title: Early posterior spinal canal decompression and circumferential reconstruction of rotationally unstable thoracolumbar burst fractures with neurological deficit.
abstract: BACKGROUND
  Among the various treatments of neurologically involved unstable thoracolumbar burst fractures, the combination of anterior and posterior instrumentation provides the most stable reconstruction. However, the use of both approaches on a trauma patient may increase the morbidity. This study is a retrospective matched cohort study to evaluate the advantages of a single stage posterior approach for spinal canal decompression in combination with circumferential reconstruction by comparing the clinical and radiographic results.
  
  
  METHODS
  From March 2005 to September 2009, patients with matched type spinal fracture, ages at surgery, and involved levels in our institute underwent either a single stage posterior approach (group one, n = 12) or traditional combined approach (group two, n = 14) for spinal canal decompression and circumferential reconstruction were reviewed. Pre- and post-operative X-ray flms were reviewed and changes in Cobb angle of thoracolumbar spine were documented. Intra-operative, post-operative, and general complications were registered.
  
  
  RESULTS
  The mean follow-up was (27.7 ± 9.6) months (range, 14 to 56 months) in group one and (29.2 ± 7.4) months (range, 20 to 60 months) in group two (P > 0.05). The mean operation time was 214 minutes (range, 186 ± 327 minutes) in group one and 284 minutes (range, 219 ± 423 minutes) in group two (P < 0.05). The average volume of intraoperative blood loss was 1856 ml (range, 1250 ± 3480 ml) in group one and 2453 ml (range, 1600 ± 3680 ml) in group two (P < 0.05). There was no statistical difference between the groups one and two in average vertebral body height loss at the injured level and the average Cobb angle in sagittal plane before and immediately after surgery. Postoperatively, there was an epidural hematoma in one patient in group one and two patients in group two. Bony union after stabilization was obtained in all patients, without loosening or breakage of screws. Loss of correction (5°) was seen in 1 patient in group one at the 6th month owing to the subsidence of the Titanium mesh cages into the vertebra. In group two, totally four patients suffered respiratory-related complication, including pneumonia in two, severe atelectasis in one and pleural effusions in one. Importantly, there were no intraoperative or postoperative deaths in any group. All patients with incomplete neurologic deficits improved at least 1 Frankel grade.
  
  
  CONCLUSIONS
  Single-stage posterior vertebra resection in combination with circumferential reconstruction is a new option to manage severe thoracolumbar burst fractures.
authors.affiliation: Department of Orthopaedics, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
authors.forename: Guo-Quan
authors.initials: GQ
authors.lastname: Zheng
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.forename: Pei-Fu
authors.initials: PF
authors.lastname: Tang
authors.forename: Yong-Gang
authors.initials: YG
authors.lastname: Zhang
authors.forename: Xue-Song
authors.initials: XS
authors.lastname: Zhang
authors.forename: Yi-Zhu
authors.initials: YZ
authors.lastname: Guo
authors.forename: Sheng
authors.initials: S
authors.lastname: Tao
mesh_terms: D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries* / Q000601:surgery; D061646:Operative Time; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012399:Rotation; D013115:Spinal Canal / Q000601:surgery*; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000293:injuries* / Q000601:surgery