>Acta Ortopédica Mexicana
>Year 2002, Issue 5
Palapa GLR, Anaya VS, Casas MG
Treatment via anterior region of the unstable lesions of the thoracolumbar column
Acta Ortop Mex 2002; 16 (5)
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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.
||spine, fracture, instability, evolution, technic.
Acarogln ER, Schwab FJ. Simultaneous anterior and posterior approaches for correction of the late deformity due to thoracolumbar fractures. Eur Spine J 1996; 5: 56-62.
An HS, Lim TH, You JW, Hong M, Eck J, McGrady L. Biomechanical evaluation of anterior thoracolumbar spine instrumentation. Spine 1995; 20: 1979-83.
Andreychik DA, Alander DH, Senica KM, Stauffer ES. Brust fractures of the second through fifth lumbar vertebrae. J Bone Joint Surg 1996; 78A: 1156-66.
Benzel EC. Biomechanics of spine stabilization. Principles and clinical practice. 1995, McGraw-Hill, Inc. 278pp.
Benzel EC. Spinal instrumentation. American Association of Neurological Surgeons Publications Committee. USA. 1994; 25-38.
Bohler L. Die technik der knochenbruchbehandlung. 1951 12-13 edn. Vol 1. Maudrich, Vienna, pp 318-480.
Denis F. The toree column spine and it’s significance in the classification of acute thoracolumbar spine injuries. Spine 1983; 8: 817-3l.
Errico TT, Bauer RD, Waugh T. Spinal trauma. JB Lippincott Company, Philadelphia. 1990; 123-143, 301-8.
Faciszewski T, Winter RB, Lonstein JE, Denis F, Jhonson L. The surgical and medical perioperative complications of anterior spinal fusion surgery in the thoracic and lumbar spine in adults. A review of 1223 procedures. Spine 1995; 20: 1592-9.
Hamilton A, Webb JK. The role of anterior surgery for vertebral fractures with and without cord compression. Clin Orthop 1994; 300: 79-89.
Holdsworth FW. Fractures dislocations and fracture-dislocations of the spine. J Bone Joint Surg 1963; 45B: 6-20.
Kaneda K, Aburni K, Fujiya M. Burst fractures with neurologic deficit of the thoracolumbar spine. Spine 1984; 9: 788-95.
Krag MH. Biomechanics of thoracolumbar spinal fixation. Spine 1991 16: 84-9.
Limb D, Shaw DL, Dickson RA. Neurological injury in thoracolumbar burst fractures. J Bone Joint Surg 1995; 77B: 774-7.
Louis R. Lés theories de l´instabilite. Rev Chir Orthop 1977; 63: 423-5.
Magerl F, Aebi M, Getzbein D, Harms J, Nazarian S. A comprehesive classification of thoracic and lumbar injuries. Eur Spine J 1994; 3: 184-201.
McCormack T, Karaikovic E, Gaines RN. The load shearing classification of spine. Spine 1994; 15: 1741-4.
Nicoll EA. Fractures of the dorso-lumbar spine. J Bone Joint Surg 1949; 31B: 376-94.
Roy Camille R, Saillant G. Les traumatismes du rachis sans complication neurologique. Int Orthop 1984; 8: 155-62.
Slosar PJ, Patwardhan AG, Lorenz M, Havey R, Sartori M. Instability of the lumbar brust fracture and limitations of transpedicular instrumentation. Spine 1995; 20: 1452-61.
Speth MJ, Oner FC, Kadic MA, Verbout AJ. Recurrent kyphosis after posterior stabilization of thoracolumbar fractures. Acta Orthop Scand 1995; 66: 406-10.
Stauffer ES. Thoracolumbar spine fractures without neurologic deficit. American Academy of Orthopaedic Surgeons 1993: 96 pp.
Tae-Hong Lim, Howard S, Toru H, McGrady L, Kaya Y, Hasanoglu, Wilson Ch. Prediction of fatigue screw loosening in anterior spinal fixation using dual energy X-ray absorptiometry. Spine 1995; 20: 2565-9.
Tasderniroglu E, Phillip A, Tibbs. Long-term follow-up results of thoracolumbar fractures after posterior instrumentation. Spine 1995; 20: 1704-8.
White AA, Panjabi MM. Clinical biomechanics of the spine. JB Lippincott Company, Second Edition. Philadelphia, 1990: 302-327.
Whitesides TE. Traumatic kyphosis of the thoracolumbar spine. Clin Orthop 1977; 128: 78-92.
>Acta Ortopédica Mexicana
>Year 2002, Issue 5