ANTEROLATERAL DECOMPRESSION AND THREE COLUMN RECONSTRUCTION THROUGH POSTERIOR APPROACH FOR TREATMENT OF UNSTABLE THORACOLUMBAR FRACTURE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Zuozhong , KE Zhenyong , CHEN Liang , YAN Zhengjian , CHEN Fu , DENG Zhongliang.

Department of Orthopedic Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P.R.China. Corresponding author: LIU Zuozhong, E-mail: liuzuozhong2006@163.com;;
KE Zhenyong, E-mail: kzy6417@163.com;

Corresponding author：

Keywords：

Unstable thoracolumbar fracture; Posterior approach; Spinal decompression; Spinal reconstruction

DOI：

10.7507/1002-1892.20130181

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Objective To discuss the effectiveness of anterolateral decompression and three column reconstruction through posterior approach for the treatment of unstable thoracolumbar fracture. Methods Between March 2009 and October 2011, 39 patients with unstable burst thoracolumbar fracture were treated. Of them, there were 32 males and 7 females, with an average age of 43.8 years (range, 25-68 years). The injury causes included falling from height in 17 cases, bruise in 10 cases, traffic accident in 4 cases, and other in 8 cases. The fracture was located at the T10 level in 1 case, T11 in 9 cases, T12 in 6 cases, L1 in 14 cases, L2 in 7 cases, L3 in 1 case, and L4 in 1 case. According to Frankel classification before operation, 5 cases were classified as grade A, 5 as grade B, 9 as grade C, 14 as grade D, and 6 as grade E. Before operation, the vertebral kyphosis Cobb angle was (26.7 ± 7.1)°; vertebral height loss was 37.5% ± 9.5%; and the space occupying of vertebral canal was 73.7% ± 11.3%. The time between injury and operation was 1-4 days (mean, 2.5 days). All patients underwent anterolateral decompression of spinal canal by posterior approach and three column reconstruction. After operation, the vertebral height restoration, correction of kyphosis, decompression of the spinal canal, and the recovery of nerve function were evaluated. Results Increase of paraplegic level, urinary infection, and pressure sore occurred in 1 case, 1 case, and 2 cases, respectively; no incision infection or neurological complications was observed in the other cases, primary healing of incision was obtained. The patients were followed up 12-36 months (mean, 27 months). The patients had no aggravation of pain of low back after operation; no loosening and breaking of screws and rods occurred; no titanium alloys electrolysis and titanium cage subsidence or breakage was observed. The imaging examination showed that complete decompression of the spinal canal, satisfactory restoration of the vertebral height, and good physiological curvature of spine at 2 years after operation. At last follow-up, 1 case was classified as Frankel grade A, 2 as grade B, 2 as grade C, 10 as grade D, and 24 as grade E, which was significantly improved when compared with preoperative one (P lt; 0.05). At immediate after operation and last follow-up, the Cobb angle was (6.3 ± 2.1)° and (6.5 ± 2.4)° respectively; the vertebral height loss was 7.9% ± 2.7% and 8.2% ± 3.0% respectively; and the indexes were significantly improved when compared with preoperative ones (P lt; 0.05). Conclusion The technique of anterolateral decompression and three column reconstruction through posterior approach is one perfect approach to treat unstable thoracolumbar fracture because of complete spinal cord canal decompression, three column reconstruction, and immediate recovery of the spinal stability after operation.

Citation： LIU Zuozhong,KE Zhenyong,CHEN Liang,YAN Zhengjian,CHEN Fu,DENG Zhongliang.. ANTEROLATERAL DECOMPRESSION AND THREE COLUMN RECONSTRUCTION THROUGH POSTERIOR APPROACH FOR TREATMENT OF UNSTABLE THORACOLUMBAR FRACTURE. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(7): 824-828. doi: 10.7507/1002-1892.20130181 Copy

