SUBTOTAL CORPECTOMY AND INTERVERTEBRAL BONE GRAFTING THROUGH POSTERIOR APPROACHALONE IN TREATMENT OF THORACOLUMBAR BURST FRACTURE OR THORACOLUMBAR FRACTUREDISLOCATION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GAO Bo , XING Rong , KONG Qingquan , SONG Yueming , LIU Hao , LI Tao , GONG Quan , ZENG Jiancheng.

Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China.;

Corresponding author：

Keywords：

Thoracolumbar burst fracture, Posterior approach surgery, Subtotal corpectomy ,Intervertebral bone grafting

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Objective To evaluate the early cl inical outcomes of subtotal corpectomy and intervertebral bone
grafting through posterior approach alone in the treatment of thoracolumbar burst fracture or thoracolumbar fracturedislocation.
Methods Between January 2009 and December 2010, 20 patients with thoracolumbar burst fracture or
thoracolumbar fracture dislocation were treated with subtotal corpectomy and intervertebral bone grafting through posterior
approach alone. There were 14 males and 6 females, with an average age of 36.1 years (range, 19-47 years). Fractures were caused
by falling from height in 12 cases, traffic accident in 6 cases, and crushing in 2 cases. According to AO classification, there were
10 cases of A3 type, 8 cases of B2 type, and 2 cases of C2 type. Single segment was involved in 8 cases, double segments in 12
cases. Twelve cases complicated by fracture dislocation and 6 cases by lateral displacement. All patients had bones occupancy
in vertebral canal. The preoperative Cobb angle was (30.2 ± 3.9)°. According to Frankel classification for neurological function,
there were 4 cases of grade B, 9 cases of grade C, and 7 cases of grade D at preoperation. The mean time between injury and
operation was 4.5 days (range, 1-12 days). Results All incisions healed by first intention, and no infection occurred.
Twenty patients were followed up 8-16 months (mean, 12 months). The interbody fusion time was 6-9 months (mean, 7
months). Neurological function recovered 1 to 3 grades: 1 case of grade C, 2 cases of grade D, 17 cases of grade E at last followup.
The Cobb angle was (6.5 ± 4.2)° at last follow-up, showing significant difference when compared with preoperative value
(t=2.39, P=0.00). No breaking or loosening of screw and implant sinkage occurred. Conclusion A combination of subtotal
corpectomy and intervertebral bone grafting through posterior approach alone has the advantages of complete decompression,
restoration of spinal stabil ity, restoration of vertebral body height, high bone healing rate, and good recovery of neurological
function. However, this surgical technique has a relatively large amount of blood loss and high requirements for surgeons.

Citation： GAO Bo,XING Rong,KONG Qingquan,SONG Yueming,LIU Hao,LI Tao,GONG Quan,ZENG Jiancheng.. SUBTOTAL CORPECTOMY AND INTERVERTEBRAL BONE GRAFTING THROUGH POSTERIOR APPROACHALONE IN TREATMENT OF THORACOLUMBAR BURST FRACTURE OR THORACOLUMBAR FRACTUREDISLOCATION. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(5): 542-545. doi: Copy

1.	Holdsworth F. Fractures, dislocation and fracture-dislocation of the spine. J Bone Joint Surg (Am), 1970, 52(8): 1534-1551.
2.	欧云生, 蒋电明, 权正学, 等. 纳米羟基磷灰石/聚酰胺66复合生物活性人工椎体在胸腰椎骨折前路重建手术中的应用. 中国修复重建外科杂志, 2007, 21(10): 1084-1089.
3.	Kaneda K, Taneichi H, Abumi K, et al. Anterior decompression and stabilization with the kaneda device for thoracolumbar burst fractures associated with neurological deficits. J Bone Joint Surg (Am), 1997, 79(1): 69-83.
4.	Knop CK, Fabian HF, Bastian L, et al. Late results of thoracolumbar fractures after posterior instrumentation and transpedicular bone grafting. Spine (Phila Pa 1976), 26(1): 88-99.
5.	陈善明, 陈琦, 刘学军. 经椎弓根植骨钉棒固定治疗胸腰椎骨折. 中国修复重建外科杂志, 2010, 24(2): 245-246.
6.	Suk SI, Kim JH, Lee SM, et al. Anterior-posterior surgery versus posterior closing wedge osteotomy in posttraumatic kyphosis with neurologic compromised osteoporotic fracture. Spine (Phila Pa 1976), 28(18): 2170-2175.
7.	Aybery G, Ozverren 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.
8.	马毅, 邓树才, 刘建坤, 等. 经后路椎弓根钉内固定加钛网骨移植椎间融合治疗胸腰椎爆裂骨折. 中华创伤骨科杂志, 2009, 11(1): 22-25.
9.	李平元, 苏小桃, 欧军, 等. I期后路270°减压、钛网重建术治疗严重胸腰椎三柱骨折. 中华创伤杂志, 2009, 25(6): 532-534.
10.	林慰光, 林本丹, 胡奕山. 经后路椎体次全切除后钛网支撑置入加椎弓根钉内固定治疗腰椎爆裂性骨折的初步报告. 中华创伤骨科杂志, 2010, 12(5): 489-291.
11.	李建江, 马信龙, 邓树才, 等. 经后路椎体次全切除及重建治疗严重胸腰椎骨折. 中华骨科杂志, 2011, 31(7): 761-766.
12.	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.
13.	Gurr KR, McAfee PC, Ahih CM. Biomechanical analysis of anterior and posterior instrumentation systems after corpectomy. A calf-spine model. J Bone Joint Surg (Am), 1988, 70(8): 1182-1191.
14.	陈天剑, 丰干均, 乔俊, 等. 后路椎弓根固定加椎间植骨治疗胸腰椎爆裂骨折. 中华创伤杂志, 2009, 25(10): 890-893.
15.	Wang MY, Kim DH, Kim KA. Correction of late traumatic thoracic and thoracolumbar hypnotic spinal deformities using posteriorly placed intervertebral distraction cages. Neurourgery, 2008, 62(3 Suppl 1):.
16.	刘兰泽, 陈先, 卢占彬, 等. 椎弓根螺钉固定治疗胸腰椎骨折术后断钉断棒原因分析. 中国脊柱脊髓杂志, 2006, 16(8): 614-618.
17.	Shen WJ, Liu TJ, Shen YS. Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit. Spine (Phila Pa 1976), 2001, 26(9): 1038-1045.
18.	Hakalo J, Wroński J. Complications of a transpedicular stabilization of thoraco-lumbar burst fractures. Neurol Neurochir Pol, 2006, 40(2): 134-139.
19.	Vaccaro AR, Lim MR, Hurtbert RJ, et al. Surgical decision making for unstable thoracolumbar spine injuries: results of a consensus panel review by the Spine Trauma Study Group. J Spinal Diserd Tech, 2006, 19(1): 1-10.
20.	-172.

