares con compromiso del muro posterior. Relación con las variables del sistema de clasificación AOSpine. [Thecal sac injury secondary to burst fractures of the thoracolumbar and lumbar spine, and its association with the AOSpine Classification System variables].

Revista de la Asociación Argentina de Ortopedia y Traumatología ◽

10.15417/issn.1852-7434.2019.84.3.926 ◽

2019 ◽

Vol 84 (3) ◽

pp. 216-223

Author(s):

Guillermo Alejandro Ricciardi ◽

Ignacio Gabriel Garfinkel ◽

Gabriel Genaro Carrioli ◽

Daniel Oscar Ricciardi

Keyword(s):

Vertebral Body ◽

Neurological Deficit ◽

Classification System ◽

Spinal Canal ◽

Body Wall ◽

Thoracolumbar Spine ◽

Cauda Equina ◽

Acute Angle ◽

Thoracolumbar Burst Fractures ◽

Burst Fractures

Introducción: Las lesiones del saco dural con atrapamiento de la cauda equina entre los fragmentos óseos pueden estar asociadas con fracturas toracolumbares.Objetivo: Realizar un análisis retrospectivo de las variables clínico-radiográficas y el sistema de clasificación AOSpine y la posibilidad de lesión dural asociada en una serie de fracturas toracolumbares por estallido, tratadas en nuestro Centro.Materiales y Métodos: Estudio retrospectivo, observacional de una serie de pacientes con fracturas toracolumbares con compromiso del muro posterior operados en nuestra institución, entre enero de 2012 y diciembre de 2017.Resultados: Se incluyeron 46 pacientes, 16 casos con lesión del saco dural asociada. Las variables porcentaje de ocupación del canal, distancia interpedicular, ángulo del fragmento retropulsado y déficit neurológico asociado mostraron diferencias estadísticamentesignificativas según la comparación en función de la presencia o ausencia de lesión dural (p = 0,046, p = 0,007, p = 0,046 y p = 0,004, respectivamente).Conclusiones: Según nuestros resultados, la lesión dural traumática podría ser contemplada en la planificación del tratamiento de fracturas toracolumbares ante fragmentos voluminosos del muro posterior con ángulo agudo, compromiso severo del canal raquídeo, distancia interpedicular elevada y daño neurológico asociado, tal como se propone en la bibliografía. AbstractIntroduction: Fractures of the thoracolumbar spine can trigger thecal sac injuries due to the impingement of the cauda equina between bone fragments.Objective: To carry out a retrospective analysis of clinical and radiological variables, the AOSpine Classification System and the possibility of secondary thecal sac injury in a series of thoracolumbar burst fractures treated at our center.Materials and Methods: A retrospective, observational study of a series of patients with thoracolumbar fractures with compromise of the posterior vertebral body wall, who underwent surgery at our center between January 2012 and December 2017.Results: Forty-six patients were included, 16 of which had secondary thecal sac injury. The differences in the variables—percentage of spinal canal involvement, interpedicular distance, angle of the retropulsed fragment, neurological deficit and type C fractures—were statistically significant according to the comparison made with the presence or absence of thecal sac injury (p=0.046, p=0.007, p=0.046, p=0.004, p=0,001 respectively).Conclusions: This study suggests that traumatic thecal sac injury could be suspectedwhen managing burst fractures with prominent fragments in the posterior vertebral body wall, acute angle of the retropulsed fragment, severe compression of the spinal canal, wide interpedicular distance, neurological deficit and fracture displacement (fracturetype C according to the AOSpine Classification System).

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