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Mallepally AR, Marathe N, Rustagi T, Mohapatra B, Mahanjan R, Das K. Management of AO-type C thoracolumbar fractures during COVID-19 pandemic using distractor device: a novel technique. Br J Neurosurg 2021; 37:1-8. [PMID: 34056964 DOI: 10.1080/02688697.2021.1929836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
STUDY DESIGN Prospective cohort study. INTRODUCTION Management of the severe thoracolumbar (TL) spine fracture-dislocation injuries have been further complicated by the COVID-19 pandemic. The need to optimize resources and minimize the personnel in the operating room (OR) led us to develop a novel technique to reduce TL fracture-dislocations (AO type-C) using an orthopedic distractor device (ODD). METHODS This prospective study was conducted at a tertiary care spine center with a study duration from March 2020 to May 2020 coinciding with the nationwide lockdown and travel restrictions imposed in view of the COVID-19 crisis. Only patients with AO type C fracture-dislocation managed using the ODD operated by a single surgeon were included in the study. RESULTS Of 12 cases, the most commonly affected level was D12-L1. Nine patients were American Spinal Injury Association Impairment Scale (AIS) A at presentation, two patients were AIS B, and one AIS C. The mean operative time was 125 min and mean blood loss was 454 ml. Eight patients remained AIS A, one patient improved from AIS B to C. Two patients became independent walkers, one remained AIS B. The post-operative VAS score improved to a mean value of 2.33. The improvement in kyphosis was 26.24° immediate postoperatively and maintained at 25.9°, percentage height loss reduced to 2.75% immediate postoperatively and maintained at 3.16% at 3 months follow-up. CONCLUSIONS Management of TL fracture-dislocations in COVID times of health care resource scarcity can be challenging. Single surgeon with ODD is a useful technique for achieving good results in these injuries.
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Affiliation(s)
| | - Nandan Marathe
- Department of Spine Services, Indian Spinal Injuries Centre, New Delhi, India
| | - Tarush Rustagi
- Department of Spine Services, Indian Spinal Injuries Centre, New Delhi, India
| | | | - Rajat Mahanjan
- Department of Spine Services, Indian Spinal Injuries Centre, New Delhi, India
| | - Kalidutta Das
- Department of Spine Services, Indian Spinal Injuries Centre, New Delhi, India
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Kumar S, Patralekh MK, Boruah T, Kareem SA, Kumar A, Kumar R. Thoracolumbar fracture dislocation (AO type C injury): A systematic review of surgical reduction techniques. J Clin Orthop Trauma 2020; 11:730-741. [PMID: 32879561 PMCID: PMC7452329 DOI: 10.1016/j.jcot.2019.09.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/21/2019] [Accepted: 09/23/2019] [Indexed: 10/26/2022] Open
Abstract
Spinal injuries constitute about 3% of all injury cases and most of these injuries affect the thoracolumbar region, but thoracolumbar fracture-dislocations are much rarer. Dislocations (AO Type C injuries) of the thoracic and lumbar vertebrae, with or without associated fractures, happen due to very high energy trauma involving simultaneous, multidirectional, distractive and compressive forces across various spinal elements, which results in translational and rotational instability of the spinal column. Various reduction maneuvers have been described for thoracolumbar fracture-dislocations in the literature aiming to provide standardization in surgery for this situation. The aim of this review article is to systematically review the literature till date and describe various reduction maneuvers which help to achieve adequate sagittal and coronal balance as well as vertebral alignment with minimal soft tissue trauma. We searched the PubMed, the Cochrane Library (the most recent issue), Scopus, Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, Web of Science, International Clinical Trials Registry Platform (WHO), ClinicalTrials.gov and Google Scholar databases, besides other sources and general internet search. The strategy used in the search was briefly(''thoracolumbar'' OR ''dorsolumbar'') AND "dislocation" in PubMed. Similar searches were made in the other databases.Reference lists of the relevant papers were also examined and any further relevant studies, which were also included in the review. The initial search revealed 332 papers in Pubmed, out of which 302 were human studies. A similar search on Scopus revealed 528 documents and on WoS revealed 289 papers. Searching the Cochrane library revealed 9 trials, which were already revealed in Pubmed search results. All the references were imported into Endnote and we had 632 references after excluding duplicates and 126 papers were left in endnote after manual title screening and duplicate removal. Finally, 70 relevant papers were selected for consideration based on inclusion criteria, after excluding unrelated papers manually. We have summarised the published literature on the surgical management of thoraco-lumbar fracture dislocations and described the reduction maneuvers used in detail.
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Affiliation(s)
| | - Mohit Kumar Patralekh
- Corresponding author. Central Institute of Orthopaedics, Safdarjung Hospital and VMMC, New Delhi, 110029, India.
