Treatment of lumbar sagittal split fracture with combined anterior and posterior short segment fixation and fusion

Abstract

To evaluate the efficacy and safety of combined anterior and posterior short segment fixation and fusion for lumbar sagittal split fracture. Methods: From March, 2005 to May, 2013, 13 patients of lumbar sagittal split fracture underwent short segment posterior fixation and anterior fusion. Preoperative and postoperative kyphotic Cobb's angle, visual analogue scale (VAS) score of back pain, Oswestry disability index (ODI), as well as the incidence of complication were accessed. Results: Mean follow-up duration was 42 months (24-60 months). Average operative time was 248 min (185-300 min) and average bleeding was 950 mL (600-1 500 mL). All patients were significantly improved in function and self-image. In the Cobb angle evaluation, there was significant improvement in 2 days or 12 months after the operation (P<0.05). In terms of average VAS pain score and ODI score, the difference was significant (P<0.05) between before and after surgery; the results of 12 months and the final follow-up after operation were significantly better than those before operation (P<0.05), but there was no significant difference at the 12 months and the final follow-up (P>0.05). According to the American Spinal Injury Association (ASIA) standard, in the last follow-up, 6 patients with grade D recovered to grade E, 3 patients had no further recovery. All patients achieved bony fusion in 4.5 months (3-6) months. There were 3 cases with dural tear and it was repaired during operation. There was no neurologic deterioration and vascular injury. Conclusion: The short construct with pedicle screws in the fractured vertebrae and disc space fusion may be a better therapeutic option for the highly lumbar unstable fracture of C1.2.1.