Efficacy of modified 270°spinal canal decompression combined with one-stage pedicle screw fixation and vertebral reconstruction for severe thoracolumbar fractures

Abstract

Objective To investigate the efficacy of modified 270°spinal canal decompression combined with one-stage pedicle screw fixation and vertebral reconstruction for severe thoracolumbar fractures. Methods A retrospective case-control study was made on 44 cases of severe thoracolumbar fractures treated from January 2009 to June 2014. There were 34 males and 10 females, with age range of 20-68 years (mean, 37.9 years). The injured vertebrae included T11/12 in one case, T12-L1 in 10, L1/2 in 21, L2/3 in nine and L3/4 in three. Injury type was all AO type B2. According to the American Spinal Injury Association (ASIA), neurological deficit was Grade A in three cases, Grade B in five, Grade C in 22, and Grade D in 14. Load sharing score (LSC) was 7-9 points (mean, 8.1 points), while the thoracolumbar injury classification and severity score (TLICS) was 7-9 points (mean, 8.2 points). According to the difference of surgical procedures, all cases were divided into traditional group (21 cases) and improved group (23 cases). The patients in traditional group were treated by 270° spinal canal decompression combined with one-stage pedicle screw fixation and vertebral reconstruction, and those in improved group were treated by modified 270°spinal canal decompression combined with one-stage pedicle screw fixation and vertebral reconstruction. Between-group differences were compared with regard to operation time, intraoperative blood loss, postoperative drainage, allogeneic blood transfusion, pain visual analogue scale (VAS) at postoperative 72 hours, Cobb angle, anterior vertebral height, spinal canal compromise, Denis score, work state, neurological function, bone graft fusion and complications. Results Duration of follow-up was (32.4±15.8)months (range, 12-60 months). No wound infection or deterioration of neurological function was found after operation. Operation time was (2.4±0.5)hours in traditional group, less than (2.8±0.6)hours in improved group (P 0.05). VAS was (3.2±0.9)points in traditional group and (3.3±0.9)points in improved group at postoperative 72 hours (P>0.05). Cobb angle, anterior vertebral height and spinal canal compromise in both groups obtained well recovery and maintained after operation (P 0.05). At the last follow-up, ASIA Grade A was noted in three cases, Grade C in two, Grade D in 23, and Grade E in 16. Bone union was achieved in all cases, with no implant loosening or breakage observed. Thirteen cases in traditional group were found with residual bone fragments in the spinal canal after surgery, and two of them received revision surgery. Conclusions Either modified or traditional 270° spinal canal decompression combined with one-stage pedicle screw fixation and vertebral reconstruction can attain satisfactory clinical results in treatment of severe thoracolumbar fractures. However, the modified 270°spinal canal decompression can achieve more thorough decompression without reducing stability of the spine. Key words: Spinal fractures; Thoracic vertebrae; Lumbar vertebrae; Fracture fixation, internal