Fracture-dislocation Of Thoracolumbar Spine Research Articles

Treatment of Unstable Thoracolumbar Burst Fractures with Single-Stage Posterior Subtotal Corpectomy and Circumferential Reconstruction: A Prospective Observational Study in Jammu

Background: The term thoracolumbar fracture essentially refers to the fact that the bone is broken in the thoracic (middle) or lumbar (lower back) region of the spine. The present prospective study has been objectively conducted to evaluate the clinical and radiological outcome of single stage subtotal corpectomy and circumferential reconstruction of unstable thoracolumbar burst fracture. Methods: This prospective study was carried out in GMC Jammu from October 2017 to December 2018. A total 20 patients with acute traumatic unstable burst fractures at thoracolumbar junctions were included in this prospective study who qualified the defined inclusion criteria.Results: The mean sagittal plane kyphosis pre operatively was 24.845.220 which reduced to 13.155.30at post-operative day 1. At final follow up, sagittal plane kyphosis was 15.105.650. The mean Anterior Body Compression was 33.646.79% which decreased to 22.3 % at post-operative day 1. At final follow up, mean ABC was 24.264.95%. VAS score reduced from mean value of 6.85 to 2.2 at final follow up which is slightly less compared to what others reported. Conclusion: The present study revealed that indirect decompression and posterior subtotal corpectomy and circumferential reconstruction fulfill all the aims of surgical treatment of fractures and fracture dislocations of thoracolumbar spine. We recommend longer follow up to assess the degree of correction of kyphosis and re-collapse and neural recovery with single stage posterior subtotal corpectomy and circumferential reconstruction

Morcellized local grafts as cost effective option for interbody fusion in thoracolumbar fracture dislocation: Seven years follow up of 53 patients

IntroductionTraumatic fracture dislocation of the spine injury is essentially a three column injury that optimally needs surgical intervention to decompress, stabilize and fuse the spinal column. This study evaluate the outcome of posterior and posterolateral decompression, instrumentation and 360 degree fusion achieved with help of locally harvested autologus morcellized grafts in traumatic fracture dislocation of thoracolumbar spine. Methods53 patients were included in this retrospective study. Patients aged 16-55 years, single level fracture dislocation of thoraco-lumbar spine (D5-L5) were included. Patients with multiple level fractures, coexisting degenerative diseases of spine ,pathological fractures, patients presenting more than three weeks after initial trauma, patients with concomitant severe head injury that necessitated emergency surgery for the same were excluded from the study. Patients underwent posterior and posterolateral decompression , posterior instrumentation and interbody as well as posterolateral fusion with use of morcellized bone from resected posterior elements. Follow up data at immediate post operative period ,12 months and yearly thereafter upto minimum 7 years was obtained from previous record. ResultsThere were 46 males and 7 females. Mean age was 31.15 ±9.64 yrs .Mean follow up period was 7.4 yrs(range 7-10 yrs). Thoracolumbar dislocation was most frequently noted at thoraco lumbar junction (T10-L2).Thirty six patients had complete neurological deficit (ASIA A) and sixteen had incomplete neurology. At one year follow up, osseous fusion was noted in 48 (90.56%) patients and 5 patients (9.44%) had fibrous union which was determined on CT scan. Immediete post operative, one year and 7 year kyphosis angle was calculated and change in kyphosis angle was not statistically significant. There was no implant failure till last follow up. ConclusionMorcellized locally harvested autologus grafts are sufficient to achieve 360 0 spinal fusion in fracture dislocation of thoracolumbar spine.