[Fractures of the lumbar spine and the lower thoracic spine--surgical technic and results]

[Comparative study of various dorsal stabilization procedures in recent fractures of the thoracic spine]

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.

Comparative study of different dorsal stabilization techniques in recent thoraco-lumbar spine fractures

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.