Abstract
BackgroundSurgery is usually recommended for thoracolumbar fracture with neurologic deficit. However, traditional open posterior approach requires massive paraspinal muscles stripping, and the canal decompression may be limited and incomplete. We aimed to investigate a new approach via the Wiltse approach and the Kambin’s Triangle.MethodsTwenty-one consecutive patients with traumatic upper lumbar fracture who received this new approach surgery between January 2015 and January 2016 constituted the new approach group. Twenty-nine patients received the traditional open posterior surgery between January 2014 and January 2015 were classified as the traditional posterior surgery group. Surgical informations including operative time, blood loss, drainage volume, hospitalization days were collected and compared among the two groups. The American Spinal Injury Association (ASIA) impairment scale and Visual Analog Score (VAS) were evaluated preoperatively, postoperatively and at 12 months follow-up.ResultsPatients in the new approach group had fewer operation time (128.3 ± 25.1 vs 151 ± 32.2 min, P = 0.01), less blood loss (243.8 ± 135.5 vs 437.8 ± 224.9 ml, P = 0.001) and drainage volume (70.7 ± 57.2 vs 271.7 ± 95.5 ml, P < 0.001), as well as shorter hospitalization stay than the traditional posterior surgery group (6.6 ± 1.8 vs 8.5 ± 2.4 d, P = 0.004). Similar neurologic recovery according to ASIA grade was achieved in both groups (Recovery index: 0.90 ± 0.53 vs 0.86 ± 0.51, P = 0.778). While the pain level was significantly lower in the new approach group postoperatively (2.6 ± 0.7 vs 3.5 ± 0.9, P < 0.001) and at 12 months follow-up (1.4 ± 0.9 vs 2.4 ± 0.8, P < 0.001).ConclusionThe present new approach was successfully applied in the treatment of upper lumbar fracture with neurologic deficit. It can reduce iatrogenic trauma and achieve similar or better outcomes compared to the traditional posterior surgery.
Highlights
IntroductionTraditional open posterior approach requires massive paraspinal muscles stripping, and the canal decompression may be limited and incomplete
Surgery is usually recommended for thoracolumbar fracture with neurologic deficit
The indirect decompression through ligaments stretch reduction, laminectomy, or partial removal of the pedicles during posterior surgery can offer comparable neurologic outcome [9, 10]. It is doubtful sometimes whether an efficient canal decompression has been achieved by these indirect means during posterior surgeries, especially when the canal encroachment is caused by repulsed bone fragments from injured vertebral bodies [11] and the posterior longitudinal ligament is likely to be injured, or the intra-canal fracture fragments are located in apterium of the posterior longitudinal ligament [12]
Summary
Traditional open posterior approach requires massive paraspinal muscles stripping, and the canal decompression may be limited and incomplete. Complete direct spinal decompression and anterior reconstruction can be achieved by anterior approaches This approach is surgically more challenging and associated with significant complications including pneumothorax, aortic injury, disruption of the lumbar plexus, retrograde ejaculation, and abdominal or diaphragmatic hernia [7]. The indirect decompression through ligaments stretch reduction, laminectomy, or partial removal of the pedicles during posterior surgery can offer comparable neurologic outcome [9, 10]. Previous posterior minimally invasive technique such as the widely used percutaneous pedicle screw fixation and kyphoplasty/vertebroplasty augmentation is still confined to thoracolumbar fracture patients without neurological deficit owing to its limitation for canal decompression [15,16,17]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
