Valles-Mata EM, Ugalde-Hernández E

Language: Spanish
References: 16
Page: 292-297
PDF size: 123.64 Kb.

ABSTRACT

Introduction: Acute traumatic lesions of the thoracolumbar segment and spinal cord are a serious cause of disability and death. The diagnosis may be delayed and non-standardized or inappropriate with the resulting increase in problems; one of the great treatment advances has been the anterior and anterolateral surgical approach. Objective: Perform a clinical-radiological assessment of patients with a diagnosis of thoracolumbar segment fracture who underwent anterolateral instrumentation and vertebral body replacement with a cage and graft, and compare their pre- and postoperative status. Material and methods: An observational, longitudinal, cross-sectional, retrospective, descriptive, open study was conducted of four patients enrolled between July and December 2001; all of them had a diagnosis of thoracolumbar segment fracture and underwent decompression treatment, vertebral body replacement and anterolateral instrumentation; they all presented at the Emergency Service. Results: The patients were seen in the outpatient service at postoperative month 2. An important improvement was observed in the two patients over 60 years of age (63 and 69 years old), who went from preoperative ASIA «D» to postoperative ASIA «E», muscle strength was 4/5, and they had independent gait without claudication. Since their bone healing was appropriate, the Jewett constructs were removed at 4 months. Thoracolumbar segment lesions are common in patients of productive ages and a delayed diagnosis and stabilization with internal fixation further compromise the spinal canal. Our study shows that more patients may benefit from an appropriate surgical management as well as from a multidisciplinary team approach.

REFERENCES

1. Rothman-Simeone: Columna Vertebral 4ta edición. Mc Graw-Hill Interamericana Editores: 2000: 1177-9.

2. Knop C, Fabian H: Late results of thoracolumbar fractures after posterior instrumentation and transpedicular bone grafting. Spine 2001; 26: 1888-99.

3. Garfin SR, Mowery CA, Guerra J, Marshall LF: Confirmation of the posterolateral technique to decompress and fuse thoracolumbar spine burst fractures. Spine 1985; 10: 218-28.

4. Vaccaro AR, Kim D: Diagnosis and management of thoracolumbar spine fractures. J Bone Joint Surg 2003; 85-A(12): 2456-70.

5. Bradford DS: Columna, Master de Cirugía Ortopédica. 1999. Lippincott-Raven publishers 227 East Washington Square Philadelphia, 19106-3780: 471-486.

6. Cambell WC: Cirugía Ortopédica 9ª. Edición, Mosby-Year Book: 1996: 2749-90.

7. Chapman J, Anderson P: Thoracolumbar spine fractures with neurologic deficit. Orthop Clinics North Am 1994; 25(4): 595-612.

8. Garfin SR, Vaccaro AR: Orthopaedic knowledge update spine. Copyright 1997. 1a edición for JAAOS. 1997: 209-17.

9. Mc Lane R: Functional outcomes after surgery for spinal fractures: Return to work and activity. Spine 2004; 29(4): 470-7.

10. Parker J, Lane J: Successful short-segment instrumentation and fusion for thoracolumbar spine fractures. Spine 2000; 25(9): 1157-69.

11. Reyes-Sánchez A, Miramontes V, Rosales L: Tratamiento de las fracturas, estallamiento toracolumbar mediante acortamiento vertebral. Rev. Méx Ortop Trauma 1996; 10(6): 259-62.

12. Spivak J, Vaccaro A: Thoracolumbar spine trauma: I. Evaluation and classification. J Am Acad Orthop Surg 1995; 3: 345-52.

13. Spivak J, Vaccaro A: Thoracolumbar spine trauma: II. Principles of management. J Am Acad Orthop Surg 1995; 3: 353-60.

14. Stryker, Spine: Técnica quirúrgica del sistema Centaur. 2005.

15. Vargas H, Anaya S: Resultados del tratamiento quirúrgico con injerto transpedicular en las fracturas, estallamientos toracolumbares. Rev Méx Ortop Trauma 1996; 10(6): 263-71.

16. Tamara N, Sánchez D, Anaya S: Aplicación de la clasificación compresiva de las fracturas toracolumbares de la AO y determinación de su funcionalidad. Rev Méx Ortop Trauma 2000; 4(1): 16-24.