Posterior interbody bone fusion and transpedicular screw internal fixation for selective treatment of thoracolumbar fracture dislocation complicated with intervertebral disc injury

Abstract:

Objective：To explore the clinical outcomes of interbody bone fusion combined with transpedicular screw internal fixation in selective treatment of thoracolumbar fracture-dislocations complicated with severe intervertebral disc injury through posterior ap－proach. Methods：From January 2005 to Marth 2011，26 patients with thoracolumbar fracture-dislocations complicated with severe in－tervertebral disc injury were treated by this method. Inclusion criteria：①thoracolumbar fracture dislocation in single segment，less than 1/3 upper parts of fractured vertebra being compressed or burst，middle and inferior parts of fractured vertebra being normal；②dam－aged segment complicated with severe intervertebral disc injury. Demogrophic data，AO classification of fracture，American Spinal In－jury Association grade of neurological status，visual analogue scale（VAS），Bridwell fusion grade，segmental height，segmental kyphosis and treatment-related complications were evaluated. Results：Based on AO classification，20 patients had type B facture and 6 had type C. Except 16 patients with grade A spinal cord function，spinal cord function of all patients improved by 1-2 degrees. VAS scores were （9.00±0.76） before operation and were （5.18±1.43） at one week post-operation and （0.74±0.57） at the last follow-up. Twenty-three patients had grade I fusion and 3 patients had grade Ⅱ fusion at the last follow-up. Height of the fractured vertebra was （84.27±5.27）% before the operation，（97.38±1.20）% at one week after the operation and （97.04±0.96）% at the last follow-up. Kyphosis angel was （22.50±6.20）° before the operation，（2.60±1.86）° at one week after the operation and （3.50±2.65）° at the last follow-up. Cerebrospinal fluid leakage occurred in 4 patients. There was no case of incision infection，cage subsidence and screw loosen or breakage. Conclusions：With the correct selection of operative indications，resection of damaged intervertebral disc through posterior approach，cage interbody bone reconstruction and transpedicular screw internal fixation are effective methods in treating thora－columbar fracture-dislocations complicated with intervertebral disc injury.