Treatment of thoracolumbar fracture with nerve injury by laminotomy decompression and internal fixation through posterior channel or open surgery

English Keywords:Thoracolumbar burst fractures  Lamina space  Percutaneous pedicle screws  Bone graft

English Abstract:

  【Abstract】 Objectives: To investigate the efficacy of treatment of thoracolumbar fracture with nerve injury by laminotomy decompression and internal fixation through posterior channel or open surgery. Methods: 66 cases of thoracolumbar fracture with nerve injury were recruited from January 2013 to March 2016, 31 cases(male, 23; femal, 8) underwent posterior minimal invasive decompression combined with percutaneous pedicle screw fixation(Mini-group), and 35 cases(male, 25; femal, 10) underwent traditional open posterior decompression and pedicle screw fixation(Open-group). The basic clinical data(age, sex ratio, injury mechanism, spinal distribution, Denis classification, ASIA classification and preoperative VAS score) of the two groups were analyzed and the imaging parameters were followed up: the spinal canal patency rate(SCP), percentage of anterior vertebral height of injured vertebra(AVH), and the Cobb angle(CA). Results: There were no significant differences between two groups of basic clinical data(P>0.05). The results of two groups showed that the nerve injury recovered well and no serious operative complications occurred. Mini-group achieved 26.58±5.98(14-38) months follow-up, and Open-group achieved 27.09±6.73(16-44) months(P>0.05). There was no statistically significant difference(P>0.05) between two groups in operation time or bone grafting mass. But the intraoperative hemorrhage(359.68±159.22ml vs 514.86±246.09ml), autologous blood transfusion(7 vs 17 cases), analgesics usage(12 vs 23 cases), hospitalization(9.48±2.72d vs 11.51±3.27d) and postoperative VAS score(3.77±1.28 vs 4.97±1.44) were better in Mini-group, compared with those of Open-group, the differences were statistically significant(P<0.05). In two groups, at 1 week, 3 months and final follow-up, the SCP, AVH and CA improved compared to those before operation, and there were statistical differences(P<0.05). But there was no significant difference in SCP, AVH or CA between two groups(P>0.05). Conclusions: For thoracolumbar fracture with severe spinal stenosis and nerve injury, minimally invasive nailing by small incision approach for decompression, bone grafting and internal fixation, as well as the traditional open surgery achieve good curative effect. Nevertheless, minimally invasive surgery has more advantages in reducing surgical trauma, bleeding volume and drainage volume.