The significance of removing ruptured intervertebral discs for interbody fusion in treating thoracic or lumbar type B and C spinal injuries through a one-stage posterior approach.
OBJECTIVE
To identify the negative effect on treatment results of reserving damaged intervertebral discs when treating type B and type C spinal fracture-dislocations through a one-stage posterior approach.


METHODS
This is a retrospective review of 53 consecutive patients who were treated in our spine surgery center from January 2005 to May 2012 due to severe thoracolumbar spinal fracture-dislocation. The patients in Group A (24 patients) underwent long-segment instrumentation laminectomy with pedicle screw-rod fixators for neural decompression. In Group B (29 patients), the patients underwent long-segment instrumentation laminectomy with pedicle screw-rod fixators for neural decompression evacuating of the ruptured disc and inserting of a bone graft into the evacuated disc space for interbody fusion. The mean time between injury and operation was 4.1 days (range 2-15 days). The clinical, radiologic and complication outcomes were analyzed retrospectively.


RESULTS
Periodic follow-ups were carried out until an affirmative union or treatment failure took place. A progressive kyphosis angle larger than 10°, loss of disc height, pseudoarthrosis, recurrence of dislocation or subluxation, or instrument failure before fusion were considered treatment failures. Treatment failures were detected in 13 cases in Group A (failure rate was 54.2%). In Group B, there were 28 cases in which definitive bone fusion was demonstrated on CT scans, and CT scans of the other cases demonstrated undefined pseudoarthrosis without hardware failure. There were statistically significant differences between the two groups (p<0.001 chi-square test). The neurologic recoveries, assessed by the ASIA scoring system, were not satisfactory for the neural deficit patients in either group, indicating there was no significant difference with regard to neurologic recovery between the two groups (p>0.05 Fisher's exact test).


CONCLUSIONS
Intervertebral disc damage is a common characteristic in type B and C spinal fracture-dislocation injuries. The damaged intervertebral disc should be removed and substituted with a bone graft because reserving the damaged disc in situ increases the risk of treatment failure.
Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, P. R. China.
Qian-Shi
QS
Zhang
Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, P. R. China.
Guo-Hua
GH
Lü
Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, P. R. China.
Xiao-Bin
XB
Wang
Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, P. R. China.
Jing
J
Li
D000328:Adult; D016025:Bone Transplantation / Q000379:methods; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D007403:Intervertebral Disc / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000601:surgery / Q000628:therapy; D004204:Joint Dislocations / Q000601:surgery / Q000628:therapy; D008159:Lumbar Vertebrae / Q000601:surgery*; D008161:Lumbosacral Region / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000601:surgery* / Q000628:therapy*; D013123:Spinal Fusion / Q000379:methods; D013124:Spinal Injuries / Q000601:surgery* / Q000628:therapy*; D013904:Thoracic Vertebrae / Q000601:surgery*; D055815:Young Adult