Three-column reconstruction through single posterior approach for the treatment of unstable thoracolumbar fracture.
METHODS
A prospective study was performed.


OBJECTIVE
To assess a technique, three-column reconstruction through single posterior (TRSP) approach, in treatment of highly unstable thoracolumbar fracture.


BACKGROUND
The goal of surgical intervention for treatment of unstable thoracolumbar fractures is to decompress the neural elements, restore vertebral body height, correct angular deformity, and stabilize the columns of the spine. Operative approaches remain disputed. Common opinions include short-segment posterior fixation, multiple-segment posterior fixation, stand-alone anterior approach fixation, and combined anterior-posterior approach. Each technique has its advantages and disadvantages.


METHODS
A consecutive series of 37 thoracolumbar fractures with load sharing scores > or =6 were managed with TRSP between May 2004 and September 2006. All patients were observed up for a minimum of 2 years. Demographic data, neurologic status, segmental kyphosis, segmental height, the fracture severity score, Visual Analogue Scale, and treatment-related complications were evaluated.


RESULTS
The mean operative time was 157 minutes (range, 120-240). The mean blood loss was 1086 mL (range, 700-3100). Averagely Frankel score improved from 3.46 to 4.46; kyphotic angulation improved from 25.75 degrees before surgery to 4.49 degrees at last follow-up, and the loss of segmental height improved from a mean of 35.22% before surgery to 7.01% at the time of the last follow-up. The mean preoperative Visual Analogue Scale score was 7.92, and most patients had no complain of pain at last follow-up. No patient experienced worsening of neurologic deficits and other severe complications at last follow-up. One patient developed titanium mess cage subsidence, but revision was not necessary.


CONCLUSIONS
The technique of TRSP approach is safe, effective, and offers some advantages over the classic posterior, anterior, combined anterior-posterior approach for some specific highly unstable thoracolumbar fractures.
Haiyun
Yang
Y
Department of Spinal Surgery, Tianjin Hospital, Tianjin, People's Republic of China. yanghaiyun@hotmail.com
Rui
Gu
G
Shucai
Deng
D
Zhanhua
Jia
J
Xiaolin
Zhang
Z
Xin
Liu
L
Xue
Wang
W
Gongyi
Lv
L
Jiankun
Liu
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000209:etiology / Q000601:surgery; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D016268:Internal Fixators; D007738:Kyphosis / Q000209:etiology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000295:instrumentation / Q000379:methods; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods*; D012720:Severity of Illness Index; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult