Operative treatment as a part of the comprehensive care for patients with injuries of the thoracolumbar spine. A review.
In a total appraisal, the advantages and drawbacks of operative decompression and stabilisation of the injured thoracolumbar spine should be evaluated in the treatment of a paraplegic patient and of a patient without neural damage. Operative treatment may be advantageous independent of its effect on the neural damage. Only a few studies allow direct comparison between operative and conservative treatment. Some studies are only of historical value. Today, a general operative policy is to use Harrington rods in the thoracic spine. For injuries caudal to the 9th thoracic vertebra and for those with injuries in the lumbar spine, internal fixators with transpedicular screws are used. Anterior decompression and stabilisation are also warranted in some cases. New implants are continuously being developed, e.g. implants which combine the advantages of hooks and pedicular screws. No study shows conclusively that operative treatment improves the neurological status compared with conservative care. Conservative and operative treatment may both have particular complications. It appears that neurological deterioration is more likely to occur after conservative treatment, while complications related to wound healing and from the implants burden the operative alternative. Mobilisation is quicker and easier after operative treatment, improving psychological and social rehabilitation. Also, these patients experience less in the way of chronic back pain. A high level of expertise is required for operative treatment and this illustrates the general need for the centralisation of the treatment of these relatively rare and severe injuries.
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Orthopaedic Department, Ullevaal Hospital, University of Oslo, Norway.
D006801:Humans; D013119:Spinal Cord Injuries / Q000534:rehabilitation / Q000601:surgery* / Q000628:therapy