The clinical application of lateral extracavitary approach in the treatment of thoracolumbar burst fractures

Abstract

Objective To explore the outcome of lateral extracavitary approach to anterior lateral decompression and bone fusion and internal fixation operation for thoracolumbar burst fracture with nerve injury. Methods The clinical data of 22 patients with thoracolumbar (T11-L2) burst fracture with nerve injury of lateral extracavitary approach to anterior lateral decompression and bone fusion and internal fixation operation were analyzed. The radiographic data of cobb angle, vertebral height compression percentage and spinal canal encroachment rate were compared. All data were collected pre-operation, post-operation and at last follow-up. According to clinical manifestations, recovery of neurological function before and after operation assessed by the American Spinal Injury Association (ASIA) classification and improvement rate of Japanese Orthopaedic Association (JOA) score from post-operation to last follow-up were compared. Results All 22 cases were followed up after operation for (18.0±7.2) months. The Cobb angle in pre-operative was (20.532±4.045)°, in post-operation days was (5.936±1.081)°, in last follow-up was (6.564±0.984)°. The difference was statistically significant before and after operation (t=14.822, P=0.000). Same difference at the last follow-up and preoperative comparison (t=16.134, P=0.000). There was no significant difference between the last follow-up and postoperative (t=-1.834, P=0.081). The percentage of vertebral height compression in pre-operative was (51.182±7.670)%, post-operation days was (91.773±2.308)%, in last follow-up was (90.545±4.284)%. At the post-operative, there was a significant difference compared with preoperative (t=-21.509, P=0.000). Between the last follow-up and preoperative aiso a significant difference (t=-18.990, P=0.000). No significant difference between the last follow-up and postoperative (t=1.528, P=0.141). The spinal canal encroachment rate in Preoperative was (34.818±5.142)%, post-operation days was (3.155±0.578)%, in last follow-up was (3.300±0.478)%. A significant difference between the postoperative and preoperative (t=29.136, P=0.000). In the same sense, the last follow-up compared with preoperative (t=28.304, P=0.000). To the contrary, no significant difference between the last follow-up and post-operative (t=-1.560, P=0.134). The ASIS score of patients there are 2 patients with complete injury, 12 patients received 1 levels of improved, and 8patients obtained 2 levels. The improvement rate of JOA score was improved in different degree expect 2 patients with complete injure, postoperative patients with excellent and good were 14 cases and 19 were followed up at the last follow-up. The excellent and good rate of post-operation was 86.363%, the excellent and good rate of the last follow-up was 63.645%, obviously improve between them. Conclusion The operation of lateral extracavitary approach to anterior lateral decompression and bone fusion and internal fixation can correct spinal kyphosis, restore and maintain vertebral height effectively, decompress the spinal canal completely and obtain satisfactory recovery in never function in the treatment of thoracolumbar burst fracture with nerve injury, which is an effective surgery. Key words: Lateral extracavitary approach; Ventrolateral decompression; Thoracolumbar; Brust fracture