Abstract
Ligamentotaxis is a known method in the management of spinal burst fractures but the indications and efficacy are controversial. In the present study we evaluated the outcome of ligamentotaxis without fusion. Thirty five patients with single-level thoracic burst fractures with intact PLL were selected for treatment with this method. The analysis of the outcome was with the help of frankel neurological grading system, radiographic measurements, and Visual analog scale and Oswestry disability index was used to evaluate the pain and functional outcome. The average follow-up period was 28.5 months. There was a statistically significant correction of anterior vertebral height from 53.9% to 96.2% postoperatively; and that of the posterior vertebral height increased from 86.6% to 98.1% postoperatively. Preoperative canal compromise which averaged to 34.96% improved to 5.52% at latest follow up. Neurological status was improved in all patients except one patient with frankel grade A. The ODI and VAS score improved significantly in all patients. Among the broad spectrum of treatment options for thoracic burst fractures ligamentotaxis with screw fixation falls in mid range of the spectrum, providing less aggressive surgery and beneficial clinical and technical outcome. Keywords: Thoracic, burst fracture, ligamentotaxis, indirect reduction, instrumentation
Highlights
The management of thoracic burst fractures have included conservative as well as direct decompressive procedure and fixation, which can be performed from anterior, posterior or combined approach
Though conservative management can be undertaken in some thoracic burst fractures, still surgical management plays a crucial role in many
We conducted a study to evaluate the outcome of thoracic burst fractures managed with indirect reduction by ligamentotaxis and posterior long segment pedicle screw fixation, having intact posterior longitudinal ligament (PLL), which included all types of Dennis fractures
Summary
The management of thoracic burst fractures have included conservative as well as direct decompressive procedure and fixation, which can be performed from anterior, posterior or combined approach. Though conservative management can be undertaken in some thoracic burst fractures, still surgical management plays a crucial role in many. Short as well as long segment instrumentation and indirect reduction is a known technique in the management of thoracic burst fractures[2,8,11]. There is limited role of short and long segment instrumentation in the management of fractures apart from Dennis Type-B fractures[4,5]. We conducted a study to evaluate the outcome of thoracic burst fractures managed with indirect reduction by ligamentotaxis and posterior long segment pedicle screw fixation, having intact posterior longitudinal ligament (PLL), which included all types of Dennis fractures
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