Thoracolumbar Fracture-dislocations Research Articles

Effectiveness of injured vertebra fixation with inclined-long pedicle screws combined with interbody fusion for thoracolumbar fracture dislocation with disc injury

To investigate the effectiveness of injured vertebra fixation with inclined-long pedicle screws combined with interbody fusion for thoracolumbar fracture dislocation with disc injury. Between January 2017 and June 2022, 28 patients with thoracolumbar fracture dislocation with disc injury were underwent posterior depression, the injured vertebra fixation with inclined-long pedicle screws, and interbody fusion. There were 22 males and 6 females, with a mean age of 41.4 years (range, 22-58 years). The causes of injury included falling from height in 18 cases, traffic accident in 5 cases, and bruise in 5 cases. Fracture segment included 1 case of T 11, 7 cases of T 12, 9 cases of L 1, and 11 cases of L 2. According to the American Spinal Injury Association (ASIA) scale, the spinal injuries were graded as grade A in 4 cases, grade B in 2 cases, grade C in 11 cases, and grade D in 11 cases. Preoperative spinal canal encroachment ratio was 17.7%-75.3% (mean, 44.0%); the thoracolumbar injury classification and severity score (TLICS) ranged from 9 to 10 (mean, 9.9). Seventeen patients were associated with other injuries. The time from injury to operation ranged from 1 to 4 days (mean, 2.3 days). The perioperative indicators (operation time, intraoperative blood loss, and the occurrence of complications), clinical evaluation indicators [visual analogue scale (VAS) score and Oswestry Disability Index (ODI)], radiologic evaluation indicators [anterior vertebral height ratio (AVHR), kyphosis Cobb angle (KCA), intervertebral space height (ISH), vertebral wedge angle (VWA), displacement angle (DA), and percent fracture dislocation displacement (PFDD)], neurological function, and interbody fusion were recorded. The operation time was 110-159 minutes (mean, 130.2 minutes). The intraoperative blood loss was 200-510 mL (mean, 354.3 mL). All incisions healed by first intention, and no surgical complications such as wound infection or hematoma occurred. All patients were followed up 12-15 months (mean, 12.7 months). The chest and lumbar pain significantly relieved, VAS scores and ODI after operation were significantly lower than those before operation, and further decreased with the extension of postoperative time, with significant differences ( P<0.05). At last follow-up, the ASIA classification of neurological function of the patients was grade A in 3 cases, grade B in 1 case, grade C in 1 case, grade D in 10 cases, and grade E in 13 cases, which was significantly different from preoperative one ( Z=-4.772, P<0.001). Imaging review showed that AVHR, KCA, ISH, VWA, DA, and PFDD significantly improved at 1 week, 3 months and last follow-up ( P<0.05). There was no significant difference between different time points after operation ( P>0.05). At last follow-up, according to the modified Brantigan score, all patients achieved good intervertebral bone fusion, including 22 complete fusion and 6 good intervertebral fusion with a few clear lines. No complications such as internal fixation failure or kyphosis occurred during follow-up. The injured vertebra fixation with inclined-long pedicle screws combined with interbody fusion is an effective treatment for thoracolumbar fracture dislocation with disc injury, which can correct the fracture dislocation, release the nerve compression, restore the injured vertebral height, and reconstruct spinal stabilization.

Management of Thoracolumbar Fracture Dislocation Resulting from High Energy Trauma: Clinical Case Series

Management of Thoracolumbar Fracture Dislocation Resulting from High Energy Trauma: Clinical Case Series

The Feasibility of the Posterior Approach as a Surgical Technique for the Management of Severe Thoracolumbar Fracture Dislocation

The Feasibility of the Posterior Approach as a Surgical Technique for the Management of Severe Thoracolumbar Fracture Dislocation

Analysis of a Hybrid Spine Fixation Approach for the Treatment of Unstable Thoracolumbar Fractures.

