Anterior Z-plate and titanic mesh fixation for acute burst thoracolumbar fracture.
METHODS
A retrospective study.


OBJECTIVE
To evaluate the clinical outcome, effectiveness, and security of the surgical management of acute thoracolumbar burst fracture with corpectomy, titanic mesh autograft, and Z-plate fixation by anterior approach.


BACKGROUND
Many surgical methods were adopted to treat acute burst thoracolumbar fracture. But the optimal surgical management remains controversial.


METHODS
A retrospective review of a consecutive series of 48 patients with thoracolumbar burst fracture treated with anterior corpectomy, titanic mesh autograft, and Z-plate internal fixation was carried out. Preoperative clinical and radiographic data of all cases were originally collected. Surgical indications were motor neurologic deficit and thoracolumbar column instability. Twenty-two patients (45.8%) with acute thoracolumbar burst fractures presented with a neurologic deficit. The postoperative recovery of neural function, restoration of anterior cortex collapse, kyphotic angle, and spinal canal compromise were observed.


RESULTS
The preoperative kyphotic angle was improved to a mean of 5.6°, radiographic height restored to 95.8% of the adjacent normal levels, and canal compromise was 0%. None of the patients had neurologic deterioration. Mean follow-up time was 32.4 months (range, 24-47 months). All 22 patients with neurologic deficit demonstrated at least one Frankel grade improvement on final observation, with 16 (73%) patients had accomplished complete neurologic recovery. Forty-six (96%) patients reported minimal or no pain at final follow-up observation, and 40 (83%) patients who had been working before injury returned to original work.


CONCLUSIONS
The authors considered spinal cord decompression with anterior corpectomy and stability reconstruction with titanic mesh autograft and Z-plate fixation at same time in one incision as an effective technique for unstable thoracolumbar burst fracture with and without neurologic deficit.
Department of Orthopedics, Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China. jianguangxu2004@yahoo.com.cn
Jian-Guang
JG
Xu
Bing-Fang
BF
Zeng
Wei
W
Zhou
Wei-Qing
WQ
Kong
Yi-Shan
YS
Fu
Bi-Zeng
BZ
Zhao
Tao
T
Zhang
Xiao-Feng
XF
Lian
D000208:Acute Disease; D000328:Adult; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D014025:Titanium; D055815:Young Adult
D014025:Titanium