Modified 270° spinal canal decompression with one-stage pedicle screw fixation and reconstruction of anterior and middle vertebral column for severe thoracolumbar vertebral fractures

English Keywords:Thoracolumbar fractures  Spinal canal decompression  Internal fixation  Pedicle scerw

English Abstract:

  【Abstract】 Objectives: To explore the feasibility and clinical efficacy of modified 270° spinal canal decompression with one-stage pedicle screw fixation and reconstruction of anterior and middle vertebral column for severe thoracolumbar vertebral fractures. Methods: A total of 21 patients with severe thoracolumbar vertebral fractures were treated from January 2011 to December 2013. There were 15 males and 6 females, with an average age of 36.1±14.8 years(range, 20 to 64 years). The cause of injury included falling injury in 13 cases, traffic accident injury in 6 cases, crush injury in 2 cases. The lesion site included T11/12 in 2 cases, T12/L1 in 6 cases, L1/2 in 7 cases, L2/3 in 4 cases, L2-L4 in 1 case and L3/4 in 1 case. According to the AO classification, there were 13 cases of type B2, 8 cases of type C. Patients all received modified 270°spinal canal decompression with one-stage pedicle screw fixation and reconstruction of anterior and middle vertebral column. The height of anterior edge of injured vertebral body, Cobb angle at the site of injury and the change of spinal canal compromise were compared before and after surgery. Bone fusion, spinal canal reconstruction, failure of instruments were evaluated. ASIA(2000) scoring standard was used to evaluate the functional recovery of spinal cord. Results: The operation time, intraoperative blood loss and volume of postoperative wound drainage were 120-180min(average 145±19.2min), 800-2200ml (average 1320±476.5ml) and 250-580ml(average 398±127.5ml) respectively. No wound infection, cerebrospinal fluid leakage, spinal nerve injury or neurological function deterioration was found after operation. All the patients were followed up for 12-36 months(average, 21.5±9.7 months) except one case who was lost of follow-up. All the patients obtained satisfactory bone fusion around the titanium mesh and received bone fusion at the surface of spinal canal with the good integrity of spinal canal. There were significant differences in the height of injured vertebral anterior edge, the Cobb angle of spine and spinal canal compromise between before and after surgery. But no significant difference in these indices was observed during the last follow-up compared to those immediately after surgery. There was no loosening, breakage of pedicle screws or displacement of titanium mesh. Dural calcification was found in one case. At the last follow-up, the neurological function of spinal cord did not change in one patient, as graded A according to ASIA scoring standard. Neurological function recovered to graded 1-2 in the other patients. Conclusions: The modified 270° spinal canal decompression with one-stage pedicle screw fixation and reconstruction of anterior and middle vertebral column can be the preferred method in treatment of severe thoracic and lumbar vertebral fractures with spinal canal compromise, it has the advantages of less trauma, perfect decompression, good stability, etc.