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Wang XB, Yang M, Li J, Xiong GZ, Lu C, Lü GH. Thoracolumbar fracture dislocations treated by posterior reduction, interbody fusion and segmental instrumentation. Indian J Orthop 2014; 48:568-73. [PMID: 25404768 PMCID: PMC4232825 DOI: 10.4103/0019-5413.144219] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Literature describing the application of modern segmental instrumentation to thoracic and lumbar fracture dislocation injuries is limited and the ideal surgical strategy for this severe trauma remains controversial. The purpose of this article was to investigate the feasibility and efficacy of single-stage posterior reduction with segmental instrumentation and interbody fusion to treat this type of injury. MATERIALS AND METHODS A retrospective review of 30 patients who had sustained fracture dislocation of the spine and underwent single stage posterior surgery between January 2007 and December 2011 was performed. All the patients underwent single stage posterior pedicle screw fixation, decompression and interbody fusion. Demographic data, medical records and radiographic images were reviewed thoroughly. RESULTS Ten females and 20 males with a mean age of 39.5 years were included in this study. Based on the AO classification, 13 cases were Type B1, 4 cases were B2, 4 were C1, 6 were C2 and 3 cases were C3. The average time of the surgical procedure was 220 min and the average blood loss was 550 mL. All of the patients were followed up for at least 2 years, with an average of 38 months. The mean preoperative kyphosis was 14.4° and reduced to -1.1° postoperatively. At the final followup, the mean kyphosis was 0.2°. The loss of correction was small (1.3°) with no significant difference compared to postoperative kyphotic angle (P = 0.069). Twenty seven patients (90%) achieved definitive bone fusion on X-ray or computed tomography imaging within 1 year followup. The other three patients were suspected possible pseudarthrosis. They remained asymptomatic without hardware failure or local pain at the last followup. CONCLUSION Single stage posterior reduction using segmental pedicle screw instrumentation, combined with decompression and interbody fusion for the treatment of thoracic or lumbar fracture-dislocations is a safe, less traumatic and reliable technique. This procedure can achieve effective reduction, sagittal angle correction and solid fusion.
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Affiliation(s)
- Xiao-Bin Wang
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P. R. China
| | - Ming Yang
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P. R. China
| | - Jing Li
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P. R. China,Address for correspondence: Dr. Jing Li, Department of Spine Surgery, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, P. R. China. E-mail:
| | - Guang-Zhong Xiong
- Department of Emergency, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P. R. China
| | - Chang Lu
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P. R. China
| | - Guo-Hua Lü
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P. R. China
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Beisse R, Verdú-López F. [Current status of thoracoscopic surgery for thoracic and lumbar spine. Part 1: general aspects and treatment of fractures]. Neurocirugia (Astur) 2013; 25:8-19. [PMID: 23578820 DOI: 10.1016/j.neucir.2013.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 02/12/2013] [Accepted: 02/13/2013] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Thoracoscopic surgery or video-assisted thoracic surgery (VATS) of the thoracic and lumbar spine has greatly evolved since it appeared less than 20 years ago. Nowadays, it is indicated in a large number of processes and injuries. The aim of this article, in its 2 parts, is to review the current status of VATS in treatment of the thoracic and lumbar spine in its entire spectrum. DEVELOPMENT After reviewing the current literature, we develop each of the large groups of indications where VATS is used, one by one. This first part contains a description of general thoracoscopic surgical technique including the necessary prerequisites, transdiaphragmatic approach, techniques and instrumentation used in spine reconstruction, as well as a review of treatment and specific techniques in the management of spinal fractures. CONCLUSIONS Thoracoscopic surgery is in many cases an alternative to conventional open surgery. The transdiaphragmatic approach has made endoscopic treatment of many thoracolumbar junction processes possible, thus widening the spectrum of therapeutic indications. These include the treatment of fractures and deformities, as well as the reconstruction of injured spinal segments and decompression of the spinal canal in any etiological processes if the lesion placement is favourable to antero-lateral approach. Good clinical results of thoracoscopic surgery are supported by the growing experience reflected in a large number of articles. The degree of complications in thoracoscopic surgery is comparable to open surgery, with benefits in morbidity of the approach and subsequent patient recovery.
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Affiliation(s)
- Rudolf Beisse
- Wirbelsäulenzentrum Starnberger See Benedictus Krankenhaus, Tutzing, Alemania
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Cadotte DW, Singh A, Fehlings MG. The timing of surgical decompression for spinal cord injury. F1000 MEDICINE REPORTS 2010; 2:67. [PMID: 21173861 PMCID: PMC2990468 DOI: 10.3410/m2-67] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Research into the pathophysiological mechanisms of spinal cord injury (SCI) has resulted in a classification scheme of primary and secondary injury. Primary injury refers to the destructive nature of the initial impact and the subsequent shearing, penetrating, and compressive forces that injure the delicate neural tissue. Secondary injury refers to a complex array of pathophysiologial processes – including ischemia, inflammation, excitotoxicity, and oxidative cell damage – that contribute to the ultimate loss of neural tissue. While our understanding of secondary mechanisms improves with continued research, novel treatments for SCI are currently being developed with a foundation rooted in halting deleterious secondary mechanisms. In this article, we will review the current evidence for surgical decompression as a treatment for SCI. Emerging evidence and a growing consensus among surgeons are in support of early surgical intervention to help minimize the secondary damage caused by compression of the spinal cord after trauma.
