Acta Ortopédica Mexicana

Palapa GLR, Anaya VS, Casas MG
Treatment via anterior region of the unstable lesions of the thoracolumbar column
Acta Ortop Mex 2002; 16 (5)

Language: Español
References: 26
Page: 245-252
PDF: 75.03 Kb.

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SUMMARY. Objective. 1. To describe to the post-operating clinical evolution of the patients with unstable injuries thoracolumbars. 2. To determine the stability of the unstable injuries thoracolumbars treated by anterior approach. 3. To correlate the proportion of invasion to the spinal conduit and the motor deficit. Study design. Descriptive Cohorte. Study site. Participants. Sequential sample of patients with unstable injuries of the thoracolumbar spine. That were treated surgically by anterior approach in our service in the period of May of 1996 to February of 1998. Interventions. Anterior approach thoracolumbar spine, interbody fusion, stabilization with Ventrofix system in the same surgical time. Circumferential in two times; USS pedicular and later Ventrofix with posterolateral arthrodesis. Measurements. Clinics; functional scale of the American Spinal Injury Association (ASIA) and Frankel. Rx; percentage of the loss of height of the anterior wall of the vertebral body, degree of post-traumatic angular deformity (cifos). TAC; percentage of invasion to the spinal conduit. Descriptive statistic; simple measures of central tendency and dispersion, frequencies, proportions. Inferencial statistic, Wilcoxon test, and r of Pearson. Results. 41 patients with unstable spine injuries were studied, treated by anterior approach, with a minimum pursuit of 12 months up to 33 months, medium 20 months. The injuries type A of the AO corresponded to 83% of the cases (32), post-traumatic deformities 4 (10%), injuries type C 2 cases (5%) and 1 tumor case (2%). The mechanism of more frequent injury was the height fall 23 cases (56%). The medium one of the vertebral collapse was of 55% (Q25 = 41%; Q75 = 62%). Cifos pre-Qx. Medium 20o (Q25 = 15°; Q75 = 27°). Cifos post Qx. Medium 10° (Q25 = 5°; Q75 =16o) [z 2 tails ‹ .0001/IC 95% 6.95 to 16.51]. Invasion to spine conduit 0 to 100%, medium 40% (Q25 = 20%; Q75 = 55%). Motor Score ASIA pre-Qx. Medium 90 points (Q25 = 64 pts.; Q75 = 100 pts.). Motor Score ASIA post-Qx. Medium 100 pts. (Q25 = 90 pts.; Q75 = 100 pts.) [z 2 tails ‹ .0001/IC 95% = -14.24 to 5.12]. Complications in 12 patients appeared (29%). The r of Pearson (0.21) showed very weak correlation between the proportion of invasion to spinal conduit and the motor deficit. The results of this study show that the clinical evolution showed statistically significant improvement, just like the stability of the treatment by anterior approach or circumferential route. The proportion of invasion to the spine conduit is not sufficient cause of the motor deficit observed in the spine injury is single more a component cause.

Key words: spine, fracture, instability, evolution, technic.