Introduction The treatment of unstable thoracolumbar burst fractures and fracture dislocations of the thoracolumbar spine remains ever evolving. Anterior or posterior approaches both have equal efficacy, but the posterior approach has been preferred in our study due to its ease of application, less extensile nature, and reduced intra-operative bleeding. Posterior approaches can employ short-segment fixation or long-segment fixation techniques. Long segment fixation may need implant removal later to increase mobility in nonfusion surgeries. The thoracolumbar segment is a transition zone where the thoracic spine is a less flexible zone, and the lumbar spine is a more flexible zone. Lumbar motion is important to preserve. Hence, we proposed to study spinal fixation two levels above and one level below the fracture for stabilization. This may provide increased stability along with preservation of the motion segment at the lumbar level. Methods We retro-prospectively reviewed the results ofunstable thoracolumbar junction fractures with incomplete or intact neurology in 34 consecutive cases operated with alternate two above and one below fixation approach between June 2018 and June 2019 at our institute. Five cases were excluded due to incomplete follow up and the remaining 29 patients were included in the study. Regular follow-up in the postoperative period at three, six, and 12 months was conducted. Data analysis was done by SPSS software version 22 (IBM Corp., Armonk, NY). Results Twenty-nine patients were included in the study out of which 16 were males and 13 were females. The average age was 36.31±1.46 years (range, 14-60 years). The average follow-up duration was 14.31 months. The average injury to surgery interval was 7.17±7.31 days (range, 1-30 days). On analysis via paired t-test, pre-operative kyphotic angle (mean=20.06±8.34º) improved to immediate post-operative (mean=8.44±5.76º, p=0.0001). The postoperative kyphotic angle at 12 months follow-up showed significant stability (Mean=14.13±5.27º, p=0.0001). A median average pre-operative neurological compromise was ASIA score C and Frankel Grade C and the median average disability was an ODI score of 61%-80%. At the end of 12 months of follow-up the median average neurological compromise improved to ASIA Score D and Frankel Grade D and the median average disability improved to an ODI score of 21%-40%. Conclusion Two levels above and one level below hybrid pedicle screw fixation with decompression for the treatment of unstable thoracolumbar fractures with partial and intact neurology was successful within the limited time frame we had for follow-up in preserving progressive post-operative kyphosis, preserving one-motion segment, improving the neurological outcome and disability of the patients without any major complications.

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.

Rare association of traumatic diaphragmatic hernia with spinal cord injury: A case report.

Introduction and importanceThe traumatic diaphragmatic hernia could be missed in the background of spinal fractures due to neurological weakness. We report the first case of the management of thoracolumbar fracture-dislocation associated with diaphragmatic injury.Presentation of case53-year-old male transferred from local hospital following fallen from a motorbike on the 4th day after the injury. He was paraplegic from L1 below with sacral root involvement. Further imaging showed fracture-dislocation of the vertebral body at the T12-L1 level and anterior displacement of T11 on T12. The left-sided diaphragmatic hernia was detected by chest x-ray with bowel shadows in the left hemithorax. Emergency laparotomy and diaphragmatic repair followed by a posterior spinal exploration and pedicle screw fixation were done. Early mobilization was done after spinal fixation and the patient is successfully continuing rehabilitation.Clinical discussionThoracolumbar fracture-dislocation associated with the traumatic diaphragmatic hernia is rare. Clinical diagnosis of associated visceral injuries could be delayed due to the neurological deficit of the patient. An initial concern was to repair the life-threatening diaphragmatic hernia. Even current studies showed improved neurological function from early spinal surgery, spinal fixation had to delay as surgery needs a prone position.ConclusionEarly identification and management of traumatic diaphragmatic hernia are life-saving and allows early surgical intervention for the spine. Early reduction and fixation are associated with improved neurological function and will allow early mobilization and reduce hospital and ICU stay.

Management of AO-type C thoracolumbar fractures during COVID-19 pandemic using distractor device: a novel technique

Study design Prospective cohort study. Introduction Management of the severe thoracolumbar (TL) spine fracture–dislocation injuries have been further complicated by the COVID-19 pandemic. The need to optimize resources and minimize the personnel in the operating room (OR) led us to develop a novel technique to reduce TL fracture–dislocations (AO type-C) using an orthopedic distractor device (ODD). Methods This prospective study was conducted at a tertiary care spine center with a study duration from March 2020 to May 2020 coinciding with the nationwide lockdown and travel restrictions imposed in view of the COVID-19 crisis. Only patients with AO type C fracture–dislocation managed using the ODD operated by a single surgeon were included in the study. Results Of 12 cases, the most commonly affected level was D12-L1. Nine patients were American Spinal Injury Association Impairment Scale (AIS) A at presentation, two patients were AIS B, and one AIS C. The mean operative time was 125 min and mean blood loss was 454 ml. Eight patients remained AIS A, one patient improved from AIS B to C. Two patients became independent walkers, one remained AIS B. The post-operative VAS score improved to a mean value of 2.33. The improvement in kyphosis was 26.24° immediate postoperatively and maintained at 25.9°, percentage height loss reduced to 2.75% immediate postoperatively and maintained at 3.16% at 3 months follow-up. Conclusions Management of TL fracture–dislocations in COVID times of health care resource scarcity can be challenging. Single surgeon with ODD is a useful technique for achieving good results in these injuries.

Outcomes of Thoracolumbar Fracture-Dislocation Managed by Short-Segment and Long-Segment Posterior Fixation: A Single-Center Retrospective Study.

Long-segment posterior fixation has been used as a mainstay treatment of spine fracture-dislocations. Studies using short-segment posterior fixation in cases of thoracolumbar fracture-dislocation are limited. We describe our experience of 26 patients with thoracolumbar fracture-dislocation treated by short-segment or long-segment posterior spinal fixation and fusion. This is a single-center retrospective study of 26 patients with thoracolumbar fracture-dislocation treated by long-segment (group 1, n = 12) and short-segment posterior instrumentation (group 2, n = 14). Clinical (visual analog scale [VAS], Oswestry Disability Index [ODI]), neurological (American Spinal Injury Association [ASIA] scale), radiological (kyphotic angle, translational percentage, and displacement angle), and surgical (blood loss, operative time) outcomes and complications were recorded with each method. The mean follow-up period was 8.64 months (6-20 months). The mean duration of surgery was 3.92 ± 0.67 hours in group 1 and 3.21 ± 0.54 hours in group 2, and mean blood loss was 583.33 ± 111.5 mL and 478.6 ±112.2 mL in groups 1 and 2, respectively (P < .05). There was no radiologically visible pseudarthrosis, implant failure, or screw breakage in either group at follow up with no statistically significant difference between the 2 groups with regard to the radiological outcome (P > .05). Two patients in group 1 and 6 patients in group 2 improved after surgery at least 1 ASIA grade. VAS and ODI improved in both groups at the final follow up. Short-segment fixation can be used for treating fracture-dislocation patients, as it results in less blood loss, decreased intraoperative time, and saves fusion segments with similar radiological and clinical outcomes as long-segment fixation. 3.

Outcome of posterior decompression and posterior stabilisation in dorsolumbar spinal fractures

Background and objectives: Vertebral Fractures with spinal cord injury represents a devastating injury with potentially drastic effects on the patient’s life. The treatment options for unstable thoracolumbar spine fractures and fracture dislocations have long been controversial. Aim of the study was to access the commonest mode, level, type of fracture, efficacy of pedicle screw and rod system and the radiological, neurological and functional out come in order to recreate a stable pain free spinal column. Methods: This study is a prospective clinical study of unstable thoracolumbar spinal injuries by posterior instrumentation (pedicular screw and rod fixation in thoracic, lumbar, and thoracolumbar spinal fractures). In all, a total of 20 cases were evaluated and assessed during the period from January 2016 to January 2018. At the end of 6 month of follow up the patients were evaluated clinically by using Denis work scale. Results: In our study, we had 70% males and 30% female patients and average age was 37.55 years. Fall from height was the most common mode of injury with 65% followed by RTA with 30%. 70% of patients were T11-L2 level, 20% were between T1-T10, 10% were between L3-L5 levels. In our study we had of patients with 20% ASIA Grade-A, 25% with Grade Band 40% with Grade-C at admission and at latest follow up showed at least 1 ASIA Grade improvement. As per Denis work scale, 5 patients were in W1 category, 11 patients in W2 category, 2 patients in W3 category, and 2 patients in W4 category at the end of 6 months follow-up. Conclusion: From our study, we conclude that posterior decompression and posterior stabilisation is a safe, relatively easier and effective approach to the management of traumatic dorsolumbar spinal fractures.

Outcomes of Including Fracture Level in Short- Segment Fixation for Th oracolumbar Fracture Dislocation.

Study DesignThis was a prospective study of 50 patients of thoracolumbar fracture dislocation treated at a single institution with short-segment fixation with the inclusion of fracture level.PurposeTo assess the outcomes of including the fracture level in short-segment fixation for thoracolumbar fracture dislocation. Overview of LiteratureTraditionally, thoracolumbar fracture dislocation is treated with long-segment posterior fixation. However, to save motion segments, short-segment fixation has been used instead in many cases of thoracolumbar trauma.MethodsIn this study, 50 patients with thoracolumbar fracture dislocation were treated with short-segment fixation with inclusion of the fracture level; patients with pathological fractures or with a McCormack load-sharing score >6 were excluded. The 50 patients were prospectively followed for at least 1 year. The duration of surgery, blood loss, and complications were noted. The Visual Analog Scale (VAS) score was used to measure pain, and the American Spinal Injury Association (ASIA) scale was used to determine the neurological status at follow-up. Preoperative, immediate postoperative, and final follow-up X-rays were used to measure the kyphotic angle using Cobb’s method.ResultsThe mean age of our patients was 33.4 years, and the male:female ratio was 1.9:1. The mean follow-up period was 18.4 months (range, 12–23 months). Injuries were mainly at the thoracolumbar junction area (T11–L2, 41 cases, 82%). The average duration of surgery was 94.6 minutes, and the average blood loss was 394.8 mL. Postoperative infection occurred in two cases and implant failure in one case. The kyphosis angle values were as follows: average preoperative, 26.80°±14.50°; immediate postoperative, 4.30°±8.70°; and final follow-up, 5.50°±110°. The ASIA scale and VAS score at final follow-up showed improvement.ConclusionsInclusion of the fracture level in short-segment fixation for thoracolumbar fracture dislocation (McCormack load-sharing score ≤6) gives good kyphosis correction and correction maintenance. It can also obviate the need for traditional long-segment fixation.

Tranexamic Acid Decreases Visible and Hidden Blood Loss Without Affecting Prethrombotic State Molecular Markers in Transforaminal Thoracic Interbody Fusion for Treatment of Thoracolumbar Fracture-Dislocation.

A randomized, double-blind, placebo-controlled clinical trial. To evaluate the efficacy and safety of tranexamic acid (TXA) administered during the surgical correction of thoracolumbar fracture-dislocation. Thoracolumbar fracture-dislocation surgery is generally associated with substantial blood loss and a high risk of deep vein thrombosis. TXA has been shown to improve hemostasis in surgical procedures. We investigated 80 patients with thoracolumbar fracture-dislocation who underwent transforaminal thoracic interbody fusion between March 2014 and December 2016. The patients were randomized into the TXA (n = 39) and Placebo (n = 41) groups, according to whether they did or did not receive pre- and intraoperative TXA treatment. The two groups were compared for demographic characteristics as well as pre- and postoperative levels of prethrombosis-state molecular markers and visible and hidden blood loss volumes. Additionally, the prevalence of TXA-related complications was determined. The two groups did not differ significantly in demographic characteristics. The visible blood loss (intra- and postoperative bleeding during the first 24 h), hidden blood loss, and true total blood loss during surgery in the TXA group were significantly lower than those in the Placebo group (835 ± 180.3 mL, 351 ± 82.3 mL, 1385 ± 102.3 mL vs. 1155 ± 175.3 mL, 564 ± 170.5 mL, 1683 ± 121.0 mL, respectively; P < 0.01). Furthermore, the levels of the prethrombosis-state molecular markers GMP-140, fibrinogen, fibrin degradation products, and D-dimer were higher in the TXA group than in the Placebo group, although the differences were not significant (P > 0.05). No significant intergroup differences were noted in the prevalence of deep venous thrombosis and pulmonary embolus during the study period. TXA significantly reduced visible and hidden blood loss without affecting the prethrombosis-state molecular markers in transforaminal thoracic interbody fusion or causing any notable adverse effects. 3.

Medical and surgical management of acute spinal injury during pregnancy: A case series in a third-world country.

Background:There is scant literature describing the management of acute spinal injury in pregnant patients. Here, we report our experience with five cases of pregnant patients including three females who suffered acute traumatic spinal cord injuries (SCIs).Methods:This retrospective study evaluated five pregnant women presenting with traumatic spinal injuries over a 16-month period. All were assessed using the International Standards for Neurological Classification of Spinal Cord Injury Patients and the American Spine Injury Association Impairment Scale (AIS).Results:Three patients sustained SCIs: two cervical spine (C4 AIS-A and C5 AIS-B) and one thoracolumbar junction fracture dislocation (T11 AIS-A). Two patients required surgical stabilization during pregnancy, with one undergoing surgery after delivery. All three patients subsequently delivered healthy newborns. The remaining two patients without neurologic deficits at admission were treated conservatively; one had a healthy child, whereas the other patient aborted the baby due to the initial trauma.Conclusions:Our study demonstrates that the same surgical principals may be applied to pregnant women as to routine patients with SCIs. Further studies with greater patient data should be performed to better develop significant guidelines for the management of pregnant patients with spinal injuries.

P213 - Posterior Reduction and Stabilization for the Treatment of Complete Thoracolumbar Fracture-Dislocations with Minimum Four-Year Follow-Up

P213 - Posterior Reduction and Stabilization for the Treatment of Complete Thoracolumbar Fracture-Dislocations with Minimum Four-Year Follow-Up

Posterior lumbar interbody fusion and internal fixation for complete thoracolumbar fracture and dislocation

Objective To investigate the clinical features, safety and clinical efficacy of the posterior decompression and interbody fusion with internal fixation for complete thoracolumbar fracture and dislocation. Methods The clinical data of 23 patients with complete thoracolumbar fracture and dislocation treated by posterior decompression and interbody fusion with pedicle screw fixation from August 2011 to October 2014 were retrospectively analyzed. There were 18 males and 15 females, aging from 20 to 50 years old with an average age of 38.2±0.3 years. There were 8 cases of T10,11 vertebral dislocation, 8 of T11,12 vertebral dislocation, 3 of T12L1 vertebral dislocation, and 4 of L1,2 vertebral dislocation. All the patients had different degrees of multiple rib fractures and pneumothorax complications. Preoperative spinal cord nerve function was evaluated according to the American Spinal Injury Association of spinal cord function (ASIA). There were 10 cases of ASIA grade A and 13 cases of grade B. Operation time, intraoperative blood loss, clinical outcome, imaging X-ray and CT examination, segmental kyphosis angle and bone graft fusion were recorded. Results All the patients were followed up for 13 to 26 months, average 20.2±4.3 months. The operation time ranged from 150 to 260 min with the average time of 180.3±14.8 min; intraoperative blood loss was 800-1 500 ml with the average of 950.2±98.1 ml. Preoperative sagittal Cobb angle was -13.5°±6.3° (range, -20.1° to 2.3°); postoperative sagittal Cobb angle was 1.43°±6.4° (range, -7.6° to 3.5°); at the latest follow-up, sagittal Cobb angle was 1.6°±6.3° (range, -8.1° to 10.3°); the dislocation reduced from preoperative 100% to postoperative 0-15% (10%±6%) . After operation, the ASIA grade of 2 cases improved from A to B, and 5 cases improved from B to C. All of the patients had bone fusion after operation, no false joint or nonunion occurred, no loosening or breakage of internal fixation occurred. Conclusion There are high risks and difficulty of surgery for those who with thoracolumbar fracture dislocation and severe injuries of spine and spinal cord combined with multiple injuries. Proper treatment of preoperative complications is the premise of good curative effect; reliable fusion and long segment internal fixation is the key of operation. Single posterior decompression and reduction with interbody fusion and internal fixation is less invasive and could achieve satisfactory clinical efficacy. Key words: Thoracic vertebrae; Lumbar vertebrae; Spinal fractures; Dislocations; Spinal fusion

Factors predicting long-term outcome after short-segment posterior fixation for traumatic thoracolumbar fractures.

