Anterior single segmental decompression and fixation for Denis B type thoracolumbar burst fracture with neurological deficiency: thirty-four cases with average twenty-six month follow-up.
METHODS
A series study of neurologically deficient patients with Denis B type thoracolumbar burst fractures treated with anterior single segmental decompression and fixation (ASSDF).


OBJECTIVE
To describe a surgical technique of ASSDF and its clinical outcome in a group of neurologically deficient patients with Denis B type thoracolumbar burst fractures.


BACKGROUND
The optimal treatment for thoracolumbar burst fractures is still controversial.


METHODS
The canals of selected patients were fully decompressed with partial dissection on fractured vertebral body. Single segmental fusion was achieved with grafting and fixation. Clinical evaluation (including Frankel scales and visual analogue scale) and radiologic assessments (including the measurements of the kyphosis Cobb angle, adjacent superior, inferior intervertebral disc height, and vertebral canal sagittal diameter on radiograph film and computer tomography scans) were performed before the operation and at 3-day, 6-month, 1-, 2-, and 3-year intervals after the operation.


RESULTS
Between June 2006 and May 2008, 37 patients with Denis B type thoracolumbar burst fractures were recruited for study. Thirty-four patients with successful ASSDF accomplished a 1-year follow-up. Average follow-up duration was 26 ± 9.2 months. The average operation time and blood loss were 173 ± 26 minutes and 445.6 ± 164.4 mL, respectively. Average Frankel scales were significantly improved at the end of follow-up. visual analogue scale decreased from 7.2 ± 0.8 before operation to less than 1.7 ± 0.7 (P < 0.05) 6 months later. The vertebral canal sagittal diameter was enlarged from an average of 5.9 ± 1.2 mm to 16.2 ± 1.0 mm (P < 0.01). The canal stenosis index also improved, from 36.0% to 99.1%. Kyphosis was corrected from 21.5° ± 6.1° to 7.3° ± 3.2° (P < 0.05) and remained at 8.2° ± 3.6° (P > 0.05) 1 year later. Adjacent disc heights remained constant. No serious complications or fixation failures were observed during follow-up.


CONCLUSIONS
ASSDF provides a novel and effective surgical option for treating Denis B type fracture with neurologic deficiency.
Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
Rui
R
Shi
Hao
H
Liu
Xiaodan
X
Zhao
Xi
X
Liu
Quan
Q
Gong
Tao
T
Li
Limin
L
Liu
Jiancheng
J
Zeng
Yueming
Y
Song
D000328:Adult; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000150:complications; D016103:Spinal Fractures / Q000150:complications / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000293:injuries*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult