Anterior fixation of thoracolumbar traumatic spinal injuries. 2015

Mariusz Kaliciński, and Andrzej Szczęśniak, and Jakub Kalisz, and Maciej Tęsiorowski
University Department of Orthopedics and Hospital Department of Orthopedics and Rehabilitation at the Jagiellonian University Medical College.

BACKGROUND Traumatic spinal fractures require surgical treatment to restore the anatomical curvatures of the spine and release the nervous structures. However, uniform management guidelines have not been established and thus the literature includes papers focussing only on the posterior techniques as well as those assessing the anterior or anteroposterior approaches. This paper presents the outcomes of the treatment of spinal fractures with anterior and anteroposterior fixation. METHODS The study enrolled 48 patients. The age of the patients at the time of injury was 36.8 years on average and the mean follow-up period was 3.8 years. All the fractures were unstable and caused stenosis of the spinal canal lumen. We used anterior or combined anterior and posterior approaches with a titanium implant in all the cases. Radiological assessment involved determination of the monosegmental and bisegmental Cobb angle, and the neurological status was evaluated according to the Frankel classification. RESULTS The mean post-traumatic monosegmental angle was -17.1°, compared to -9.1° post-operatively and -9.2° at followup. The bisegmental angle was -12.7° at baseline, -7.9° post-operatively, and -8° in the follow-up period. Neurological assessment showed no neurological deficits in 27 patients while 2 persons had complete limb paralysis and the other 19 patients had various degrees of neurological deficits. The last follow-up examination did not show any improvement with respect to the neurological status of the patients with complete paralysis. However, an improvement of at least 1 Frankel group was noted in 15 patients with partial neurological deficits. CONCLUSIONS 1. The most common causes of traumatic spinal injuries are falls from a height and road accidents. 2. fractures occur most often at the thoracolumbar junction of the spine. 2. Anteroposterior fixation with release of the spinal canal and spinal fusion is a beneficial treatment method. 3. Apart from vertebral body mesh, treating lumbar spine fractures requires the additional use of vertebral body screws or transpedicular posterior fixation. 4. Anterior fixation ensures the restoration of the physiological curvatures of the spine and stabilizes the spine until a complete bone union is achieved, preventing the loss of correction during the follow-up period.

UI MeSH Term Description Entries
D008159 Lumbar Vertebrae VERTEBRAE in the region of the lower BACK below the THORACIC VERTEBRAE and above the SACRAL VERTEBRAE. Vertebrae, Lumbar
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D005260 Female Females
D005500 Follow-Up Studies Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease. Followup Studies,Follow Up Studies,Follow-Up Study,Followup Study,Studies, Follow-Up,Studies, Followup,Study, Follow-Up,Study, Followup
D005592 Fracture Fixation The use of metallic devices inserted into or through bone to hold a fracture in a set position and alignment while it heals. Skeletal Fixation,Fracture Reduction,Fixation, Fracture,Fixation, Skeletal,Fixations, Fracture,Fixations, Skeletal,Fracture Fixations,Fracture Reductions,Reduction, Fracture,Reductions, Fracture,Skeletal Fixations
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D013123 Spinal Fusion Operative immobilization or ankylosis of two or more vertebrae by fusion of the vertebral bodies with a short bone graft or often with diskectomy or laminectomy. (From Blauvelt & Nelson, A Manual of Orthopaedic Terminology, 5th ed, p236; Dorland, 28th ed) Spondylodesis,Spondylosyndesis,Fusion, Spinal,Fusions, Spinal,Spinal Fusions,Spondylodeses,Spondylosyndeses
D013904 Thoracic Vertebrae A group of twelve VERTEBRAE connected to the ribs that support the upper trunk region. Vertebrae, Thoracic

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