OTA 1997 Posters - Spine Fractures

Surgical Management of Thoracolumbar Fractures

Robert Lifeso, MD, Michael Ostempowski, MD, Christopher Hamill, MD

Erie County Medical Center, Buffalo, New York, USA

Purpose: To assess the results of posterior spinal stabilization procedures in fractures at the thoracolumbar junction.

Method: One hundred thirty patients presenting to a Level 1 spinal cord injury unit with fractures or fracture dislocation at the thoracolumbar junction were retrospectively reviewed at a minimum of 2 years post injury. Seventy patients underwent posterior spinal stabilization, sixty patients were treated conservatively with thoracolumbar orthoses. Of the seventy patients with posterior stabilization, sixty-two were available for follow up at a minimum of 2 years. Fractures were classified as flexion distraction, i.e., chance and/or true double jump facet. Flexion compression: primarily anterior and posterior column injuries and unstable burst, i.e., 3 column injuries. Flexion distraction injuries did very well with open reduction and one level stabilization utilizing pedicle screws. Flexion compression injuries involving failure of the anterior and posterior columns did less well with posterior stabilization and 50% of these required further treatment or developed unacceptable late postoperative kyphosis. True unstable burst, i.e., 3 column injuries, did well with posterior stabilization and posterior vertebral body impaction.

Technical problems primarily occurred in the flexion compression group and in this group we recommend a minimum of 2 levels above the fracture be stabilized with pedicle screws, 1 level below be stabilized with screws augmented by sublaminar hooks. If postoperatively there is evidence that the anterior vertebral body height has not been reconstituted then an anterior stabilization procedure is warranted. Technical errors occurred primarily in the flexion compression group, and in this group short fusions had a failure rate of 50% where the anterior column was not restored.

Conclusions: Flexion distraction injuries do well with single level fusions, 3 column burst fractures - 80% did well with posterior fusions plus vertebral body impaction, major complications occurred in flexion compression injuries where the anterior body was not reconstituted by posterior distraction and we would recommend in this group fusion should entail at least 2 levels above and 1 level below augmented by sublaminar hooks or anterior stabilization.