Abstract
Background: Thoraco-lumbar burst fractures occur as a result of axial load which often causes displacement of the middle column into the vertebral canal. Posterior surgery reduces the morbid outcomes of different other approaches. Objective: To evaluate the clinical and radiological success of posterior corpectomy and instrumentation in the management of traumatic unstable thoraco-lumbar burst fractures. Methods: It is a prospective interventional study carried out in Bangabandhu Sheikh Mujib Medical University and different private hospitals in Dhaka from July 2008 to December 2011. Total 18 patients; 13 male and 05 female within an age range of 21-40 years were selected. Total 09 cases involved L1, 05 cases at D12, 02 cases at D11 and at L2 each. Neurological status was assessed by Frankels grading and pain status by Visual Analogue Score (VAS). Paired t-test was used for statistical analysis. Results: All the patients were followed up for minimum 1 year. Eleven out of 12 patients with Frankel grade-B and 04 patients out of 06 with Frankel grade-C recovered fully and could walk without support (p<0.05). Overall 03 patients ended with some degrees of persistant neurological deficit. The mean postoperative pain improvement and kyphotic angle correction was significant (p<0.05). Conclusion: Decompression through posterior approach by laminectomy, corpectomy and fusion by cage with bone graft and stabilization by pedicle screw and rod significantly improves the clinical and radiological outcome in management of traumatic unstable thoraco-lumbar burst fractures.DOI: http://dx.doi.org/10.3329/bsmmuj.v5i1.10998 BSMMU J 2012; 5(1):35-41
Highlights
Spinal column injuries represent approximately 3% of all trauma cases[1] and 90% of these injuries involve the thoraco-lumbar region.[2,3,4,5] The thoraco-lumbar segment of spine (D10 to L2) is an unstable zone between fixed dorsal and mobile lumbar spine and an acute injury to this segment is the second most frequent site after cervical spine injury in adults.[6]
Thoraco-lumbar burst fractures occurs as a result of axial load on the spinal column after trauma which often causes displacement of the middle column into the vertebral canal and reduces the diameter.[7]
It is estimated that approximately 75% of patients with thoraco-lumbar injuries sustain some degree of neurological deficit.[8]
Summary
Spinal column injuries represent approximately 3% of all trauma cases[1] and 90% of these injuries involve the thoraco-lumbar region.[2,3,4,5] The thoraco-lumbar segment of spine (D10 to L2) is an unstable zone between fixed dorsal and mobile lumbar spine and an acute injury to this segment is the second most frequent site after cervical spine injury in adults.[6]. Objective: To evaluate the clinical and radiological success of posterior corpectomy and instrumentation in the management of traumatic unstable thoraco-lumbar burst fractures. Conclusion: Decompression through posterior approach by laminectomy, corpectomy and fusion by cage with bone graft and stabilization by pedicle screw and rod significantly improves the clinical and radiological outcome in management of traumatic unstable thoraco-lumbar burst fractures
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