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Affiliation(s)
- David W Cadotte
- Department of Surgery, Division of Neurosurgery, University of Toronto, and Spinal Program, Toronto Western Hospital, University Health Network McLaughlin Pavilion, 12th Floor, Room 407, 399 Bathurst Street, Toronto, ON, M5T 2S8
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Beisse R. Endoscopic surgery on the thoracolumbar junction of the spine. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 19 Suppl 1:S52-65. [PMID: 19693549 PMCID: PMC2899720 DOI: 10.1007/s00586-009-1124-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Indexed: 10/20/2022]
Abstract
The thoracolumbar junction is the section of the truncal spine most often affected by injuries. Acute instability with structural damage to the anterior load bearing spinal column and post-traumatic deformity represent the most frequent indications for surgery. In the past few years, endoscopic techniques for these indications have partially superseded the open procedures, which are associated with high access morbidity. The particular position of this section of the spine, which lies in the border area between the thoracic and abdominal cavities, makes it necessary in most cases to partially detach the diaphragm endoscopically in order to expose the operation site, and this also provides access to the retroperitoneal section of the thoracolumbar junction. A now standardised operating technique and instruments and implants specially developed for the endoscopic procedure, from angle stable plate and screw implants to endoscopically implantable vertebral body replacements, have gradually opened up the entire spectrum of anterior spine surgery to endoscopic techniques.
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Affiliation(s)
- Rudolf Beisse
- Spine Center Munich, Orthopedic Hospital München-Harlaching, Grünwalderstr. 51, 81547, Munich, Germany.
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Hans-Joachim Riesner D, Katscher S, Blattert T, Josten C. Posterior Fusion in Patients with Trauma, Instability, and Tumor of the Cervical Spine. Eur J Trauma Emerg Surg 2009; 35:562-79. [PMID: 26815380 DOI: 10.1007/s00068-009-8057-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Accepted: 03/22/2009] [Indexed: 10/20/2022]
Abstract
Trauma, instabilities and tumors of the cervical spine are treated with established methods of surgery. Therefore, anterior fusion is considered to be a standardized procedure for the lower cervical spine, while posterior and anterior instrumentation facilitates stabilization of the upper cervical spine. However, special situations that particularly require posterior instrumentation in traumatic lesions, tumor or other kinds of instabilities arise again and again. Neurological deficit symptoms, bone quality and related diseases fundamentally lead to a decision of posterior access and fusion. Different pathologies and corresponding reasons for posterior surgical interventions on the cervical spine are described in this paper and discussed using the current literature.
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Affiliation(s)
- Dr Hans-Joachim Riesner
- Department of Trauma, Plastic and Reconstructive Surgery, University of Leipzig, Leipzig, Germany. .,Department of TraumaPlastic and Reconstructive Surgery, University of Leipzig, Liebigstr 20, 04103, Leipzig, Germany.
| | - Sebastian Katscher
- Department of Trauma, Plastic and Reconstructive Surgery, University of Leipzig, Leipzig, Germany
| | - Thomas Blattert
- Department of Trauma, Plastic and Reconstructive Surgery, University of Leipzig, Leipzig, Germany
| | - Christoph Josten
- Department of Trauma, Plastic and Reconstructive Surgery, University of Leipzig, Leipzig, Germany
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Kingwell SP, Curt A, Dvorak MF. Factors affecting neurological outcome in traumatic conus medullaris and cauda equina injuries. Neurosurg Focus 2008; 25:E7. [PMID: 18980481 DOI: 10.3171/foc.2008.25.11.e7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The purpose of this review was to describe the relevant factors that influence neurological outcomes in patients who sustain traumatic conus medullaris injuries (CMIs) and cauda equina injuries (CEIs). Despite the propensity for spinal trauma to affect the thoracolumbar spine, few studies have adequately characterized the outcomes of CMIs and CEIs. Typically the level of neural axis injury is inferred from the spinal level of injury or the presenting neurological picture because no study from the spinal literature has specifically evaluated the location of the conus medullaris with respect to the level of greatest canal compromise. Furthermore, the conus medullaris is known to have a small but important variable location based on the spinal level. Patients with a CMI will typically present with variable lowerextremity weakness, absent lower-limb reflexes, and saddle anesthesia. The development of a mixed upper motor neuron and lower motor neuron syndrome may occur in patients with CMIs, whereas a CEI is a pure lower motor neuron injury. Many treatment options exist and should be individualized. Posterior decompression and stabilization offers at least equivalent neurological outcomes as nonoperative or anterior approaches and has the additional benefits of surgeon familiarity, shorter hospital stays, earlier rehabilitation, and ease of nursing care. Overall, CEIs and CMIs have similar outcomes, which include ambulatory motor function and a variable persistence of bowel, bladder, and potentially sexual dysfunctions.
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Affiliation(s)
- Stephen P. Kingwell
- 1Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedics; and
| | - Armin Curt
- 2Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marcel F. Dvorak
- 1Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedics; and
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Ringel F, Stoffel M, Stüer C, Totzek S, Meyer B. Endoscopy-assisted Approaches for Anterior Column Reconstruction after Pedicle Screw Fixation of Acute Traumatic Thoracic and Lumbar Fractures. Oper Neurosurg (Hagerstown) 2008; 62:ONS445-52; discussion ONS452-3. [DOI: 10.1227/01.neu.0000326033.69961.c1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Objective:
Surgical treatment of thoracic and lumbar vertebral body fractures combines instrumentation to stabilize the fracture and an anterior reconstruction to promote fusion of the fractured spine. The aim of the present study was to show that minimally invasive thoracoscopic or endoscopy-assisted approaches to the thoracic and lumbar spine are feasible for anterior column reconstruction.
Methods:
This prospective, single-center study included 83 consecutive patients harboring 100 acute thoracic and lumbar vertebral fractures. Patients' neurological status; preoperative, postoperative, and follow-up radiographic data; and surgical data were obtained.
