The complications and management of posterior three-column reconstruction in unstable thoracolumbar burst fracture

English Keywords:Spinal fractures  Thoracolumbar vertebrae  Decompression  Complication

English Abstract:

  【Abstract】 Objectives: To analyze the cause and treatment of the postoperative complications by using three-column reconstruction through single posterior approach for the treatment of unstable thoracolumbar burst fracture. Methods: Form April 2009 to November 2014, 97 patients with unstable thoracolumbar burst fractures were involved, among them there were 74 males and 23 females, aged 26-68 years old(33.1 in average). 29 cases suffered from bruise injury caused by heavy object, 14 suffered from falling injury and 21 suffered from vehicle accident injury, 16 were complicated with vital organ injury. 12 cases suffered from old fracture. T11 was involved in 5 cases, T12 in 16 cases, L1 in 31 cases, L2 in 29 cases, L3 in 10 cases and L4 in 6 cases. The intra- and post-operative complications were summarized, and the relevant management undertaken was evaluated. Results: 39 complications were noted in 21 cases. The causes were as follows, excessive blood loss(＞1500ml) in 17 cases, transient nerve root injury in 10 cases, nerve root rupture in 2 cases, cerebrospinal fluid leakage in 3 cases, mesh cage displacement in 3 cases, and superficial infection in 2 cases. All complications got good relief after surgical exploration, blood transfusion, Methylprednisolone and neurotrophic drugs, anti-infection and symptomatic treatment. All 21 patients were followed up from 2 to 53 months(average, 23.27±3.10 months), neurological complications recovered from 1 week to 3 months, bone graft fusion was achieved and cerebrospinal fluid leakage had been cured in 1 stage. Conclusions: The three-column reconstruction through single posterior approach is a safe and effective technique for the treatment of unstable thoracolumbar burst fracture. The complications should be managed cautiously, and the results are promising after proper intervention.