Clinical efficacy and therapeutic value of delayed surgery in patients with symptomatic old thoracolumbar fractures

Pan Li,Zhuojing Luo,Zhuowen Liang,Bin Wei,Yunfei Huang,Mo Li,Zhengxu Ye,Lu Gan

doi:10.1186/s12893-021-01240-0

Abstract

BackgroundTo investigate the clinical efficacy and therapeutic value of posterior decompression reduction, bone grafting fusion, and internal fixation for treatment of symptomatic old thoracolumbar fractures.MethodRetrospective analysis was conducted for 14 patients (9 men, 5 women; average age 40.1 years) with old thoracolumbar fractures who underwent posterior operation. American Spinal Injury Association (ASIA) scores were used to evaluate neurologic function. Vertebral body height, Cobb angle in the sagittal plane, spinal canal volume ratio (%) and bone graft fusion were analyzed by radiography and computed tomography on different follow-up times.ResultsMean follow-up was 27.1 months (23–36 months). Of three patients with ASIA grade A, 2 had improved postoperative urination and defecation, although no classification change. Preoperative ASIA score for eight patients with incomplete injury was grade B; four patients recovered to grade C at final follow-up. Preoperative ASIA score was C in three patients, increased to D in two patients and returned to normal E in one patient. Preoperative results showed average injured vertebra height loss rate decreased from 50.4 to 8.9%; average Cobb angle on the sagittal plane recovered from 39.6 to 6.9°; and the average spinal canal volume ratio recovered from 33.8 to 5.9%. Bony fusion was achieved; local lumbago and leg pain were relieved to some extent. No patients exhibited loosening of the fracture treated by internal fixation, pseudoarthrosis, or other related serious complications.ConclusionTreatment of old thoracolumbar fractures by posterior decompression reduction, bone grafting fusion, and internal fixation can relieve spinal cord compression, improve neurologic function of some patients (ASIA grades B–C), effectively relieve pain, correct deformity, restore biomechanical stability, and significantly improve quality of life.

Highlights

Thoracolumbar fracture is the most common type of spinal fracture caused by high-energy trauma [1], with most of these fractures occurring at the junctional area where the mechanical load is maximal [2, 3]
No patients exhibited loosening of the fracture treated by internal fixation, pseudoarthrosis, or other related serious complications
All patients were examined by radiography, computed tomography (CT), and magnetic resonance imaging (MRI) before operation

Summary

Introduction

Thoracolumbar fracture is the most common type of spinal fracture caused by high-energy trauma [1], with most of these fractures occurring at the junctional area where the mechanical load is maximal [2, 3]. Significant controversy is ongoing regarding the surgical effect and value of old thoracolumbar fractures [7]. Because of the difficulty and trauma of surgery and the potential for forced surgical reduction to damage large blood vessels and thoracic organs [8], create high hospitalization costs [9], and result in poor recovery of neurologic function after surgery [10], many patients with old thoracolumbar fractures have not been effectively treated. In the face of old fractures, surgical treatment is still recommended to avoid further compression of the fractured fragments, aggravating kyphosis, and damaging to neurological function [11]. To investigate the clinical efficacy and therapeutic value of posterior decompression reduction, bone grafting fusion, and internal fixation for treatment of symptomatic old thoracolumbar fractures

Objectives

Methods

Results

Discussion

Conclusion