POSTERIOR SHOURT-SEGMENT PEDICLE INSTRUMENTATION WITHOUT FUSION FOR THORACOLUMBAR BURST FRACTURE

Abstract

The treatment for thoracolumbar burst fractures is controversial. The aim of surgical treatment is promoting neurological recovery by decompression of spinal canal and nerve roots and Obtaining rigid fixation.
Methods: A consecutive series of 30 patients with thoracolumbar burst fractures were treated by posterior short segment pedicle screw fixation between January 2009 and June 2015. Five patients were lost during follow up and all the remaining 25 patients were followed up for a minimum of three years (average 42.24 months). All the patients were treated with short-segment pedicle instrumentation and laminectomy without fusion, and the restoration of retropulsed bone fragments. The mean operation time and blood loss during surgery were analyzed; the Regional Kyphotic Angle and neurological status were compared before and after the operation.
Results: The mean fracture kyphosis was 35.84° at the time of admission and 2.04° post-operative and 5.24° at the final follow-up evaluation. The mean operation time was 97.4 min (range: 70–120 min) and the mean intraoperative blood loss was 385.6 mL in all cases. No intraoperative or immediate postoperative complications were noted. The post-operative radiographs demonstrated a good fracture reduction. Neurological recovery of one to three Frankel grade was seen in six patients with partial neurological deficit, three grades of improvement was seen in one patient, two grades of improvement was observed in six patients and one grade of improvement was found in four patients. All eight patients with no paraplegia on admission remained neurological intact, and in two patients with Frankel D.
Conclusions: This technique allows for satisfactory canal clearance and restoration of vertebral body height and kyphotic angle, and despite the loss of kyphosis correction in the last follow up visit, clinical pain and disability improved at long-term follow-up.
Keywords :Instrumentation-Thoracolumbar-Treatment-Burst Fracture.