Results:
Fractures ranged from T5 to L5. All fractures underwent posterior pedicle screw fixation followed by a thoracoscopic or endoscopy-assisted anterior approach for anterior column reconstruction to promote fusion. Ventral graft position was correct in 45 patients and acceptable in 37 patients; one patient required a surgical repositioning. Initial correction of kyphosis was 9 degrees; during follow-up (23 ± 11 mo), the mean loss of correction was 6 degrees. In 84 minimally invasive approaches, five conversions to an open approach were necessary. Complications included one case of L1 nerve root injury, two cases of transient neurological worsening, one case of posterior wound infection, and one case of pleural empyema.
Conclusion:
The minimally invasive endoscopic approach for anterior column reconstruction is a feasible strategy in the treatment of unstable thoracic and lumbar fractures. Fracture type and the material of the anterior graft can affect long-term maintenance of correction.
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Affiliation(s)
- Florian Ringel
- Department of Neurosurgery, University of Bonn, Bonn, Germany
- Department of Neurosurgery, Technical University of Munich, Munich, Germany
| | - Michael Stoffel
- Department of Neurosurgery, University of Bonn, Bonn, Germany
- Department of Neurosurgery, Technical University of Munich, Munich, Germany
| | - Carsten Stüer
- Department of Neurosurgery, University of Bonn, Bonn, Germany
- Department of Neurosurgery, Technical University of Munich, Munich, Germany
| | - Silke Totzek
- Department of Neurosurgery, University of Bonn, Bonn, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, University of Bonn, Bonn, Germany
- Department of Neurosurgery, Technical University of Munich, Munich, Germany
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Beisse R. Video-assisted techniques in the management of thoracolumbar fractures. Orthop Clin North Am 2007; 38:419-29; abstract vii. [PMID: 17629989 DOI: 10.1016/j.ocl.2007.02.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The thoracolumbar junction is the most common region of the spine to be affected by injuries. Acute instability with structural damage to the anterior load-bearing spinal column and posttraumatic deformity represent the most frequent indications for surgery. A standardized operating technique with instruments and implants specially developed for the endoscopic procedure, ranging from an angled, stable plate and screw implant to endoscopically implantable vertebral body replacements, have gradually opened up the entire spectrum of anterior spine surgery to endoscopic techniques at the thoracolumbar junction.
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Affiliation(s)
- Rudolf Beisse
- Department of Neurosurgery, University of Utah, Salt Lake City, UT 84132, USA.
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Mueller LA, Degreif J, Schmidt R, Pfander D, Forst R, Rommens PM, Mueller LP, Rudig L. Ultrasound-guided spinal fracture repositioning, ligamentotaxis, and remodeling after thoracolumbar burst fractures. Spine (Phila Pa 1976) 2006; 31:E739-46; discussion E747. [PMID: 16985441 DOI: 10.1097/01.brs.0000237012.83128.80] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Computed tomography aided evaluation of spinal decompression by ultrasound-guided spinal fracture repositioning, ligamentotaxis, and remodeling after thoracolumbar burst fractures. OBJECTIVES To determine the necessity of spinal canal widening by ultrasound-guided fracture repositioning for fractures with and without neurologic deficit. SUMMARY OF BACKGROUND DATA Ultrasound-guided spinal fracture repositioning is an alternative new approach. Reports have varied concerning ligamentotaxis and remodeling. METHODS Computed tomography aided planimetry of the spinal canal (64 consecutive burst fractures) and neurologic evaluation by Frankel grades. RESULTS Ultrasound-guided spinal fracture repositioning (n = 37) reduced the stenosis of the spinal canal area from 45% before surgery to 20% after surgery of the estimated original area. Fifteen patients had a primary neurologic deficit, which improved markedly in 11 cases after treatment. Patients with neurologic symptoms had a greater preoperative spinal stenosis than those without. No correlation was seen between the degree of pretreatment spinal stenosis, fracture type, and severity of the neurologic deficit. Ligamentotaxis (n = 27) reduced the stenosis from 30% before surgery to 18% after surgery and remodeling (n = 11) from 25% after surgery to 13% after metal removal. CONCLUSION Ultrasound-guided fracture repositioning is an efficient method for spinal canal decompression of burst fractures with neurologic symptoms. The marked degree of widening of the spinal canal due to the effects of ligamentotaxis and remodeling may render the reposition of retropulsed fragments unnecessary in cases of fractures without a neurologic deficit.
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Affiliation(s)
- Lutz Arne Mueller
- Department of Orthopaedic Surgery, University of Erlangen, Erlangen, Germany.
