Segmental Spine Instrumentation in Thoracolumbar and Lumbar Fractures—12 Years Experience

Abstract

Introduction Thoracolumbar and lumbar fractures are serious lesions associated commonly with neurological deficits. Posterior stabilization by internal fixation is actually a frequent procedure for the treatment of unstable fractures. The objective of this study is to retrospectively analyze the functional outcome of segmental spine instrumentation of unstable thoracolumbar and lumbar fractures, and the association with neurological impairment. Materials and Methods This retrospective study included 70 patients (49 men and 21 women) with acute unstable thoracolumbar and lumbar fractures, between January 1996 and December 2007 treated with segmental instrumentation (61 with transpedicular fixation and 9 sublaminar wiring fixation). The medium age was 38.22 years (15 to 70 years) and the medium time of follow-up was 75.60 months (20 to 150 months). The fractures were in 14 cases D12, 26 L1, and 30 in other locations. The evaluation included location, mechanism, and type of fractures and associated injuries, neurological symptoms pre- and postsurgery, complications, and radiograph evaluation of the degree of reduction. The injuries were evaluated with the thoraco-lumbar injury classification and severity score (TLICS) and the patients with the Oswestry Disability Index (ODI) and visual pain analogical scale. Results The lesion resulted from a fall from height in 71.6%, from a car accident in 20%, and from another cause in 8.6%. In 56 cases 1 vertebra was affected, in 12 two vertebras and in 2 multi-level injuries. The angle of kyphosis was on average 22.1. Vertebral body was completely restored in 48 cases and incompletely in 22 (up to 5 deficit). TLICS was 5 in 25.7%, 6 in 21.4%, 7 in 11.4%, 8 in 11.4%, and 9 in 8.6%. 55.7% of the patients had no neurologic lesions; 7.1% nerve root, 14.3% incomplete and 20% complete cord lesion and 2,9% with cauda equina. 71.4% returned to work: 57.1% to the same and 14.3% to a lighter job; and the rest didn't work at all. According to the ODI, 36 patients had <20% disability, 21>20 to 40%, 7>40 to 60% and 6>80%. Conclusion Work status correlated directly with neurological impairment but not with injury level or mechanism. Although the important trauma experienced by these patients is return to work and results in the ODI were good. The group with complete neurological lesion had elevated disability scores associated with functional impairment. With adequate and early treatment of spine fractures, we can prevent further neurological deficits. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared Krbec M, StulikJ. Treatment of thoracolumbar spinal fractures using internal fixators (evaluationof120 cases) Acta ChirOrthopTraumatolCech 2001;68(2):77–84 Avanzi O, landin E., Meves R. Fractura thoracolumbar por explosion: correlacionen tre el comprometimientodelcanal vertebral y resultados deltratamento conservador. Coluna 2009;8(1):49–56