Curative effect of surgical treatment on thoracolumbar burst fracture complicated with incomplete spinal cord injury

Abstract

Objective To investigate the timing and methods in surgical treatment of thoracolumbar burst fracture complicated with incomplete spinal cord injury. Methods A retrospective analysis was conducted on 52 patients who had surgical treatment for thoracolumbar burst fracture complicated with incomplete spinal cord injury from February 2011 to March 2014. The patients comprised 45 males and 7 females, at mean 41.8 years of age (range, 19-67 years). Multiple trauma was noted in 29 patients. Mean injury severity score (ISS) was 23 points (range, 16-50 points). There were altogether 61 fractured segments including 2 T11, 10 T12, 29 L1 and 20 L2. Ten patients suffered from bi-segmental lesions and 2 tri-segmental lesions. American Spinal Injury Association (ASIA) scale was B in 16 patients, C in 15 and D in 21. Two patients underwent anterior spinal decompression and fusion, and the remaining patients were treated by posterior reduction, decompression, interbody fusion and pedicle screw fixation. ASIA scale, sense or motion score, spinal stenosis and Cobb angle were recorded and their correlation with different operation time was evaluated. Results All patients were followed up for 13-50 months[(32.8±10.4) months]. ASIA scale (3 grade B, 14 grade C, 16 grade D and 19 grade E) and sense or motion score presented some improvements after operation, with the results much better in patients operated within 1-3 d after injury than those operated 4-7 d and 9-22 d after injury (P<0.05 or 0.01). Operation within 4-7 d postinjury exhibited no apparent improvements in spinal stenosis and Cobb angle, but the result was still better than that when operation was done 9-22 days postinjury (P<0.05). Conclusions Thoracolumbar burst fracture complicated with incomplete spinal cord injury should adopt active operation treatment within 3 days postinjury as soon as possible. The time of decompression and deformity correction should not be over 1 week postinjury. Early operation of posterior spinal decompression and fusion appears to have good effects. Key words: Spinal fractures; Thoracic vertebra; Lumbar vertebra; Spinal cord injuries; Decompression