Long Segment Posterior Instrumentation with Interbody Fusion using Locally Harvested Bone Graft for Fracture Dislocations of Thoraco Lumbar Spine: An Outcome Study of 60 Cases

Abstract

Material and Methods Sixty (60) cases of Fracture Dislocations of thoraco lumbar spine were treated at JPN Apex level one Trauma Center, A.I.I.M.S., New Delhi, from Jan. 2008 to April 2014. All the cases were treated by long segment pedicle screw constructs, two levels above and below the dislocation level, from a posterior approach. A combined posterior and postero lateral decompression from posterior approach was done in 56 cases. In 3 cases, only posterior decompression by complete laminectomy was done. In one case only, additional anterior decompression from anterior approach was done along with posterior approach. Partial corpectemy and interbody fusion using Harms type mesh cage was done in 20 cases. Complete Discectomy at the dislocation level and Interbody Fusion, using locally harvested bone graft(Spinous process and Lamina) from the posterior decompression was done in 32 cases. A partial corpectemy and interbody fusion using the TLIF banana type cages was done in 4 cases. In Situ postero lateral fusion was done in 3 cases. In one case, additional anterior surgery along with posterior surgery was done to achieve anterior reconstruction with expandable cage. Results Follow up of cases ranged from one year to six years. There was no case of implant failure or loss of fixation, in any of the 60 cases. Fusion was achieved in all cases, as evidenced by direct and indirect markers. All patients achieved at least a sitting balance. 20 patients were ambulating on wheel chair, while 40 patients achieved independent mobilization, with or without the help of calipers and braces. Neurologic recovery of one ASIA grade was seen in 15 patients, and two ASIA grades was seen in 20 patients. There was no neurologic recovery seen in 25 patients. There was deep seated infection, in two cases, which resolved with debridement and antibiotics. Sacral bed sores developed in six cases, which were treated by local flaps. Conclusion Long segment posterior fixation, two levels above and below the injury from a posterior only approach is sufficient and adequate treatment for fracture dislocation injuries of thoraco lumbar spine. Interbody Fusion using locally harvested bone graft is a novel technique to enhance the fusion rate and minimize instrumentation failures.