Objective To evaluate the early cl inical outcomes of subtotal corpectomy and intervertebral bonegrafting 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 orthoracolumbar fracture dislocation were treated with subtotal corpectomy and intervertebral bone grafting through posteriorapproach alone. There were 14 males and 6 females, with an average age of 36.1 years (range, 19-47 years). Fractures were causedby falling from height in 12 cases, traffic accident in 6 cases, and crushing in 2 cases. According to AO classification, there were10 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 12cases. Twelve cases complicated by fracture dislocation and 6 cases by lateral displacement. All patients had bones occupancyin 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 andoperation 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, 7months). 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 subtotalcorpectomy 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 neurologicalfunction. However, this surgical technique has a relatively large amount of blood loss and high requirements for surgeons.
Objective To evaluate the cl inical effectiveness and advantages of one-stage posterior debridement, bone graft, and internal fixation for thoracic tuberculosis. Methods The data were retrospectively analysed, from 21 cases of thoracic tuberculosis undergoing one-stage posterior debridement, bone graft, and internal fixation between June 2007 andNovember 2009. There were 16 males and 5 females with an average age of 42.2 years (range, 22-73 years). The average disease duration was 13.2 months (range, 7-21 months). The lesions were located at the level of T5, 6 (1 case), T6, 7 (1 case), T8, 9 (4 cases), T9, 10 (3 cases), T10, 11 (5 cases), T11, 12 (6 cases), and T9-11 (1 case). According to the Frankel grading criterion, the neurological function was rated as grade B in 2 cases, grade C in 6 cases, grade D in 10 cases, and grade E in 3 cases. The preoperative Cobb angle was (26.3 ± 9.2)°. The erythrocyte sedimentation rate (ESR) was (35.9 ± 11.2) mm/ 1 hour. Results Thoracic tuberculosis was confirmed in postoperative pathological examination in all 21 cases. All incisions healed primarily without fistules formation. The average follow-up time for 21 patients was 16.2 months (range, 1-3 years). Bony fusion was achieved within 7-12 months (mean, 9 months) without pseudoarthrosis. No loosening and breakage of internal fixation were found, and no local recurrence occurred. The ESR decreased to (25.1 ± 8.9) mm/1 hour at 1 week postoperatively, showing significant difference when compared with preoperative value (t=5.935, P lt; 0.01); it decreased to (14.1 ± 4.6) mm/1 hour at 3 months postoperatively. According to Frankel grade, the neurological function was significantly improved at 1 year after operation (χ2=13.689, P=0.003). The average Cobb angle was (17.1 ± 4.5)° at 1 years postoperatively, showing significant difference when compared with preoperative value (t=7.476, P lt; 0.01). Conclusion One-stage posterior debridement, bone graft, and internal fixation has a good cl inical effectiveness for thoracic tuberculosis with less injury and complete focal cleaning, as well as a goodeffectiveness of spinal canal decompression and kyphosis deformity correction.