Objective To compare the cl inical effects of indirect decompression versus open decompression to vertebral canal in treatment of thoracolumbar burst fractures without neurologic deficit. Methods From April 2004 to June 2008, 52 cases of thoracolumbar burst fracture without neurologic deficit underwent posterior exposition, reduction and fixation with Atlas Fixator (AF) instrumentation. There were 34 males and 18 females with an average age of 43.1 years (range, 31-63 years). The affectd locations were T11 in 5 cases, T12 in 24 cases, L1 in 16 cases, and L2 in 7 cases. The time from injury to operation was 3-8 days (4.4 days on average). All cases were devided into indirect decompression group (group A) and open decompression group (group B). There were no statistically significant differences (P gt; 0.05) in sex, age, affect site, and disease course between two groups. The operative time, blood loss were recoded. Preoperatively, immediately postoperstively and at last follow-up, the height of the fracture vertebra and the Cobb angle were obtained from X-ray pictures and were statistically analysed. Radiographic parameters on computed tomography (CT) pictures were used to get the encroachment rate of vertebral canal. Results The operative time was (87.3 ± 7.9) minutes and (125.3 ± 13.6) minutes, and the blood loss was (273.7 ± 23.4) mL and (512.6 ± 37.7) mL in groups A and B, respectively; showing statistically significant differences (P lt; 0.05). The average follow-up time was 17.4 months (range, 11-31 months) in group A and 19.9 months (range, 12-33 months) in group B. All wounds achieved primary heal ing postoperatively without deaths and spinal cord injuries. Postoperative compl ications in group B included 3 cases of screws loosening, 1 case of screw breakage, and 3 cases of low back pain, and were given symptomatic management. There were no statistically significant differences (P gt; 0.05) in the height of the fracture vertebra, the Cobb angle andthe encroachment rate of vertebral canal preoperatively or postoperstively between two groups. There were statistically significant differences (P lt; 0.05) in the above three parameters between preoperation and postoperation in two groups, but there were no statistically significant differences (P gt; 0.05) in the spinal correction between two groups. The losing-rate of spinal correction of the height of the fracture vertebra and the Cobb angle of group A was lower than group B, showing statistically significant differences (P lt; 0.05). Conclusion The short-term results of two decompression styles in treatment of thoracolumbar burst fractures without neurologic deficit were satisfactory, but indirect decompression has more merits than open decompression: shorter operative time, less blood loss, lower losing-rate of spinal correction, and better stabil ization of vertebral column.
Objective To discuss influence of spinal surgery on quality of life (QOL) of patients with late-period spinal metastatic tumor and to explore if spinal surgery could influence on survival time of patients or not. Methods From July 2007 to March 2009, we identified patients who were eligible for the observational study hospitalized in Changzheng Hospital, the Second Military Medical University in Shanghai, China. All eligible patients were divided into two groups depending on whether they would receive spinal surgery or not. Then, all eligible patients completed five QOL assessments using the Functional Assessment of Cancer Therapy-General (FACT-G) Questionnaire when they were diagnosed as late-period spinal metastatic tumor, after 1-month treatment, after 3-month treatment, after 6-month treatment, and after 9-month treatment. Survival time of each patient was also recorded. Results We identified 312 patients who were eligible for the study (surgery group, 147 cases; and non-surgery group, 165 cases). There was no significant difference in survival time between the two groups (χ2=3.167, P=0.075). Within 9 months, the surgery group had significantly higher physical well-being scores, emotional well-being scores, functional well-being scores and total QOL scores than the non-surgery group. Conclusion The results of this study suggest that spinal surgery can significantly improve the QOL of patients with late-period spinal metastatic tumor, but cannot prolong the survival time.