Background:The “gold standard” for instrumentation of unstable thoracolumbar fracture-dislocations is pedicle screw and rod fixation. Although traditional treatment supports long-segment posterior fixation (LSPF), more recent studies show short-segment posterior fixation (SSPF) may be effective, but incur higher failure rates. Here, we evaluated the effectiveness of SSPF in the management of unstable thoracolumbar injuries and analyzed the factors impacting long-term outcomes.Methods:In this retrospective analysis of 91 patients with thoracolumbar fractures managed with SSPF alone, we assessed the clinical and radiological parameters at preoperative, postoperative, and follow-up intervals along with reasons for failures of SSPF.Results:We analyzed 91 patients (mean age: 33.5 years; Male: Female = 50:41) with thoracolumbar fractures treated with SSPF over a median follow-up period of 30 months. SSPF failures were observed in 26 of 91 (28.6%) patients; the median time to implant failure was 17 months. On univariate analysis, statistically significant factors contributing to failure of SSPF included the presence of a burst fracture, a preoperative LSC (load-sharing classification) score >6, and translation/dislocation. With multinomial regression analysis, the only factor predictive for SSPF failure was the patients' postoperative ambulatory status.Conclusion:Patients with thoracolumbar facture dislocations, subjected to axial spinal loading postoperatively, should not be considered for SSPF alone. The following factors also contributed to SSPF failures: a burst fracture, a preoperative LSC score of >6, and/or presence of transverse dislocation.

Anterior Approach for Thoracolumbar Fracture Dislocations: Surgical Management in Poor Resource Region, Record of 7 years Follow-up

Introduction: Thoracolumbar fracture dislocation is a trauma of high energy which generally is treated with longsegment stabilization. Anterior spine exposure may be used alone or in combination with a posterior midline approach in a staged or sequential fashion. In this study, we report the 7-years’ experience of the anterior approach to the thoracolumbar spine fracture dislocations at a single institution. Patients and methods: Over a 7-year period (2007–2014), 15 patients (9 males and 7 females) with a mean age of 41.1 years ranging between 25 and 61 years, were operated on using an anterior approach at our institution. All patients were submitted to standard anterior spine surgery, thoracotomy (in 9 patients), thoracophrenolumbotomy (in 3 patients) and lumbotomy (in 2 patients), one patient required left thoracotomy alone. In all cases, we used heavy duty plate fixation and autologous bone (rib or vertebral bone) inside the cylinder. The criteria for surgical intervention were: partial or progressive neurologic deficit, kyphotic angulation =25o at one segment, progressive kyphosis, lesion with a loss of 50% of vertebral height with angulation and a residual canal diameter 50% of normal. All patients had a failure of the anterior and middle columns as viewed on a CT scan or MRI if available. Results: The average duration of follow-up was 24 months. One patient died during the follow-up period. Concerning ethiology, there were two types of vertebral body lesions, which were traumatic and infectious. There were also 12 patients with traumatic lesions. The mean age was 41.1 years (range 25-61). There were 10 males and 5 female patients. Six patients had a burst fracture (type A3), with compression failure of the anterior and middle columns of the spine (level T12 in 3, level T11 in 1, level L1 in 2,). All patients with traumatic lesions underwent singlestage anterior fixation by heavy duty conventional plate and screw and the gap filled with autograft (rib and morselized vertebral bone). Three patients were operated because of the thoracic and lumbar tuberculous spondylitis and Hydatid cyst (one patient T9, one at T10, one T5). Discussion: Initial reports of the anterior thororacotomic approach to the thoracic spine were related to Pott’s disease, spine surgery innovations and aging with a more active population resulting in a progressive increase in spine instrumentation. The main indication for anterior decompression is an incomplete neurological injury with radiographically demonstrated neural compression by bone or disk fragments. The anterior surgical treatment allows direct decompression of the neural elements and correction of the deformity. Conclusion: The anterior approaches provide excellent exposure of the relevant bony anatomy and can be used to secure anterior column support with bony fusion. Anterior spinal fusion surgery is a safe procedure and can be used with confidence when the nature of a patient’s spinal disorder dictates its use.

