Application of titanium plate reconstruction in laminoplasty during the thoracolumbar burst fractures

Abstract

Objective To investigate the application value of using reconstruction of the posterior wall of vertebral canal with titantium plate and bone grafting in the thoracolumbar burst fracture surgery. Methods Twenty-seven patients with thoracolumbar burst fracture with spinal cord injury were treated with posterior pedicle screw fixation+ holo-laminectomy+ titanium plate bending for reconstruction of posterior expansive laminoplasty, and the depressurized lamina process was trimmed into bone grains and were mixed with allogeneic bone for bone grafting along the titanium plate surface. The kyphotic Cobb angle, bone graft fusion, and neurological recovery were of the patients were assessed after procedure. Results The postoperative CT and MRI findings in 27 patients suggested that the vertebral canal volume recovered well, the spinal cord compression relieve was satisfactory. The neurological function of 16 patients was improved during the hospitalization. All patients were followed up after discharge. They were followed up for 12 to 30 months (mean 17.8 months). Their final neurological function was improved in 21 patients compare with before procedure (ASIA grade: type A 3 cases, type B 6 cases, type C 8 cases, and type D 10 cases), and 14 of them recovered completely, 7 recovered partially, and 6 did not have any changes (ASIA grade: type A 3 cases, type B 3 cases, type C 3 cases, type D 4 cases, and type E 14 cases). The function improvement rate of the patients was 78% (21/27) after procedure. No symptoms of delayed spinal cord compression were observed during the follow up period. The internal fixation screw rods of 9 patients were removed from 13 to 21 months after procedure because of their personal reasons, but the forming titantium plates were reserved. All patients did not have the phenomena including increased kyphosis angle, titantium plate shift, deformation, and decreased vertebral canal volume. The bone grafting fusion rate was 100%. No spine instability was observed. There was no significant differences in the lost degrees of kyphosis angle and the height change ratio of the injured vertebrae (P>0.05). Conclusions Using titanium plate for laminoplasty and bone grafting are simple, safe and reliable after surgical reduction decompression and fixation in the treatment of thoracolumbar burst fractures with spinal cord injury. It is conducive to maintaining the integrity and stability of spines. The recovery of spinal cord function is satisfactory. Key words: Titanium plate; Thoracolumbar fracture; Fracture