Anterior Single Segmental Decompression and Fixation for Denis B Type Thoracolumbar Burst Fracture With Neurological Deficiency

Abstract

A series study of neurologically deficient patients with Denis B type thoracolumbar burst fractures treated with anterior single segmental decompression and fixation (ASSDF). To describe a surgical technique of ASSDF and its clinical outcome in a group of neurologically deficient patients with Denis B type thoracolumbar burst fractures. The optimal treatment for thoracolumbar burst fractures is still controversial. The canals of selected patients were fully decompressed with partial dissection on fractured vertebral body. Single segmental fusion was achieved with grafting and fixation. Clinical evaluation (including Frankel scales and visual analogue scale) and radiologic assessments (including the measurements of the kyphosis Cobb angle, adjacent superior, inferior intervertebral disc height, and vertebral canal sagittal diameter on radiograph film and computer tomography scans) were performed before the operation and at 3-day, 6-month, 1-, 2-, and 3-year intervals after the operation. Between June 2006 and May 2008, 37 patients with Denis B type thoracolumbar burst fractures were recruited for study. Thirty-four patients with successful ASSDF accomplished a 1-year follow-up. Average follow-up duration was 26 ± 9.2 months. The average operation time and blood loss were 173 ± 26 minutes and 445.6 ± 164.4 mL, respectively. Average Frankel scales were significantly improved at the end of follow-up. visual analogue scale decreased from 7.2 ± 0.8 before operation to less than 1.7 ± 0.7 (P < 0.05) 6 months later. The vertebral canal sagittal diameter was enlarged from an average of 5.9 ± 1.2 mm to 16.2 ± 1.0 mm (P < 0.01). The canal stenosis index also improved, from 36.0% to 99.1%. Kyphosis was corrected from 21.5° ± 6.1° to 7.3° ± 3.2° (P < 0.05) and remained at 8.2° ± 3.6° (P > 0.05) 1 year later. Adjacent disc heights remained constant. No serious complications or fixation failures were observed during follow-up. ASSDF provides a novel and effective surgical option for treating Denis B type fracture with neurologic deficiency.