Alpizar-Aguirre A, Riquelme-Molina LM, Zárate-Kalfopulos B, Sánchez-Bringas G, Rosales-Olivares LM, Reyes-Sánchez A

Language: Spanish
References: 34
Page: 39-44
PDF size: 582.98 Kb.

ABSTRACT

Introduction: The currently accepted treatment of thoracolumbar fractures is reduction, decompression, fixation and arthrodesis. However, it is not the perfect solution due to the medium- and long-term consequences of arthrodesis, which include the wear of the adjacent segments above and below. Some previous studies have proposed the treatment with fixation without arthrodesis. However, there are no reports on the medium- and long-term clinical and radiographic follow-up. Material and methods: Two 20-patient groups treated with transpedicular fixation and decompression, one with and one without posterolateral arthrodesis, were compared. Results: Control group: The mean hospital stay was 5 days. The postoperative visual analog scale pain score was 2-3 in 4 patients; the rest were asymptomatic. The functional Oswestry disability index was 8.3%. The functional economic rehabilitation scale was 4.55. Case group: The mean hospital stay was 5 days. The postoperative visual analog scale pain score was 1-2 in 2 patients; the rest were asymptomatic. The functional Oswestry disability index was 6.3%. The functional economic rehabilitation scale was 6.4. Conclusions: Both groups had very similar results. The group without arthrodesis had better results in the Oswestry functional disability scale and the functional economic rehabilitation scale.

REFERENCES

1. Yi L, Jinping B, Gele J, Baoleri X, Taixiang W: Tratamiento quirúrgico versus no quirúrgico para las fracturas toracolumbares por compresión axial sin déficit neurológico. Biblioteca Cochrane Plus 2008; 2: 1-17.

2. Vacaro AR, Lehman RA, Hurlbert RJ, Anderson PA, Harris M, Hedlund R, et al: A new classification of thoracolumbar injuries. The importance of injury morphology, the integrity of the posterior ligamentous complex and neurologic status. Spine 2005; 30(20): 2325-33.

3. Tamara NG, Sánchez D, Anaya S: Aplicación de la clasificación de las fracturas toracolumbares de la AO y determinación de su funcionalidad. Rev Mex Ortop Traum 2000; 14(1): 16-24.

4. Davidson M, Sci BA, Keating JL, Eyres S. A low back-specific version of the SF-36 physical functioning scale. Spine 2004; 29(5): 586-94.

5. Dai LY, Jin WJ: Interobserver and intraobserver reliability in the load Sharing classification of the assessment of thoracolumbar burst fractures. Spine 2005; 30(3): 354-8.

6. Dai LY, Wang XY, Jiang LS, Jiang SD, Xu HZ: Plain radiography versus computed tomography scans in the diagnosis and management of thoracolumbar burst fractures. Spine 2008; 33(16): E548-52.

7. Patel AA, Vaccaro AR, Albert TJ, Hilibran AS, Harrop JS, Anderson DG, et al: The adoption of a new classification system: Time-Dependent Variation in Interobserver Reliability of the thoracolumbar injury severity score classification system. Spine 2007; 32(3): E105-10.

8. Majerl F: Comprehensive classification of thoracic and lumbar injuries. Eur Spine J 1994; 3(4): 184-201.

9. Ohana N, Sheinis D, Rath E, Sasson A, Atar D: is there a need for lumbar orthosis in mild compression fractures of the thoracolumbar spine? A retrospective study comparing the radiographic results between early ambulation with and whithout lumbar orthosis. Journal of Spinal Disorders 2000; 13(4): 305-8.

10. Korovessis P, Repantis T, Petsinis G, Iliopoulos P, Hadjipavlou A: Direct reduction of thoracolumbar burst fractures by means of balloon kyphoplasty with calcium phosphate and stabilization with pedicle-screw instrumentation and fusion. Spine 2008; 33(4): E100-8.

11. Tropiano P, Huang RC, Louis CA, Poitout GD, Louis RP: Functional and radiographic outcome of thoracolumbar and lumbar burst fracture managed by closed orthopedic reduction and casting. Spine 2003; 28(21): 2459-65.

12. Verlann JJ, Diekerhof CH, Buskens E, Twewl IV, Verbout AJ, Dhert WJA, Oner FC: Surgical treatment of traumatic fracture of the thoracic and lumbar spine. Spine 2004; 29(7): 803-14.

