Effect of manual reduction and indirect decompression on thoracolumbar burst fracture: a comparison study

Jian Huang,Zhaodong Yan,Zongbo Zhou,Xuejian Gou,Limin Zhou

doi:10.1186/s13018-020-02075-w

Abstract

ObjectiveTo evaluate the effect of manual reduction and indirect decompression on thoracolumbar burst fracture.MethodsSixty patients with thoracolumbar burst fracture who were hospitalized from January 2018 to October 2019 were selected and divided into an experimental group (33 cases) and control group (27 cases) according to different treatment methods. The experimental group was treated with manual reduction and indirect decompression, while the control group was not treated with manual reduction. The operation time and intraoperative blood loss were recorded. VAS score was used to evaluate the improvement of pain. The anterior height of the injured vertebra, wedge angle of the injured vertebral body, and encroachment ratio of the injured vertebral canal were used to evaluate the spinal canal decompression and fracture reduction. JOA score was used to evaluate the improvement of spinal function.ResultsThere was no significant difference in operation time and intraoperative blood loss between the two groups. Compared with the control group, the VAS score and the wedge angle of the injured vertebral body of the experimental group 3 days after the operation and the last follow-up were significantly lower than that of the control group, and the difference was statistically significant. The ratio of the anterior height of the injured vertebra of the experimental group 3 days after the operation and the last follow-up was significantly higher than that of the control group, and the difference was statistically significant. The difference of the encroachment ratio of the injured vertebral canal between preoperation and 3 days after operation was significantly higher than that of the control group, and the difference was statistically significant. The bladder function of JOA 3 days after the operation of the experimental group was significantly higher than that of the control group, and the difference was statistically significant. And the rest aspect of JOA on 3 days after the operation and last follow-up of the experimental group has no significant difference compared with the control group.ConclusionManipulative reduction and indirect decompression can obtain a better clinical effect in the treatment of thoracolumbar burst fractures.

Highlights

Thoracolumbar burst fracture most often occurs in the thoracolumbar segment (T11-L2) [1]
Because the posterior edge of the vertebral body protrudes into the spinal canal, burst fracture is easy to cause symptoms of the spinal cord or nerve compression
Patient selection method Inclusion criteria include the following: (a) there was a clear history of trauma; (b) chest and waist pain, limited movement; (c) Denis type B thoracolumbar burst fracture diagnosed by Computed tomography (CT) scan [11]; (d) TLICS score is 4 points or greater [12, 13]; (e) Asia Grade E; (f) 18 years and older; (7) follow-up time is 1 year or longer; and (g) institutional Review Board approval was obtained before the study commenced

Summary

Introduction

Thoracolumbar burst fracture most often occurs in the thoracolumbar segment (T11-L2) [1]. When the compression force is enough, the vertebral body will break radially, which will cause a burst fracture. Because the posterior edge of the vertebral body protrudes into the spinal canal, burst fracture is easy to cause symptoms of the spinal cord or nerve compression. The purpose of surgical treatment is to restore the stability of the spine and to decompress the nerve structure in patients with progressive aggravation of the spinal cord or nerve compression symptoms [7]. Manual reduction and indirect decompression technique were used to treat thoracolumbar burst fracture, using X-ray and CT scan data to create anatomical models of human anatomy, to evaluate the surgical effect, which was in line with the concept of translational orthopedics. Mediouni proposed a “T-Model,” through the participation of a multidisciplinary team, and basic research scientists participated in the operation of the clinical surgeon, aiming to bridge the gap between basic science and clinical science and improve the surgeon’s surgical competencies [8–10]

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Conclusion