Abstract
Background: Fracture-dislocations of the thoracic and lumbar spine are uncommon and highly unstable injuries, and the ideal management for patients with thoracic and lumbar spine fracture-dislocations is challenging. This study was designed to evaluate the clinical and radiographic results following posterolateral decompression, distractive reduction and reconstructive stabilization for patients with severe thoracic and lumbar spine fracture-dislocations.Methods: Twenty-three patients with thoracic and lumbar spine fracture-dislocations underwent this procedure. Demographic data, radiographic results, neurologic function, clinical functions and treatment-related complications were prospectively evaluated. Results: The average preoperative sagittal and coronal displacement was 31.9% and 6.7%, significantly improved to 6.4% and 2.1% after surgery, respectively. The final sagittal and coronal displacement was 5.3% and 1.5%. The average segmental kyphosis was 20.4° before surgery, markedly corrected to 4.7° immediately after surgery. The final sagittal kyphosis was 6.1°. Twelve patients with incomplete neurologic deficits had improvement by at least one ASIA grade neurologic improvement. The preoperative pain level showed a mean VAS score of 9.5 improved to 3.5 postoperatively, and to 1.2 at the final follow-up. Mean ODI preoperatively was 90.2%, and improved to 38.3% postoperatively, and to 24.9% at the final follow-up. No patient had persistent postoperative back pain. No obvious complications were observed in this series.Conclusions: Posterolateral decompression, distractive reduction and reconstructive stabilization is a reasonably safe and effective technique for thoracic and lumbar spine fracture-dislocations. This replicable procedure can result in satisfactory clinical and radiographic outcomes, with sufficiently circumferential decompression, excellent reduction, perfect spine alignment, solid instrumentation and sound fusion.
Pathology of spinal cord injuries due to fracture-dislocations of the thoracic and lumbar spine
