title: Posterolateral approach in the treatment of unstable vertebral body fractures of the thoracic-lumbar junction with incomplete spinal cord injury in the paediatric age group.
abstract: OBJECTIVE
  Our retrospective study was carried out to demonstrate the value of, indications for, and results of use of the posterolateral approach (PLA) with decompression and instrumental stabilisation in paediatric patients with unstable vertebral body fractures at the thoracic-lumbar junction.
  
  
  METHODS
  Fourteen patients aged 7-14 years were operated on from 1990 to 2000. All these patients were admitted with unstable vertebral body fractures at the thoracic-lumbar junction with incomplete spinal injuries and were operated on within 24 h after sustaining the trauma: a PLA was used to achieve unilateral or bilateral spinal canal decompression and instrumental stabilisation with the Cotrel-Dubousset instrumentation.
  
  
  RESULTS
  A good neurological recovery was noted in 13 patients (4/13 Frankel D and 9/13 Frankel E) during 1 year of follow-up. The postoperative anterior-posterior diameter of the spinal canal was evaluated by percentile referred to an average value between the measurements at the superior and inferior levels. The radiographic control estimated the vertebral alignment. An important tendency to hyperkyphosis in 1 patient necessitated surgical correction after 1 month in the interests of a good vertebral alignment.
  
  
  CONCLUSIONS
  The PLA makes if possible to define a proper surgical corridor to accomplish all surgical goals in the treatment of spinal fractures in children: decompression, spinal alignment and stabilisation minimising the surgical stress, that are essential in paediatric surgery. It allows early mobilisation and an early start on the rehabilitative treatment, which is very important in children and is difficult to reconcile with bracing and a long period of bed rest as recommended for conservative treatment.
authors.affiliation: Department of Neurosurgery, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gambardella
authors.forename: Teodora Camelia
authors.initials: TC
authors.lastname: Coman
authors.forename: Claudio
authors.initials: C
authors.lastname: Zaccone
authors.forename: Marco
authors.initials: M
authors.lastname: Mannino
authors.forename: Alexandru Vlad
authors.initials: AV
authors.lastname: Ciurea
mesh_terms: D000293:Adolescent; D002648:Child; D019299:Decompression, Surgical; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D006801:Humans; D015601:Injury Severity Score; D008159:Lumbar Vertebrae / Q000293:injuries / Q000601:surgery*; D008297:Male; D020127:Recovery of Function; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods; D013904:Thoracic Vertebrae / Q000293:injuries / Q000601:surgery*; D016896:Treatment Outcome