J Korean Soc Spine Surg.  2016 Mar;23(1):7-14. 10.4184/jkss.2016.23.1.7.

Posterior Fusion for Thoracolumbar Fractures with a Neurologic Deficit: A Comparison of Fusion and Additional Decompression

• Sohn HM
• You JW
• Park SS
• Kim BS
• Jung S

• KMID: 2161007
• DOI: http://doi.org/10.4184/jkss.2016.23.1.7

Abstract

STUDY DESIGN: A retrospective study.
OBJECTIVES
To understand the necessity of additional posterior decompression when treating a patient with posterior fusion for thoracolumbar fractures with a neurologic deficit. SUMMARY OF LITERATURE REVIEW: Additional posterior decompression is still controversial when treating a patient with posterior fusion for thoracolumbar fractures with neurologic a deficit.
MATERIALS AND METHODS
40 patients who underwent posterior fusion surgery for thoracolumbar fractures with a neurologic deficit were evaluated. The posterior fusion group (Group 1) included 23 patients (M:F=14:9), and the posterior decompression with laminectomy and posterolateral fusion group (Group 2) included 17 patients (M:F=9:8). According to the Frankel grade, the most common neurologic deficit was grade D in both groups. Unstable burst fractures were the most commonly observed fractures in both groups according to the McAfee classification. A radiographic evaluation was carried out along with a comparison of the spinal canal encroachment and the kyphotic angle. We evaluated neurologic improvement as the clinical criterion.
RESULTS
The l-kyphotic angle at last follow-up was smaller than the preoperative kyphotic angle in both groups. The preoperative canal encroachment was 53.4% (Group 1) and 59.8% (Group 2). Further, neurologic improvement was observed in 19 cases (Group 1) and 14 cases (Group 2). There was no significant difference in the proportion of cases with neurologic improvement between the two groups (improvement in 19 cases in Group 1 and in 14 cases in Group 2) (p<0.05). Further, the preoperative canal encroachment, kyphotic angle, and final neurologic improvement showed no significant correlations between the two groups (p>0.05).
CONCLUSION
We concluded that additional posterior decompression in the case of thoracolumbar fractures with neurologic deficit is not required for neurologic improvement.

Keyword

Thoracolumbar fracture; Neurologic deficit; Posterior fusion; Posterior decompression

MeSH Terms

Classification
Decompression*
Follow-Up Studies
Humans
Laminectomy
Neurologic Manifestations*
Retrospective Studies
Spinal Canal

Figure

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  Fig. 1. A 43-year-old male patient with an L2 flexion-distraction injury and Frankel grade C neurologic deficit. Preoperative X-ray and sagittal and axial computed tomography (CT) images showed a 40% canal compromise, and magnetic resonance imaging (MRI) showed neural compression and L1–2 interspinous ligament rupture (A– D). After posterior instrumentation and fusion, the X-ray showed fracture reduction (E) and the axial CT image showed an 18% canal compromise (F). The 1.5-year follow-up X-ray (G) showed that the patient's neurologic deficit improved to Frankel grade D.

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  Fig. 2. A 52-year-old female patient with a T12, L2 unstable burst fracture, and Frankel grade C neurologic deficit. Preoperative X-ray and sagittal and axial CT images showed a T12: 70%, L2: 80% canal compromise, and MRI showed neural compression and posterior ligament complex injury (A–E). After posterior decompression and fusion, X-ray showed fracture reduction (E) and the axial CT image showed canal decompression (F– H). The 2-year follow-up X-ray (I) showed that the patient's neurologic deficit had improved to Frankel grade D.

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