Abstract
Introduction
Surgical treatment strategies for thoraco-lumbar spine fractures differ widely around the world. Choice of operative approach varies depending on many factors including fracture classification, presence of spinal cord injury and whether subluxation or dislocation is present. Combinations of anterior and posterior approaches vary depending on surgeon choice, available resources and fracture morphology. We reviewed our experience of thoraco-lumbar vertebral fractures treated at our institution from Jan 14 – May 2015 to determine if our policy of posterior multi- level segmental fixation produced acceptable restoration of spinal alignment and reduction of kyphosis.
Materials and Methods
A retrospective cohort review was performed using the hospital electronic medical records system (Cerner, USA). All surgical cases were identified from the operating theater records. Only fractures from T1 to L5 were included. Imaging was reviewed using the hospital PACS system and classified according to the AO thoraco -lumbar classification system. Spinal cord injury was classified according to the ASIA scale. Post-operative images were reviewed and levels of fixation recorded. Accuracy of screw placement was assessed. Neurological status at discharge was recorded.
Results
135 cases of TL fracture underwent surgery via an open posterior approach. Screw placement was performed using C-arm fluoroscopy.Data on the extent of kyphosis reduction is presented. Post-operative results in cases of vertebral subluxation and dislocation are presented. Early surgical outcome in cases with spinal cord injury are presented. Due to the high level of loss to follow up in our region we were unable to carry out longitudinal outcome studies.
Conclusion
The majority of thoraco -lumbar fractures can be managed by posterior approaches alone with good surgical outcomes. Type C fractures and fractures with dural tears and nerve damage can be adequately dealt with via this approach. The majority of cases had pedicle screw fixation two levels above and one level below the affected level. This strategy allowed good reduction of deformity, especially for fractures at L1, where fixation only to T12 can be associated with late onset of adjacent segment degeneration.The inability to carry out longitudinal outcome measures is an acknowledged weakness of our study, but the short-term surgical results are comparable to those in the literature using other surgical strategies. This retrospective cohort review supports our continuing use of the posterior multi-level segmental approach for T-L fractures irrespective of fracture type.