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Mueller LA, Mueller LP, Schmidt R, Forst R, Rudig L. The phenomenon and efficiency of ligamentotaxis after dorsal stabilization of thoracolumbar burst fractures. Arch Orthop Trauma Surg 2006; 126:364-8. [PMID: 16721620 DOI: 10.1007/s00402-005-0065-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2005] [Indexed: 02/09/2023]
Abstract
Thirty-six consecutive patients with burst fractures of the thoracolumbar spine and with a fractured posterior vertebral surface dislocated into the spinal canal without neurological symptoms were treated with the AO internal fixator. Computed tomography-aided planimetry of the spinal canal was undertaken preoperatively and within 1 week postoperatively to elucidate the effect of kyphosis correction and distraction on spinal canal widening (ligamentotaxis). The stenosis of the spinal canal area (SCA) was reduced from 29% preoperatively to 19% postoperatively (+10%) of the estimated original area, and the stenosis of the mid-sagittal diameter (MSD) reduced from 31 to 23% (+8%). The widening of the SCA was greater at the level of L1/L2 (+13%) than at L3/L4 (+6%). High preoperative canal compromise was associated with greater absolute spinal canal widening. Large trapezoid-shaped fragments resisted reduction by ligamentotaxis. Even though the effect of ligamentotaxis after operative treatment with the internal fixator was proven, a certain stenosis of the spinal canal remains in most cases. Especially for patients with fracture-related neurological symptoms, ligamentotaxis alone does not seem sufficient for the requested spinal decompression. Even an exact analysis of preoperative CT scans under consideration of the fracture level will not always allow an exact prognosis of the expected effect of ligamentotaxis.
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Affiliation(s)
- L A Mueller
- Department of Orthopaedic Surgery, University of Erlangen, Rathsberger Str. 57, 91054 Erlangen, Germany.
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13
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Beisse R. Endoscopic surgery on the thoracolumbar junction of the spine. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2006; 15:687-704. [PMID: 16474942 PMCID: PMC3489423 DOI: 10.1007/s00586-005-0994-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2005] [Revised: 06/05/2005] [Accepted: 06/19/2005] [Indexed: 11/26/2022]
Abstract
The thoracolumbar junction is the section of the truncal spine most often affected by injuries. Acute instability with structural damage to the anterior load-bearing spinal column and post-traumatic deformity represents the most frequent indications for surgery. In the past few years, endoscopic techniques for these indications have partially superseded the open procedures, which are associated with high access morbidity. The particular position of this section of the spine, which lies in the transition area between the thoracic and abdominal cavities, makes it necessary in most cases to partially detach the diaphragm endoscopically in order to expose the surgical site, and this also provides access to the retroperitoneal section of the thoracolumbar junction. A now standardised operating technique, instruments and implants specially developed for the endoscopic procedure, from angle stable plate and screw implants to endoscopically implantable vertebral body replacements, have gradually opened up the entire spectrum of anterior spine surgery to endoscopic techniques.
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Affiliation(s)
- Rudolf Beisse
- Department of Surgery and Trauma Surgery, Trauma Center Murnau, Küntscher-Str.8, 82418 Murnau, Germany.
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14
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Beisse R, Mückley T, Schmidt MH, Hauschild M, Bühren V. Surgical technique and results of endoscopic anterior spinal canal decompression. J Neurosurg Spine 2005; 2:128-36. [PMID: 15739523 DOI: 10.3171/spi.2005.2.2.0128] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Decompression of the spinal canal in the management of thoracolumbar trauma is controversial, but many authors have advocated decompression in patients with severe canal compromise and neurological deficits. Anterior decompression, corpectomy, and fusion have been shown to be more reliable for spinal canal reconstruction than posterior procedures; however, traditional anterior-access procedures, thoracotomy, and thoracoabdominal approaches are associated with significant complications. Endoscopy-guided spinal access avoids causing these morbidities, but it has not been shown to yield equivalent results in spinal canal clearance. This study was conducted to demonstrate the effectiveness of endoscopic spinal canal decompression and reconstruction quantitatively by using pre- and postoperative computerized tomography (CT) scanning. METHODS Thirty patients with thoracolumbar canal compromise underwent endoscopic anterior spinal canal decompression, interbody reconstruction, and stabilization for fractures (27 cases), and tumor, infection, and severe degenerative disc disease (one case each). The mean follow-up period was 42 months (range 24 months-6 years). Neurological examinations, Frankel grades, radiological studies, and intraoperative findings were prospectively collected. Spinal canal clearance quantified on pre- and postoperative CT scans improved from 55 to 110%. A total of 25% of patients with complete paraplegia and 65% of those with incomplete neurological deficit improved neurologically. The complication rate was 16.7% and included one reintubation, two pleural effusions, one intercostal neuralgia, and one persistent lesion of the sympathetic chain. CONCLUSIONS The authors describe the endoscopic technique of anterior spinal canal decompression in the thoracolumbar spine. The morbidities associated with an open procedure were avoided, and excellent spinal canal clearance was accomplished as was associated neurological improvement.
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Affiliation(s)
- Rudolf Beisse
- Departments of Surgery and Traumasurgery, Trauma Center Murnau, Murnau, Germany.