13. Sasso RC, Renkens K, Hanson D, Reilly T, McGuire RA, Best NM: Unstable thoracolumbar burst fracture. Anterior-only versus short-segment posterior fixation. J Spinal Disord Tech 2006; 19(4): 242-8.

14. Rosales L, Solorio A, Miramontes V, Alpizar A, Arenas M, Reyes-Sánchez A: Resultados del tratamiento de fracturas torácicas y lumbares. Comparación de artrodesis versus no artrodesis. Reporte preliminar. Coluna/Columna 2006; 6(2): 68-72.

15. Roer N, Lange E, Bakker F, Vet H, Tulder M: Management of traumatic thoracolumbar fractures: A systematic review of the literature. Eur Spine J 2005; 14: 527-34.

16. Yurac R, Marre B: Residual mobility of instrumented and non-fused segments in thoracolumbar spine fractures. Eur Spine J 2006; 15(6): 864-75.

17. Katonis PG, Kontakis GM: Treatment of unstable thoracolumbar and lumbar spine injuries using cotrel-dubousset intrumentation. Spine 1999; 24(22): 2352-7.

18. Kramer DL, Rodgers WB, Mansfield FL: Transpedicular instrumentation short - segment fusion of thoracolumbar fractures: a prospective study using a single instrumentation system. Orthop Trauma 1995; 9(6): 499-506.

19. Knop C, Fabian HF, Bastian L, Blauth M: Late results of thoracolumbar fractures after posterior instrumentation and transpedicular bone grafting. Spine 2001; 26(1): 88-99.

20. Gullung G, Theiss SM: Thoracolumbar spine: Surgical treatment of thoracolumbar fractures: Fusion versus nonfusion. Current Orthopaedics Practice 2008; 19(4): 383-7.

21. Parker JW, Lane JR, Karaikovic EE, Gaines RW: Successful short–segment instrumentation and fusion for thoracolumbar spine fractures: a consecutive 41/2 series. Spine 2000: 25(9): 1157-70.

22. Wend, Tsung-Jen L, Young-Shig S: Nonoperative treatment versus posterior fixation for thoracolumbar junction burst without neurologic deficit. Spine 2001; 26(9): 1038-45.

23. Daniels A, Arthur M, Hart R: Variability in rates of arthrodesis for patients with thoracolumbar spine fractures with and without associated neurologic injury. Spine 2007; 32(21): 2334-8.

24. Yurac R, Marre B, Urzua A, Munjin M, Lecaros MA: Residual mobility of instrumented and non-fused segments in thoracolumbar spine­fractures. Eur Spine J 2006; 15(6): 864-75.

25. Mc Lain R, Sparling E, Benson D: Early failure of short-segment instrumentation for thoracolumbar fractures. A preliminary report. J Bone Joint Surg Am 1993; 75(1): 162-7.

26. Jacobs R, Asher M, Snider R. Thoracolumbar spinal injuries. A comparative study of recumbent and operative treatment in 100 patients. Spine 1980; 5(5): 463-77.

27. Knop C, Blauth M, Buhren V, Hax PM: Surgical treatment of injuries of the thoracolumbar transition 1: epidemiology. Unfallchirug 1999; 102(12): 924-35.

28. Daniux H, Seykora P, Genelin A, Lang T, Kathhrein A: Application of posterior plating and modifications in thoracolumbar spine injuries indication techniques and results. Spine 1991: 16 (Suppl); S125-33.

29. Louis CA, Gauthier VY, Louis RP: Posterior approach with Louis plates for fractures of the thoracolumbar and lumbar spine with and without neurologic deficits. Spine 1998; 23(18): 2030-9. Discussion 2040.

30. Escriba RI, Bonete LDJ, Mudarra GJ: Tratamiento quirúrgico de las fracturas toracolumbares: Osteosíntesis de la vértebra fractura. Rev Ortop Traumatol 2000; 6: 513-8.

31. Holmes JF, Miller PQ, Panacek EA, Lin S, Horne NS: Epidemiology of thoracolumbar spine injury in blunt trauma. Acad Emerg Med 2001; 8(9): 866-72.

32. Delfino HL, Scarparo P: Fractures thoracolumbar spine: monosegment fixation. Injury 2005; 36 (Suppl 2B): 90-7.

33. Etebar CDW. Risk factors for adjacent segment failure following lumbar fixation with rigid instrumentation for degenerative instability. J Neurosurg 1999; 90(4): 163-9.

34. McLain RF: The biomechanics of long versus short fixation for thoracolumbar spine fractures. Spine 2006; 31(11): S70-9.