The operative stabilization and grafting of thoracic and lumbar spinal fractures

Abstract

In this paper several concepts of surgical treatment of thoracic and lumbar fractures are reviewed. Most classifications of these fractures are primarily radiologic, but pathomechanical aspects are very important as these guide the insight into and the rationale of the different modes of treatment. The segment of movement can be considered biomechanically as a three-dimensional system, built up from two rings, linked together at five functional points of support. Our principal mode of surgical therapy after closed reduction by halo-femoral traction is anterolateral decompression, stabilization and grafting to induce fusion. In suitable cases, a dorsal or posterolateral approach and instrumentation can be combined with ventral methods. By using the primary anterolateral approach, one can reduce malalignment at the site where it is needed. Decompression can be carried out where it is truly necessary. One can give support within the segment of movement at the logical place from a biomechanical point of view: the weight bearing part, i.e., the anterior ring. By excision of the injured bony and ligamentous tissue, motion in the damaged segment of movement is eliminated, the original height is restored by grafting, and at the same time the load-bearing capacity of the fractured area is repaired. By applying Zielke instrumentation one can compress the grafts in accordance with modern views on fracture treatment. This “philosophy” is illustrated with case histories and a decision making flow chart.