Abstract
We aimed to describe the surgical technique and clinical outcomes of paraspinal-approach reduction and fixation (PARF) in a group of patients with Denis type B thoracolumbar burst fracture (TLBF) with neurological deficiencies. A total of 62 patients with Denis B TLBF with neurological deficiencies were included in this study between January 2009 and December 2011. Clinical evaluations including the Frankel scale, pain visual analog scale (VAS) and radiological assessment (CT scans for fragment reduction and X-ray for the Cobb angle, adjacent superior and inferior intervertebral disc height, and vertebral canal diameter) were performed preoperatively and at 3 days, 6 months, and 1 and 2 years postoperatively. All patients underwent successful PARF, and were followed-up for at least 2 years. Average surgical time, blood loss and incision length were recorded. The sagittal vertebral canal diameter was significantly enlarged. The canal stenosis index was also improved. Kyphosis was corrected and remained at 8.6±1.4o (P>0.05) 1 year postoperatively. Adjacent disc heights remained constant. Average Frankel grades were significantly improved at the end of follow-up. All 62 patients were neurologically assessed. Pain scores decreased at 6 months postoperatively, compared to before surgery (P<0.05). PARF provided excellent reduction for traumatic segmental kyphosis, and resulted in significant spinal canal clearance, which restored and maintained the vertebral body height of patients with Denis B TLBF with neurological deficits.
Highlights
Surgical procedures for thoracolumbar burst fractures (TLBFs) are performed through an anterior, posterior, or combined approach
The selection of the surgical method for the treatment of TLBF remains a matter of debate [5,6]
The paraspinal approach was first used by Wiltse for lumbar spine fusion [8]
Summary
Surgical procedures for thoracolumbar burst fractures (TLBFs) are performed through an anterior, posterior, or combined approach. These surgical approaches can be traumatic for patients [1,2]. The treatment goals are the restoration of stability and alignment of the spine, but the optimal management for TLBF remains controversial [3,4]. For a typical Denis type B fracture with neurological deficiency, decompression is considered necessary. This study was designed to describe a surgical technique that involves paraspinalapproach reduction and fixation (PARF) and to evaluate the outcome of TLBF managed with indirect reduction and posterior short-segment pedicle screw fixation without laminectomy and fusion in patients with Dennis type B fractures with neurologic deficits
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