Surgical Treatment of Thoracolumbar Fractures with Osteosynthesis

Abstract

Introduction The aim of this study is to describe the results obtained in 44 patients, all between 20 and 65 years, operated between 2011 and 2013 with the diagnosis of thoracic and lumbar vertebral fractures posttraumatic, treated in our department. In all cases, we used the same technique, which consists of fixing two levels above and two levels below the fractured vertebrae including it in the osteosynthesis system getting full or partial reduction of the fracture. After the fracture consolidation, we proceeded to the removal of the implant between 6 to 9 months after surgery. The indication was always surgical treatment with temporary fixation without arthrodesis. After the removal of the osteosynthesis material, all patients recovered the capacity of flexo-extension of the thoracolumbar spine. The patients returned to their previous levels of daily life and sport. It took them 35 days on an average to return to work and from 6 to 9 months to their sports activities. Patients were followed for 1 year after surgery. Patients and Methods A total of 44 patients were evaluated, 34 men and 10 women. The complaint was for posttraumatic back or low back pain by falls from their own height standing or sitting, in the 72% of cases, with no more than 48 hours of evolution that did not get better with rest and got worse with mobilization. The rest of the cases were traffic accidents. All patients were studied by MRI and X-rays. All fractures were treated by the same surgeon within the first 72 hours of making the diagnosis. Fractures were divided as follows: D9 (1 case), D10 (7 cases), D11 (6 cases), D12 (11 cases), L1 (10 cases), L2 (7 cases), L3 (1 case) and L4 (1 case). Overall, 83% of cases were type A fractures according to the AO classification, and the remaining 17% were type B, which were associated with rupture of the posterior wall and invasion of the spinal canal. Only two fractures had neurological and motor compromise C, according to Frenkel classification. The rest of the fractures had Frenkel E. Results All patients returned to their usual physical activities, even those who played sports with the exception of the two Frenkel C. As postoperative complications, patients had scar hygromas that were cured with puncture and compressive bandage. Everyone referred complete or partial improvement of their symptoms. Only in one case, we had a postoperative complication which was the rupture of one of the lower transpedicular screws of the system at 3 months; after the removal of the implant at 6 months, the pain disappeared without complications. Conclusion This method, temporary fixation without arthrodesis of five levels, is usually used in our department to treat thoracolumbar fractures. Patients had no postoperative complications except one patient who presented a ruptured of a transpedicular screw but no reoperation was needed. In all cases, there was a complete remission of symptoms and return to normal activity.