Stabilization of Fractures and Fracture-Dislocations of the Thoracolumbar Spine

Kim, Nam Hyun; Oh, Jeong Hwan

Abstract

There are many hypotheses of spinal instability after trauma and the concept had been recently changed from 2-column concept by Holdsworth to 3-column concept by Francis Denis & McAfee and also there are controversies about the operative management of the unstable thoracolumbar spine fractures and fracture-dislocations. So we tried to find some relationship between the spinal instability and the effect of the stabilization operation for the fractures and fracture-dislocations in the thoracolumbar spine in this study. Totally 53 cases that stabilization operation had been performed for the unstable fractures and fracture-dislocations of the thoracolumbar spine at Yonsei University Hospital, including Yongdong hospital, from March, 1973 to October, 1984 and followed up over 6 months, were reviewed. 1. Majority of the patients (84.9%) was in an active age group (20-49 years of his age) and more common in males. 2. The first lumbar vertebra was most commonly involved segment (43.3%) and falling from a height was the most common cause of injuries (50.9%). 3. Injuries to the anterior, middle and posterior column of the spine (58.5%) was the most common mechanism of injury according to the classification by Francis Denis and McAfee. 4. The wedged deformity of the involved segment over 50% was usual (71.7%) and mean wedged deformity was 57% of the height of the vertebral body and most commonly associated fractures besides the body itself was laminae fractures (46.5%). 5. Seventy eight percent of the angular deformity was corrected after Luque rod instrumentation and 76%, after Harrington rod instrumentation, 68%, after posterior wiring, 58%, after anterior decompression and anterior interbody fusion. 6. Forty twa point seven percent of the displacement in anteroposterior plain X-ray film and 58.8% in the lateral film were corrected by Luque rod instrumentation and 39.5% in anteroposterior film and 44.3% in the lateral film were corrected by Harrington rod instrumentation. 7. No significant differences in the recovery of the neurologic signs were found according to the method of surgical treatments. 8. So Luque rod or Harrington rod instrumentation is now recommended for obtaining the spinal stability as a method of surgical treatment in the unstable thoracolumbar spine fractures and fracture-dislocations.