1. Holdsworth F. Fractures, dislocation and fracture-dislocation of the spine. J Bone Joint Surg (Am), 1970, 52(8): 1534-1551.
2. 欧云生, 蒋电明, 权正学, 等. 纳米羟基磷灰石/聚酰胺66复合生物活性人工椎体在胸腰椎骨折前路重建手术中的应用. 中国修复重建外科杂志, 2007, 21(10): 1084-1089.
3. Kaneda K, Taneichi H, Abumi K, et al. Anterior decompression and stabilization with the kaneda device for thoracolumbar burst fractures associated with neurological deficits. J Bone Joint Surg (Am), 1997, 79(1): 69-83.
4. Knop CK, Fabian HF, Bastian L, et al. Late results of thoracolumbar fractures after posterior instrumentation and transpedicular bone grafting. Spine (Phila Pa 1976), 26(1): 88-99.
5. 陈善明, 陈琦, 刘学军. 经椎弓根植骨钉棒固定治疗胸腰椎骨折. 中国修复重建外科杂志, 2010, 24(2): 245-246.
6. Suk SI, Kim JH, Lee SM, et al. Anterior-posterior surgery versus posterior closing wedge osteotomy in posttraumatic kyphosis with neurologic compromised osteoporotic fracture. Spine (Phila Pa 1976), 28(18): 2170-2175.
7. Aybery G, Ozverren 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.
8. 马毅, 邓树才, 刘建坤, 等. 经后路椎弓根钉内固定加钛网骨移植椎间融合治疗胸腰椎爆裂骨折. 中华创伤骨科杂志, 2009, 11(1): 22-25.
9. 李平元, 苏小桃, 欧军, 等. I期后路270°减压、钛网重建术治疗严重胸腰椎三柱骨折. 中华创伤杂志, 2009, 25(6): 532-534.
10. 林慰光, 林本丹, 胡奕山. 经后路椎体次全切除后钛网支撑置入加椎弓根钉内固定治疗腰椎爆裂性骨折的初步报告. 中华创伤骨科杂志, 2010, 12(5): 489-291.
11. 李建江, 马信龙, 邓树才, 等. 经后路椎体次全切除及重建治疗严重胸腰椎骨折. 中华骨科杂志, 2011, 31(7): 761-766.
12. 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.
13. Gurr KR, McAfee PC, Ahih CM. Biomechanical analysis of anterior and posterior instrumentation systems after corpectomy. A calf-spine model. J Bone Joint Surg (Am), 1988, 70(8): 1182-1191.
14. 陈天剑, 丰干均, 乔俊, 等. 后路椎弓根固定加椎间植骨治疗胸腰椎爆裂骨折. 中华创伤杂志, 2009, 25(10): 890-893.
15. Wang MY, Kim DH, Kim KA. Correction of late traumatic thoracic and thoracolumbar hypnotic spinal deformities using posteriorly placed intervertebral distraction cages. Neurourgery, 2008, 62(3 Suppl 1):.
16. 刘兰泽, 陈先, 卢占彬, 等. 椎弓根螺钉固定治疗胸腰椎骨折术后断钉断棒原因分析. 中国脊柱脊髓杂志, 2006, 16(8): 614-618.
17. Shen WJ, Liu TJ, Shen YS. Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit. Spine (Phila Pa 1976), 2001, 26(9): 1038-1045.
18. Hakalo J, Wroński J. Complications of a transpedicular stabilization of thoraco-lumbar burst fractures. Neurol Neurochir Pol, 2006, 40(2): 134-139.
19. Vaccaro AR, Lim MR, Hurtbert RJ, et al. Surgical decision making for unstable thoracolumbar spine injuries: results of a consensus panel review by the Spine Trauma Study Group. J Spinal Diserd Tech, 2006, 19(1): 1-10.
20. -172.

Chinese Journal of Reparative and Reconstructive Surgery

SUBTOTAL CORPECTOMY AND INTERVERTEBRAL BONE GRAFTING THROUGH POSTERIOR APPROACHALONE IN TREATMENT OF THORACOLUMBAR BURST FRACTURE OR THORACOLUMBAR FRACTUREDISLOCATION

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