Modified posterior decompression for the management of thoracolumbar burst fractures with canal encroachment.
METHODS
A retrospective study.


OBJECTIVE
The purpose of this study is to explore the application of a self-designed canal decompressor in the posterior surgical treatment of thoracolumbar burst fractures with canal encroachment.


BACKGROUND
Surgical treatment is often indicated in the management of thoracolumbar burst fractures accompanied with canal encroachment. Efficient canal decompression would prevent progressive neurologic deterioration and facilitate recovery. Compared with anterior surgical methods, posterior approaches offer rigid fixation without formidable surgical onslaughts. However, the reduction of retropulsed bone fragments via posterior approaches is indirect and thus often inefficient.


METHODS
In this study, we designed and applied a canal decompressor in the surgical treatment of 48 cases of thoracolumbar burst fractures using posterior approaches. Canal comprise, Cobb's angles, residual vertebral body height, neurologic outcome, and back pain were evaluated preoperatively and postoperatively. Patients were followed for 18 to 28 months (mean 22.5 + or - 3.5 mo) on an outpatient basis.


RESULTS
Operations were performed within relatively short time and without significant blood loss. Radiographs indicated that applying the canal decompressor allowed efficient reduction of canal encroachment from preoperative 53.4% + or - 16.7% to postoperative 12.8 + or - 4.2%. Cobb's angles reduced from preoperative 31.0 + or - 2.5 degree to postoperative 5.1 + or - 0.6 degree. Mean vertebral height was restored to 82.5 + or - 5.7% after operations. Follow-up evaluation within 28 months indicated that neurologic recovery presented in 77.1% of patients, with average improvement of 0.86 Frankel grades. Neurologic deterioration was not observed.


CONCLUSIONS
Applying the canal decompressor enables efficient and safe reduction of bone fragments retropulsing into the canal in posterior operations. This technique thus provides an alternative method for the management of thoracolumbar burst fractures.
Kong
Weiqing
W
Department of Spine Surgery, Shanghai No. 6 People's Hospital, Shanghai Jiaotong University, Shanghai, PR China.
Sun
Yirui
Y
Hu
Jin
J
Xu
Jianguang
J
D000328:Adult; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods*; D005260:Female; D018460:Fractures, Comminuted / Q000150:complications / Q000601:surgery*; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D011859:Radiography; D013115:Spinal Canal / Q000000981:diagnostic imaging / Q000601:surgery*; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery*; D016103:Spinal Fractures / Q000150:complications / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult