title: Anterior D-rod and titanium mesh fixation for acute mid-lumbar burst fracture with incomplete neurologic deficits: A prospective study of 56 consecutive patients.
abstract: BACKGROUND
  Anterior decompression and reconstruction have gained wide acceptance as viable alternatives for unstable mid-lumbar burst fracture, but there are no mid and long term prospective studies regarding clinical and radiologic results of mid-lumbar burst fractures.
  
  
  METHODS
  An Institutional Review Board-approved prospective study of 56 consecutive patients of mid-lumbar burst fractures with a load-sharing score of 7 or more treated with anterior plating was carried out. All patients were evaluated for radiologic and clinical outcomes. The fusion status, spinal canal compromise, segmental kyphotic angle (SKA), vertebral body height loss (VBHL), and adjacent segment degeneration was examined for radiologic outcome, whereas the American Spinal Injury Association scale, the visual analog scale (VAS), and the employment status were used for clinical evaluation.
  
  
  RESULTS
  The patients underwent clinical and radiologic followup for at least 5 years after the surgery. At the last followup, there was no case of internal fixation failure, adjacent segment degeneration, and other complications. Interbody fusion was achieved in all cases. The average fusion time was 4.5 months. No patient suffered neurological deterioration and the average neurologic recovery was 1.3 grades on final observation. Based on VAS pain scores, canal compromise, percentage of VBHL and SKA, the difference was statistically significant between the preoperative period and postoperative or final followup (P < 0.05). Results at postoperative and final followup were better than the preoperative period. However, the difference was not significant between postoperative and final followup (P > 0.05). Thirty-four patients who were employed before the injury returned to work after the operation, 15 had changed to less strenuous work.
  
  
  CONCLUSIONS
  Good mid term clinicoradiological results of anterior decompression with D-rod and titanium mesh fixation for suitable patients with mid-lumbar burst fractures with incomplete neurologic deficits can be achieved. The incident rate of complications was low. D-rod is a reliable implant and has some potential advantages in L4 vertebral fractures.
authors.affiliation: Department of Orthopaedics, The 174 Hospital of PLA, Spinal Orthopaedics Center of PLA, Chenggong Hospital of Xiamen University, Xiamen Fujian Province, China.
authors.forename: Zhe-Yuan
authors.initials: ZY
authors.lastname: Huang
authors.affiliation: Department of Orthopaedics, The 175 Hospital of PLA, Traumatic Orthopaedics Center of PLA, Southeast Hospital of Xiamen University, Zhangzhou Fujian Province, China.
authors.forename: Zhen-Qi
authors.initials: ZQ
authors.lastname: Ding
authors.affiliation: Department of Orthopaedics, The 174 Hospital of PLA, Spinal Orthopaedics Center of PLA, Chenggong Hospital of Xiamen University, Xiamen Fujian Province, China.
authors.forename: Hao-Yuan
authors.initials: HY
authors.lastname: Liu
authors.affiliation: Department of Orthopaedics, The 180 Hospital of PLA, Spinal Orthopaedics Center of PLA, Quanzhou Fujian Province, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Fang
authors.affiliation: Department of Orthopaedics, The 175 Hospital of PLA, Traumatic Orthopaedics Center of PLA, Southeast Hospital of Xiamen University, Zhangzhou Fujian Province, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Orthopaedics, The 175 Hospital of PLA, Traumatic Orthopaedics Center of PLA, Southeast Hospital of Xiamen University, Zhangzhou Fujian Province, China.
authors.forename: Mo
authors.initials: M
authors.lastname: Sha
keywords: Anterior lumbar fusion; Lumbar vertebrae; fracture fixation; internal fixation; lumbar burst fractures; mesh cage; neurologic deficit; neurologic deficits; spinal cord compression