title: Bilateral transpedicular decompression and Harrington rod stabilization in the management of severe thoracolumbar burst fractures.
abstract: Fifty-eight patients with severe thoracolumbar burst fractures were treated with bilateral transpedicular decompression, Harrington rod instrumentation, and spine fusion. Spinal realignment and stabilization was achieved by contoured dual Harrington distraction rods supplemented by segmental sublaminal wiring. Posterior element fractures were noted in 25 patients, 9 of whom had associated dural tears. Computed tomography was performed to assess the cross-sectional area of the spinal canal before surgery and after decompression. Patients at initial evaluation averaged greater than 67% spinal canal compromise. After surgery, successful decompression was accomplished in 57 patients. One patient required staged, anterior thoracoabdominal decompression and fibula strut grafting. At follow-up (average, 43 months; range, 25-70 months), neurologic improvement was found in 77% of the patients who initially presented with neurologic deficits. Thirty-four of 40 patients with incomplete paraplegia improved one or more subgroups on the Frankel scale. A solid fusion was attained in all 58 patients. No patient had a significant residual kyphotic deformity. Single-stage bilateral transpedicular decompression and dual Harrington rod instrumentation reliably provides decompression of the spinal canal and restores spinal alignment. The procedure allows early mobilization and provides an environment for solid fusion and maximum neurologic return.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: W T
authors.initials: WT
authors.lastname: Hardaker
authors.forename: W A
authors.initials: WA
authors.lastname: Cook
authors.forename: A H
authors.initials: AH
authors.lastname: Friedman
authors.forename: R D
authors.initials: RD
authors.lastname: Fitch
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D006801:Humans; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000293:injuries*; D008297:Male; D010264:Paraplegia / Q000209:etiology; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D013123:Spinal Fusion; D013130:Spinal Stenosis / Q000209:etiology; D013904:Thoracic Vertebrae / Q000293:injuries*; D013997:Time Factors; D014057:Tomography, X-Ray Computed