Management of Unstable Fractures and Fracture - Dislocations of the Thoracolumbar Spine with Harrington Instrumentation and Posterior Spinal Fusion

Chung, Yung Khee; Chang, Ik Yull; Shin, Do Sik

Abstract

The spine can be divided into two structural columns; an anterior column consisting of vertebral bodies, discs and ligaments and a posterior column consisting of the neural arch, facet joints and interconnecting ligaments. Disruption of both anterior and posterior columns results in spinal instability. Laminectomy may produce greater spinal instability and will convert a stable injury into a unstable one. The compression that exists in these injury is anterior and therefore posterior laminectomy do little more than produce spinal instability. The technique of open reduction and Harrington rod fixation of unstable fractures improved nursing care, shortened rehabilitation and was effective in maintaining fracture reduction and promoting bony healing. Between 1978 and 1980, thirteen consecutive patient with unstable fractures and fracture-dislocations of thoracolumbar spine were treated by open reduction and spinal fusion with Harrington rod fixation at the Department of Orthopaedic Surgery of the Han Gang and Kang Nam Sacred Heart Hospitals. The following results were obtained from analysis of the cases. 1. The reduction and stability after reduction with Hsrrington instrumentation was excellent. 2. Laminectomy produced greater spinal instability. 3. Early ambulation was possible and the period of hospitalization was shortened. 4. Neurological recovery from incomplete neural deficit was good but from complete paraplegia was less effective.