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Verlaan JJ, Diekerhof CH, Buskens E, van der Tweel I, Verbout AJ, Dhert WJA, Oner FC. Surgical treatment of traumatic fractures of the thoracic and lumbar spine: a systematic review of the literature on techniques, complications, and outcome. Spine (Phila Pa 1976) 2004; 29:803-14. [PMID: 15087804 DOI: 10.1097/01.brs.0000116990.31984.a9] [Citation(s) in RCA: 271] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A systematic review of the literature, pertaining surgical treatment of traumatic thoracic and lumbar spine fractures, was performed. OBJECTIVES To provide information on surgical techniques for traumatic spine fracture management, their respective performance and complication rates, based on previously published information. SUMMARY OF BACKGROUND DATA The treatment of traumatic fractures of the thoracic and lumbar spine remains controversial. There is insufficient evidence in the literature to choose between the various surgical options. In absence of conclusive studies, a systematic review can be an alternative to obtain more convincing information. METHODS Full-text papers from 1970 until 2001 were included if strict inclusion criteria were met. Five surgical subgroups were recognized: posterior short-segment (PS), posterior long-segment (PL), reports on both posterior short- and long-segment (PSL), anterior (A), and anterior combined with posterior (AP) techniques. Clearly defined and generally accepted parameters were scored and subsequently analyzed. The preoperative injury severity of the surgical groups was compared. The neurologic, radiologic, and functional outcome and complications of all groups were assessed. RESULTS A total of 132 papers, the majority being retrospective case-series, were included representing 5,748 patients. The preoperative injury severity revealed an inequality between the subgroups. Partial neurologic deficits had the potential to resolve irrespective of treatment choice. None of the five techniques used was able to maintain the corrected kyphosis angle. The functional outcome after surgery seems to be better than generally believed. Complications are relatively rare. CONCLUSIONS In general, surgical treatment of traumatic spine fractures is safe and effective. Surgical techniques can only be compared using randomized controlled trials.
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Affiliation(s)
- J J Verlaan
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands.
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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 (Phila Pa 1976) 1998; 23:2030-9; discussion 2040. [PMID: 9779538 DOI: 10.1097/00007632-199809150-00022] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This is a retrospective revue of the long-term outcome of posterior Louis plate fixation for the treatment of irreducible or ligamentously unstable fractures of the thoracolumbar and lumbar spine with or without neurologic deficit. OBJECTIVES To determine the clinical, radiologic, and functional status of patients who underwent posterior fracture fixation with Louis plates and to evaluate the effect of instrumentation length on the construct's ability to maintain reduction of the fracture. SUMMARY OF BACKGROUND DATA Since the development of pedicle screw fixation described by Roy-Camille, there has been a rapid evolution in the number and complexity of systems available for posterior spinal stabilization. Along with this escalation in implant and instrument sophistication, there has been a corresponding increase in implant cost. To date, no series has been reported of the clinical, radiologic, and functional results of posterior instrumentation with semirigid Louis plates for spinal fractures. METHODS A retrospective review of spinal fractures from T11 to L5 treated since 1985 by posterior plate fixation showed that 56 patients (37 men and 19 women) with an average age of 34 years and a minimum follow-up of 2 years (average, 41 months) were available for review. There were 36 burst fractures, 4 Chance fractures and 16 fracture-dislocations treated. Forty-three patients had neurologic injury. RESULTS Before surgery, vertebral kyphosis averaged 15 degrees, improved to 5 degrees with reduction, and reached a steady 10 degrees at final follow-up. Similarly, corrected kyphosis initially averaged 12 degrees but improved to 0.5 degree with reduction, and was 10 degrees at final follow-up. Vertebral canal compromise initially averaged 50% but was reduced to 13% with surgery and 6% at 1 year. There was no significant difference between the ability of short and long constructs to maintain reduction. Eighty-eight percent of patients with neurologic injury improved at least one Frankel grade with treatment. Functional and pain evaluation by the Denis scale showed 25 patients rated P1, 25 rated P2, and 6 rated P3. Twenty-eight were rated W1, 16 were W3, and 12 were W5 at last follow-up. CONCLUSIONS Fractures of the thoracolumbar spine can be treated effectively with the semirigid Louis plating system. Because of its low cost and ease of insertion, the Louis system is an excellent choice for short arthrodesis and instrumentation of these fractures. Although there is some loss of reduction when compared with more rigid systems, there is no functional compromise in these patients.
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Affiliation(s)
- C A Louis
- Department of Orthopaedic and Spinal Surgery, Hôpital de la Conception Marseilles, France
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Dick JC, Brodke DS, Zdeblick TA, Bartel BD, Kunz DN, Rapoff AJ. Anterior instrumentation of the thoracolumbar spine. A biomechanical comparison. Spine (Phila Pa 1976) 1997; 22:744-50. [PMID: 9106314 DOI: 10.1097/00007632-199704010-00005] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
STUDY DESIGN To evaluate the fatigue strength and stiffness of four anterior thoracolumbar fixation devices using a corpectomy model without load-sharing bone graft to test the devices under the worst case scenario of instability. OBJECTIVES To gain a more thorough understanding of the biomechanical qualities of anterior fixation devices to improve clinical application and design. SUMMARY OF BACKGROUND DATA For many surgeons, the anterior approach has become the treatment of choice for patients with compression of the spinal cord, whether it is caused by trauma, tumor, or infection. When stabilization is needed, anterior fixation devices have been advocated for many years to avoid the additional approach required for posterior fixation. Many of these devices, however, have an unacceptably high rate of hardware failure. Recently, several new devices for anterior fixation have been marketed with purported advantages in fatigue life and ease of use. METHODS Four implants, the Synthes Anterior Thoracolumbar Locking Plate, the Kaneda device, a Texas Scottish Rite Hospital anterior construct, and the Z-Plate were attached to vertebral models and tested for stiffness in multiple planes on a modified Materials Testing System machine. They then were fatigued to failure on an Instron testing machine. RESULTS The Anterior Thoracolumbar Locking Plate was the stiffest in axial compression, lateral flexion, and torsion. The Texas Scottish Rite Hospital anterior construct was the least stiff in flexion-extension, with no significant differences in the stiffness of the anterior thoracolumbar locking plate, that of the Kaneda device, and that of the Z-Plate. Fatigue life exceeded 80,000 cycles for the anterior thoracolumbar locking plate and averaged 26,472 cycles for the Z-Plate, 6915 cycles for the Teas Scottish Rite Hospital construct, and 4419 cycles for the Kaneda device. CONCLUSIONS The significantly greater fatigue life of the Anterior Thoracolumbar Locking Plate and the Z-Plate may predict a lower incidence of hardware failure than with previous anterior devices. This has been confirmed in preliminary clinical studies with the Z-Plate. Further clinical studies are needed to show if these lower failure rates will continue over a long-term period.