Surgery for severe thoracolumbar fracture dislocation via a posterior approach

Between June 2008 and June 2013, our department treated 16 severe thoracolumbar fracture dislocations (13 male and three female patients; mean age 33.6years) with a pedicle screw system via an entirely posterior approach. We followed all patients for 18–69months (mean 35months). The mean operation time was 170minutes (range: 120–280), and mean blood loss was 700ml (range: 450–1300). The percentage displacement (mean±standard deviation) improved from a preoperative value of 72±20% to 10±6% postoperatively, and the deformity angle (mean±standard deviation) improved from 29.2±15.0° to 12.6±6.7°. Of the six patients with American Spinal Injury Association Grade A, one improved to Grade B, one to Grade C and four had little improvement. Of the five patients with Grade B, three improved to Grade C and two to Grade D. Of the four Grade C patients, two improved to Grade D, and the other two to Grade E. One Grade D patient improved to Grade E. No loosening or breakage of the internal implants occurred in the follow-up period. Therefore, we conclude that although it is difficult, the posterior approach alone is safe and biomechanically reliable for treating severe thoracolumbar fracture dislocations. The maintenance of deformity correction and stable local mechanical reconstruction in the follow-up period support this single approach strategy.

Single-stage posterior vertebral column resection and internal fixation for old fracture-dislocations of thoracolumbar spine: a case series and systematic review.

To evaluate the efficacy of single-stage posterior vertebral column resection for old thoracolumbar fracture-dislocations with spinal cord injury. From January 2007 to June 2013, twelve male patients (average age, 32.6years; range 19-57years) with old fracture-dislocations of the thoracolumbar spine and spinal cord injury underwent single-stage posterior vertebral column resection and internal fixation. All patients were assessed for relief of the pain and restoration of neurologic function. Postoperative Cobb angle was measured and bone graft fusion was evaluated by X-ray. A systematic review of 25 studies evaluating surgical management of thoracolumbar fractures with spinal cord injuries was also performed. From our case series, six of the nine patients with Frankel grade A had significant improvement in urination and defecation after surgery. The three patients with Frankel grades B and C had progression of 1-2 grades after surgery. Bony fusion was achieved and local back pain was relieved in all patients after surgery. From our systematic review of 25 studies, the majority of patients had improved back pain, the postoperative kyphotic angle was significantly reduced compared with pre-operative kyphotic angle. Single-stage posterior vertebral column resection and internal fixation for old thoracolumbar fracture-dislocations is an ideal treatment allowing for thorough decompression, relief of pain, correction of deformities, and restoration of spinal stability. IV.

Partial vertebrectomy with vertebral shortening for thoraco-lumbar fracture-dislocation. Case report and technical note

AbstractThoraco-lumbar fracture-dislocations represent one of the most instable lesions and are frequently associated with neurological deficit. We present a patient with a T11 - T12 fracture-dislocation with complete neurological deficit - ASIA - A, who underwent partial vertebrectomy, shortening of the spine and posterior instrumentation 21 days after a motor vehicle accident.

Abdominal aortic rupture from an impaling osteophyte following blunt trauma

Blunt injury of the abdominal aorta is highly fatal. We present an unusual case of an osteophyte impaling the abdominal aorta treated by endovascular repair. A 77-year-old man sustained a thoracolumbar fracture-dislocation with posterior aortic rupture between his celiac and superior mesenteric artery origins. His aortic injury was treated with a stent graft, excluding the celiac origin. He was dismissed on postoperative day 6. At 6 months, he had returned to most preinjury activities, and at 2-year follow-up, he continues to have good functional outcome. Endovascular repair may be successfully employed in select aortic injuries in hemodynamically stable patients.