[Results of treatment of acute injuries of the thoracolumbar spine by ridged plates.].
The authors evaluate the results of surgery of fresh injuries of the thoracolumbar spine achieved by transpedicular fixation, using ridged plates. At the orthopaedic clinic in Brno-Bohunice this technique was systematically introduced in 1989; in 1991 they started to use a better principle of stabilization by an internal fixation device. The authors used plates fixed in a transpedicular way in 58 injured subjects. Most frequently fractures of L1, T12 and L2 were involved, usually of a burst type. In more than half the patients they recorded a nervous deficit of varying degree. They stabilized usually typically four mobile segments and fused two internal ones. In 44 patients manual realignment before operation and during its course were used. After reduction of the vertebral body by reposition of the adjacent surfaces they added spongioplasty. In 3/4 they decompressed nervous structures. In more than 1/3 they supplemented the operation by intersomatic fusion. Stabilization was enhanced by translaminar fusion of intervertebral joints. The results of treatment were evaluated in 54 patients; 38 patients were checked for more than two years after operation. A positive neurological finding after operation did not change in 15 patients, in 13 it improved and in one it deteriorated. In 1/4 the screws cracked, usually caudal ones, in two operated patients a pseudoarthrosis was repaired. In 38 patients checked for a minimum period of 2 years after operation two are confined to a wheelchair, two walk with two French crutches, three with one, 31 without support. Impaired voiding is reported by 18 patients, impaired sexual function by four. Sixteen patients resumed their original occupation, 22 operated patients have invalid pensions. Transpedicular fixation by means of plates contributed significantly to the improvement of comprehensive care of deformities, injuries and spinal injuries. It proved useful not only in the treatment of fresh injuries but also in the treatment of their sequelae and the necessity to 1 LQ / ACTA CHIRURGIAE ORTHOPAEDICAE I DO / ET TRAUMATOLOGIAE CECHOSL., 59. 1992, CS PUVODNI PRACE achieve stabilization in other diseases, e. g. tumours or olisthesis. However, with regard to the mentioned disadvantages the authors abondoned this technique in 1991 and started to use the principles of stabilization of the spine by internal fixation devices. Key words: injuries of the thoracolumbar spine, transpedicular stabilization, surgical technique.
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Ortopedická klinika FNsP, Brno-Bohunice.
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