J Korean Neurosurg Soc.  2019 Nov;62(6):700-711. 10.3340/jkns.2019.0093.

Clinical Features and Treatment Outcomes of Acute Multiple Thoracic and Lumbar Spinal Fractures: A Comparison of Continuous and Noncontinuous Fractures

• Cho Y
• Kim YG

• KMID: 2463662
• DOI: http://doi.org/10.3340/jkns.2019.0093

Abstract

OBJECTIVE
The treatment of multiple thoracolumbar spine fractures according to fracture continuity has rarely been reported. Herein we evaluate the clinical features and outcomes of multiple thoracolumbar fractures depending on continuous or noncontinuous status.
METHODS
From January 2010 to January 2016, 48 patients with acute thoracic and lumbar multiple fractures who underwent posterior fusion surgery were evaluated. Patients were divided into two groups (group A : continuous; group B : noncontinuous). We investigated the causes of the injuries, the locations of the injuries, the range of fusion levels, and the functional outcomes based on the patients' general characteristics.
RESULTS
A total of 48 patients were enrolled (group A : 25 patients; group B : 23 patients). Both groups had similar pre-surgical clinical and radiologic features. The fusion level included three segments (group A : 4; group B : 5) or four segments (group A : 19; group B : 5). Group B required more instrumented segments than did group A. Group A scored 23.5 and group B scored 33.4 on the Korean Oswestry Disability Index (KODI) at the time of last follow-up. In both groups, longer fusion was associated with worse KODI score.
CONCLUSION
In this study, due to the assumption of similar initial clinical and radiologic features in both group, the mechanism of multiple fractures is presumed to be the same between continuous and noncontinuous fractures. The noncontinuous fracture group had worse KODI scores in long-term follow-up, thought to be due to long fusion level. Therefore, we recommend minimizing the number of segments that are fused in multiple thoracolumbar and lumbar fractures when decompression is not necessary.

Keyword

Spinal fractures; Decompression; Fractures, Multiple

MeSH Terms

Decompression
Follow-Up Studies
Fractures, Multiple
Humans
Spinal Fractures*
Spine

Figure

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  Fig. 1. A 32-year-old man with noncontinous thoracolumbar fractures. He fell from the second floor and the physical exam at the emergency department showed motor grade II below the L2 level and a tingling sensation in both lower limbs. A-C : A lumbar CT shows fractures on the T11 and L2 vertebral bodies. Axial CT scan shows severe canal compromise at both T11 and L2. D : MR sagittal scan demonstrates spinal canal compromise. E and F : Instrumentation and posterolateral fusion of T10–L3 with posterior decompression of L2 was performed. T11 fracture had spinous process fracture and then we included T11 into instrumented level. CT : computed tomography, MR : magnetic resonance.

• 

  Fig. 2. A 20-year-old man with continous thoracolumbar fractures. He injured from traffic accident. The physical exam at the emergency department showed motor grade III below the L4 level and a tingling sensation in both lower limbs. A-C : A lumbar CT and MRI show stable burst fracture and unstable burst fractures on the L4, L5 on each other. Axial CT scan shows severe canal compromise at L5. D : MR sagittal T2 scan demonstrates cauda equina compression and instability. E and F : Instrumentation from L3 to pelvis and posterolateral fusion with posterior decompression of L5 was performed. We could reduce instrumentation level by inserting screws into L4 fractured vertebral body. CT : computed tomography, MR : magnetic resonance, MRI : magnetic resonance imaging.

Reference

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