1.	Korovessis P, Baikousis A, Zacharatos S, et al. Combined anterior plus posterior stabilization versus posterior short-segment instrumentation and fusion for mid-lumbar (L2-L4) burst fractures. Spine (Phila Pa 1976), 2006, 31(8): 859-868.
2.	Tezer M, Ertuer RE, Ozturk C, et al. Conservative treatment of fractures of the thoracolumbar spine. Int Orthop, 2005, 29(2): 78-82.
3.	McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine (Phila Pa 1976), 1994, 19(15): 1741-1744.
4.	Benson DR, Burkus JK, Montesano PX, et al. Unstable Thoracolumbar and lumbar burst fractures treated with the AO fixateur inerne. J Spinal Disord, 1992, 5(3): 335-343.
5.	Willen J, Anderson J, Toomoka K, et al. The natural history of burst fractures at the thoracolumbar junction. J Spinal Disord, 1990, 3(1): 39-46.
6.	Reid DC, Hu R, Davis LA, et al. The nonoperative treatment of burst fractures of thoracolumbar junction. J Trauma, 1988, 28(8): 1188-1194.
7.	Mcdonough PW, Davis R, Tribus C, et al. The management of acute thoracolumbar burst fractures with anterior corpectomy and Z-plate fixation. Spine (Phila Pa 1976), 2004, 29(17): 1901-1909.
8.	徐兆万, 隋国侠, 王炳武, 等. 有限减压相邻节段植骨内固定术治疗胸腰椎骨折. 中国矫形外科杂志, 2007, 15(2): 91-93.
9.	Wood K, Buttermann G, Mehbod A, et al. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomized study. J Bone Joint Surg (Am), 2003, 85-A(5): 773-781.
10.	袁文. 脊柱脊髓损伤诊治的历史、现状与展望. 中华创伤杂志, 2007, 23(9): 641-642.
11.	马维虎, 徐荣明, 冯建翔, 等. 经椎弓根植骨和椎体成形术治疗胸腰椎爆裂性骨折. 骨与关节损伤杂志, 2003, 18(8): 511-513.
12.	Wood KB, Bohn D, Mehbod A. Anterior versus posterior treatment of stable thoracolumbar burst fractures without neurologic deficit: a prospective, randomized study. J Spinal Disord Tech, 2005, 18 Suppl: S15-23.
13.	Heary RF, Salas S, Bono CM, et al. Complication avoidance: thoracolumbar and lumbar burst fractures. Neurosurg Clin N Am, 2006, 17(3): 377-388.
14.	侯力强, 李建军, 汪力平, 等. 后路椎管三方减压病椎植骨重建治疗胸腰椎爆裂性骨折. 浙江创伤外科杂志, 2010, 15(6): 782-783.
15.	Tomita K, Kawahara N, Murakami H, et al. Total en bloc spondylectomy for spinal tumors: improvement of the technique and its associated basic background. J Orthop Sci, 2006, 11(1): 3-12.
16.	Ayberk G, Ozveren MF, Altundal N, et al. Three column stabilization through posterior approach alone: transpedicular placement of distractable cage with transpedicular screw fixation. Neurol Med Chir (Tokyo), 2008, 48(1): 8-14.
17.	Sasani M, Ozer AF. Single-stage posterior corpectomy and expandable cage placement for treatment of thoracic or lumbar burst fractures. Spine (Phila Pa 1976), 2009, 34(1): E33-40.
18.	Haiyun Y, Rui G, Shucai D, et al. Three-column reconstruction through single posterior approach for treatment of unstable thoracolumbar fracture. Spine (Phila Pa 1976), 2010, 35(8): E295-302.
19.	Young W, Flamm ES. Effect of high-dose corticosteroid therapy on blood flow, evoked potentials, and extracellular calcium in experimental spinal injury. J Neurosurg, 1982, 57(5): 667-673.
20.	Mahar A, Kim C, Wedemeyer M, et al. Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Spine (Phila Pa 1976), 2007, 32(14): 1503-1507.
21.	Verlaan JJ, Diekerhof CH, Buskens E, et al. Surgical treatment of traumatic fractures of the thoracic and lumbar spine: a systematic review of the literature on techniques, complications, and outcome. Spine (Phila Pa1976), 2004, 29(7): 803-814.

