Thoracolumbar fracture reduction by percutaneous in situ contouring.
OBJECTIVE
Percutaneous in situ contouring is based on bilateral bending of rods on the spine, thus increasing lordosis at the fracture. It was analyzed if this technique would provide a better reduction than prone positioning and how sagittal alignment would behave.


METHODS
Twenty-nine patients were operated using in situ contouring and selective anterior fusion for non-neurologic A2, A3 or B2 fractures. Clinical results were assessed prospectively using visual analog scale (VAS) and Oswestry Disability Index (ODI). The radiographic deformity correction was measured by sagittal index and regional kyphosis. Sagittal balance was assessed using kyphosis, lordosis, T9 tilt, pelvic incidence, pelvic tilt and sacral slope. Posterior wall fragment reduction was evaluated by computed tomography.


RESULTS
After 2 years, VAS and ODI were comparable to the status prior to the accident. The sagittal index was 19.7° preoperatively, 5.3° after prone positioning and -1.1° after in situ contouring (p < 0.001). The loss of correction was 2.4°, mainly during the first 3 months. Similar observations were made for regional kyphosis. The sagittal spino-pelvic alignment was stable postoperatively. A preoperative canal obstruction ≥50 % was observed in 16 patients, and the fragments migrated anteriorly in all patients.


CONCLUSIONS
Percutaneous instrumentation and anterior fusion provides good clinical results. In situ contouring increases lordosis obtained by prone positioning. Anterior column lengthening and ligamentotaxis reduce posterior wall fragments, which decompress the canal without laminectomy. The fusion of anterior defects prevents the loss of correction and provides a stable sagittal profile. The instrumentation may be removed without damaging the paravertebral muscles and loss of correction.
Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, 1, Place de l'Hôpital, B.P. 426, 67091, Strasbourg Cedex, France. yann.philippe.charles@chru-strasbourg.fr
Yann Philippe
YP
Charles
Axel
A
Walter
Sébastien
S
Schuller
Dakheel
D
Aldakheel
Jean-Paul
JP
Steib
D000293:Adolescent; D000328:Adult; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D016103:Spinal Fractures / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013904:Thoracic Vertebrae; D016896:Treatment Outcome; D055815:Young Adult