Anterior stabilization of three-column thoracolumbar spinal trauma

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Object

The purpose of this study was to evaluate the results obtained in patients who underwent anterior stabilization for three-column thoracolumbar fractures.

Methods

The authors retrospectively reviewed available clinical and radiographic data (1997–2006) to classify three-column thoracolumbar fractures according to the Association for the Study of Internal Fixation (AO) system, neurological status, spinal canal compromise, pre- and postoperative segmental angulation, and arthrodesis rate.

The mean computed tomography–measured preoperative spinal canal compromise was 48.3% (range 8–92%), and the mean vertebral body height loss was 39.4%. The mean preoperative kyphotic deformity of 14.9° improved to 4.6° at the final follow-up examination. Although this angulation had increased a mean of 1.8° during the follow-up period, the extent of correction was still significant compared with the preoperative angulation (p < 0.01). There were no cases of vascular complication or neurological deterioration.

Conclusions

Contemporary anterior spinal reconstruction techniques can allow certain types of unstable three-column thoracolumbar fractures to be treated via an anterior approach alone. Compared with traditional posterior approaches, the anterior route spares lumbar motion segments and obviates the need for harvesting of the iliac crest.

Abbreviations used in this paper:AP = anteroposterior; ASIA = American Spinal Injury Association; CT = computed tomography; SCI = spinal cord injury; VB = vertebral body.

Article Information

Address reprint requests to: Rod J. Oskouian Jr., M.D., Department of Neurological Surgery, University of Virginia Health System, Box 800212, Charlottesville, Virginia 22902. email: rjo2w@virginia.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Preoperative sagittal (A) and axial (B) CT reconstructions obtained in a 29-year-old patient presenting with paraparesis and an L-1 burst fracture associated with 65% canal compromise.

  • View in gallery

    Immediate postoperative sagittal (A) and AP (B) CT reconstructions of an L-3 burst fracture, demonstrating adequate canal decompression, a titanium cage filled with autograft, and bicortical trans-VB screw purchase.

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