1. Korovessis P, Baikousis A, Zacharatos S, et al. Combined anterior plus posterior stabilization versus posterior short-segment instrumentation and fusion for mid-lumbar (L2-L4) burst fractures. Spine (Phila Pa 1976), 2006, 31(8): 859-868.
2. Tezer M, Ertuer RE, Ozturk C, et al. Conservative treatment of fractures of the thoracolumbar spine. Int Orthop, 2005, 29(2): 78-82.
3. McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine (Phila Pa 1976), 1994, 19(15): 1741-1744.
4. Benson DR, Burkus JK, Montesano PX, et al. Unstable Thoracolumbar and lumbar burst fractures treated with the AO fixateur inerne. J Spinal Disord, 1992, 5(3): 335-343.
5. Willen J, Anderson J, Toomoka K, et al. The natural history of burst fractures at the thoracolumbar junction. J Spinal Disord, 1990, 3(1): 39-46.
6. Reid DC, Hu R, Davis LA, et al. The nonoperative treatment of burst fractures of thoracolumbar junction. J Trauma, 1988, 28(8): 1188-1194.
7. Mcdonough PW, Davis R, Tribus C, et al. The management of acute thoracolumbar burst fractures with anterior corpectomy and Z-plate fixation. Spine (Phila Pa 1976), 2004, 29(17): 1901-1909.
8. 徐兆万, 隋国侠, 王炳武, 等. 有限减压相邻节段植骨内固定术治疗胸腰椎骨折. 中国矫形外科杂志, 2007, 15(2): 91-93.
9. Wood K, Buttermann G, Mehbod A, et al. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomized study. J Bone Joint Surg (Am), 2003, 85-A(5): 773-781.
10. 袁文. 脊柱脊髓损伤诊治的历史、现状与展望. 中华创伤杂志, 2007, 23(9): 641-642.
11. 马维虎, 徐荣明, 冯建翔, 等. 经椎弓根植骨和椎体成形术治疗胸腰椎爆裂性骨折. 骨与关节损伤杂志, 2003, 18(8): 511-513.
12. Wood KB, Bohn D, Mehbod A. Anterior versus posterior treatment of stable thoracolumbar burst fractures without neurologic deficit: a prospective, randomized study. J Spinal Disord Tech, 2005, 18 Suppl: S15-23.
13. Heary RF, Salas S, Bono CM, et al. Complication avoidance: thoracolumbar and lumbar burst fractures. Neurosurg Clin N Am, 2006, 17(3): 377-388.
14. 侯力强, 李建军, 汪力平, 等. 后路椎管三方减压病椎植骨重建治疗胸腰椎爆裂性骨折. 浙江创伤外科杂志, 2010, 15(6): 782-783.
15. Tomita K, Kawahara N, Murakami H, et al. Total en bloc spondylectomy for spinal tumors: improvement of the technique and its associated basic background. J Orthop Sci, 2006, 11(1): 3-12.
16. Ayberk G, Ozveren MF, Altundal N, et al. Three column stabilization through posterior approach alone: transpedicular placement of distractable cage with transpedicular screw fixation. Neurol Med Chir (Tokyo), 2008, 48(1): 8-14.
17. Sasani M, Ozer AF. Single-stage posterior corpectomy and expandable cage placement for treatment of thoracic or lumbar burst fractures. Spine (Phila Pa 1976), 2009, 34(1): E33-40.
18. Haiyun Y, Rui G, Shucai D, et al. Three-column reconstruction through single posterior approach for treatment of unstable thoracolumbar fracture. Spine (Phila Pa 1976), 2010, 35(8): E295-302.
19. Young W, Flamm ES. Effect of high-dose corticosteroid therapy on blood flow, evoked potentials, and extracellular calcium in experimental spinal injury. J Neurosurg, 1982, 57(5): 667-673.
20. Mahar A, Kim C, Wedemeyer M, et al. Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Spine (Phila Pa 1976), 2007, 32(14): 1503-1507.
21. Verlaan JJ, Diekerhof CH, Buskens E, et al. Surgical treatment of traumatic fractures of the thoracic and lumbar spine: a systematic review of the literature on techniques, complications, and outcome. Spine (Phila Pa1976), 2004, 29(7): 803-814.

Chinese Journal of Reparative and Reconstructive Surgery

ANTEROLATERAL DECOMPRESSION AND THREE COLUMN RECONSTRUCTION THROUGH POSTERIOR APPROACH FOR TREATMENT OF UNSTABLE THORACOLUMBAR FRACTURE

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