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Medientyp:
E-Artikel
Titel:
Selection criteria and outcome of operative approaches for thoracolumbar burst fractures with and without neurological deficit
Beteiligte:
Schnee, Charles L.;
Ansell, Lee V.
Erschienen:
Journal of Neurosurgery Publishing Group (JNSPG), 1997
Erschienen in:Journal of Neurosurgery
Sprache:
Nicht zu entscheiden
DOI:
10.3171/jns.1997.86.1.0048
ISSN:
0022-3085
Entstehung:
Anmerkungen:
Beschreibung:
<jats:p content-type="fine-print">✓ Criteria for choosing operative techniques for the treatment of thoracolumbar burst fractures remain disputed, particularly in neurologically intact patients. A retrospective study of 25 patients with thoracolumbar burst fractures was performed to assess fracture characteristics, operative approaches, fixation, radiographic results, and neurological, functional, and pain outcomes.</jats:p><jats:p content-type="fine-print">Anterior corpectomy, allograft strut, and plate fixation were performed in 14 patients with or without neurological deficit when vertebral compression or canal encroachment was at least 40% or kyphosis was 15° or more with a stable posterior column. In nine cases, an anterior operation and a posterior segmental fixation were combined for similar deformity and three-column instability. Posterior transpedicular decompression, fixation, and fusion were used primarily for two symptomatic patients with less than 40% encroachment and at most 40% compression.</jats:p><jats:p content-type="fine-print">Overall, 21 patients (84%) were walking and 18 (72%) were continent at follow-up evaluation (mean 16.3 months) versus eight (32%) and 11 (44%) at presentation, respectively. Preoperatively, 17 patients experienced neurological deficit; 16 improved and 12 increased one Frankel grade. No patient deteriorated. Prior employment or activity level was resumed by 19 patients (76%) and only four patients professed incapacity. Pain was eliminated after 18 procedures (72%), all anterior or combined approaches. Restoration of anatomical alignment (< 5°) was achieved in 19 cases. No anterior construct failed and only one patient treated posteriorly had postoperative kyphosis progression. Operative morbidity occurred in three cases (12%).</jats:p><jats:p content-type="fine-print">Satisfactory neurological and functional outcomes were achieved in a majority of patients with thoracolumbar burst fractures after correction of canal compromise, middle column compression, and attendant deformity. These results indicate that anterior decompression and a weight-bearing strut graft are critical to clinical success in patients with significant vertebral destruction.</jats:p>