Unstable fractures of the thoracic and lumbar spine: the audit of an 8-year series with early reduction using Harrington instrumentation.
A series of 112 patients with acute unstable fractures of the thoracic or lumbar spine managed uniformly by early reduction using Harrington's instrumentation was analysed. The level of injury was T6-T11 in 19, T12-L1 in 67 and L2-L5 in 26 patients. On admission, 28 patients had complete paraplegia corresponding to the level of the lesion, 55 had partial lesions and 29 no neural damage. The policy of management comprised reduction by dual distraction rods and simultaneous short posterolateral fusion as an emergency procedure. Anterior decompression of the spinal canal, if required, was performed subsequently. The duration of the postoperative period in bed was 6 weeks. The rods were removed after 9-12 months. The radiographical result and neurological recovery were assessed after an average personal follow-up for 3.1 years. The height of the fractured vertebra was initially well restored, the mean angle of kyphosis being 14 degrees on admission and 5 degrees immediately postoperatively. However, gradually the fractured vertebral body and the intervertebral discs collapsed slightly and at follow-up the mean angle of kyphosis was 12 degrees. On the other hand, the reduction of the initial sagittal displacement of the fractured vertebral body into the spinal canal, could be maintained and a good anatomical end-result was achieved in most cases. The ultimate radiographical results were better after injuries of the thoracic spine and the thoracolumbar junction than after those of the lumbar spine. Improvement of neural function was seen in 28 patients (34 per cent of those with a deficit). Complications of clinical importance occurred in 29 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007738:Kyphosis / Q000150:complications; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications; D011859:Radiography; D013117:Spinal Cord Compression / Q000150:complications / Q000628:therapy; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*