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Affiliation(s)
- J C Dick
- Orthopaedic Consultants, PA, Minneapolis, Minnesota, USA
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de Peretti F, Hovorka I, Cambas PM, Nasr JM, Argenson C. Short device fixation and early mobilization for burst fractures of the thoracolumbar junction. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 1996; 5:112-20. [PMID: 8724191 DOI: 10.1007/bf00298390] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The authors present a retrospective study based on a homogeneous series of 34 patients with burst fractures of the thoracolumbar junction, fixed using Cotrel-Dubousset instrumentation. These patients underwent instrumentation using a short construct of hooks and screws gripping the two vertebrae above the lesion (2HS) and screws and hooks gripping the first vertebra below the lesion (1SH). This construct was therefore called "2HS-1SH". In order to evaluate just the material resistance after getting up, only the patients who were upright on the 4th day without a body cast and with no secondary anterior osteosynthesis were included in this study. Four patients showed some neurological symptoms on admission but recovery was so quick that they could be included in this study. Mean follow-up was 4 years 1 month (range 3 years 1 month and 6 years 2 months). Vertebral and regional kyphosis angles were measured preoperative, postoperatively and at the final follow-up. Functional recovery and complications were analyzed. Mean vertebral kyphosis was 21.2 degrees preoperatively, 3.8 degrees postoperatively and 5.3 degrees at the final follow-up. Regional kyphosis angles were respectively 19.2, 0.2, and 2.7 degrees. We had two cases of deep suppuration, one early and the other late. None of the patients required analgesics for more than 6 months after the operation. Patients returned to work after 5 months on average. The authors concluded that fixation by screw-and-hook constructs is an effective way to stabilize thoracolumbar junction burst fractures.
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Affiliation(s)
- F de Peretti
- Department of Traumatology and Orthopedic Surgery, CHU de Nice, Hôpital St. Roch, Nice, France
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Akalm S, Kiş M, Benli IT, Citak M, Mumcu EF, Tüzüner M. Results of the AO spinal internal fixator in the surgical treatment of thoracolumbar burst fractures. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 1994; 3:102-6. [PMID: 7874545 DOI: 10.1007/bf02221448] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The potential for clinical instability following thoracolumbar fractures has evoked a progressive increase in interest in the surgical treatment of unstable thoracolumbar fractures. From September 1988 to October 1991, 44 thoracolumbar burst fractures were treated surgically by the AO Spinal Internal Fixator at the Orthopaedics and Traumatology Clinics of Ankara Social Security Hospital. Mean follow-up period was 28.8 (range 12-48) months. Fourteen (31.8%) of the patients were female, and 30 (68.2%) were male. Postoperatively, the mean anterior vertebral height loss and spinal canal compromise were corrected by 36.5% and 39.9%, respectively. Also, postoperatively 15.9% of improvement was obtained in the mean kyphosis angle. The mean compression angle, which was 19.5 degrees preoperatively, was corrected by 12.3 degrees and came to an average of 7.1 degrees postoperatively. In light of these data, it is suggested that the AO Spinal Internal Fixator effectively restores three-dimensional alignment of the spine and provides a rigid fixation.
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Affiliation(s)
- S Akalm
- Ankara Social Security Hospital, 1st Orthopaedics and Traumatology Clinics, Turkey
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Crawford RJ, Askin GN. Fixation of thoracolumbar fractures with the Dick fixator: the influence of transpedicular bone grafting. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 1994; 3:45-51. [PMID: 7874541 DOI: 10.1007/bf02428316] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Fifty patients with thoracolumbar fractures were treated by internal fixation using the Dick fixator. In the first 22 patients (group 1) this was accompanied by posterior intertransverse grafting. The technique was then modified in the following 28 patients (group 2) to include transpedicular elevation of the depressed vertebral end plate and grafting of the vertebral body, in an attempt to reduce the postoperative loss of correction of the kyphotic deformity. The clinical records and X-rays were reviewed to determine whether the change in technique had achieved this objective and whether it affected operative time, blood loss, postoperative recovery and complications. The mean operating time and blood loss in group 1 were 2 h, 38 min and 650 ml, respectively, and in group 2 2 h, 59 min and 783 ml. These differences were not statistically significant. Time from operation to mobilisation and discharge from hospital were related to neurological deficit, but there was no significant difference between group 1 and group 2 in this regard. There was no difference in the complication rate between the two groups and no complication attributable to transpedicular bone grafting. The radiological results postoperatively and at a mean follow-up period of 9 months were assessed by measurement of the kyphosis angle, anterior vertebral height, anterior displacement, scoliosis, and reduction in cross-sectional area of the spinal canal. In group 1 the mean preoperative kyphosis angle and anterior vertebral height were 8 degrees and 21 mm; postoperatively these values were -12 degrees (lordosis) and 27 mm; and at follow-up they were -4 degrees and 24 mm.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R J Crawford
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK
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Huler RJ, Esses SI, Botsford DJ. Work status after posterior fixation of unstable but neurologically intact burst fractures of thoracolumbar spine. PARAPLEGIA 1991; 29:600-6. [PMID: 1787984 DOI: 10.1038/sc.1991.88] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Thirty nine patients with unstable burst injuries of the thoracolumbar junction who did not suffer neurological injury have been prospectively followed. There were 24 males and 15 females. Five patients were covered under the Workers' Compensation Board (WCB). The average patient age was 34 years (14-66). All patients were stabilised using the AO 'Fixateur Interne' and posterior fusion. The post-operative instrumented sagittal curve averaged six degrees of lordosis (-20 to +20). The length of follow-up averaged 24 months (range 12-24). Pre-operatively 28 patients were employed, 2 were housewives, 6 were students, and 3 were unemployed. At follow-up, all students and housewives had returned to their usual activities. No patient who was initially unemployed had found work. Of the remaining 28 patients who were employed before injury, 23 (82%) had returned to gainful employment, one had returned to school for job retraining, and 5 had not returned to work. Of the 23 patients who had returned to work, 5 returned to lighter duties, and 18 returned to their original occupation. Only 2 of the 5 WCB-covered patients did not return to work. Most neurologically intact patients undergoing surgery for unstable bursting injuries of the thoracolumbar spine can return to work.
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Affiliation(s)
- R J Huler
- Indiana University Medical Centre Indianapolis
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Eysel P, Meinig G, Sanner F. [Comparative study of various dorsal stabilization procedures in recent fractures of the thoracic spine]. UNFALLCHIRURGIE 1991; 17:264-73. [PMID: 1962370 DOI: 10.1007/bf02588405] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
After giving a brief summary describing the development of different methods for stabilisation of traumatic spine fractures the authors discuss their own results on 125 patients, who were treated between January 1st 1983 and September 15th 1988. The different surgical procedures (Harrington-instrumentation, transpedicular osteosynthetic stabilisation, fixateur interne) are compared. In the neurological physical examination 25% of the patients improved at least one degree in the Frankel-scale. In four patients there was worsening of the neurological findings. The radiological postoperative studies analyzed the angles of kyphosis and scoliosis within the traumatized spine segments. In overall-comparison of surgical procedures the fixateur interne showed best results (repositional loss of kyphosis angle 6.8 degrees, no fracture instability). Worse results were found for Harrington-stabilisation (repositional loss 9.1 degrees, fracture instability in three cases) and for transpedicular osteosynthetic stabilisation (repositional loss 12.4 degrees, fracture instability in two cases). In conclusion the authors describe the possible different complications for the three methods of judging from the clinical aspect and propose the following standard way of procedure: Fusion of the vertebral bodies with a stable implant and the possibility for intraoperative repositioning, postero-lateral spongiosa-grafting, fusion of the vertebral arc joints, transpedicular spongiosal filling of the traumatized vertebral body, resection of traumatized tissue from intervertebral discs and intercorporal blocking.
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Affiliation(s)
- P Eysel
- Orthopädische Universitätsklinik und Poliklinik, Mainz
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Eysel P, Meinig G. Comparative study of different dorsal stabilization techniques in recent thoraco-lumbar spine fractures. Acta Neurochir (Wien) 1991; 109:12-9. [PMID: 2068961 DOI: 10.1007/bf01405690] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The authors initially outline the development of operative techniques to stabilize traumatic thoraco-lumbar spine fractures. Thereafter their own results in 125 patients, treated operatively between 1.1.1983 and 15.9.1988, are presented. The different techniques (Harrington-instrumentation, transpedicular plate stabilization, fixateur interne) are evaluated. In the clinical neurological examination 25% of the patients experienced an improvement by at least one point in the FRANKEL classification. Four patients suffered neurological deterioration. In the radiological follow-up the "Sintering" process, the kyphotic and scoliotic deformity of the spinal segment were measured. The fixateur interne had the best overall results (loss of reposition averaged a kyphosis of 6.8 degrees, no fracture instability). Less good results were obtained with both the Harrington stabilization (loss of reposition 9.1 degrees, fracture instability in 3 cases) and with the transpedicular plate stabilization (loss of reposition 12.4 degrees, fracture instability in 2 cases). Finally the complications are described. The optimal approach is based on the clinical development. The fusion should be as short as possible with a stable angle implant and the possibility to reposition intraoperatively should be given. Postero-lateral spongiosa application, fusion of the vertebral arch joints, diskectomy with transpedicular spongiosa application and intercorporal blocking should be considered.
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Affiliation(s)
- P Eysel
- Neurochirurgische Universitätsklinik Giessen, Federal Republic of Germany
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Abstract
The treatment of unstable fractures of thoracolumbar vertebrae is a controversial issue in the orthopedic community. The various methods employed for operative stabilization of these injuries have to date been found to have major disadvantages. A new therapeutic principle and a new device for stable internal fixation are presented.
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Affiliation(s)
- G Karlström
- Department of Orthopedic Surgery, Uppsala University, University Hospital, Sweden
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