Osteosynthesis and Trauma Care 2005; 13(4): 208-213
DOI: 10.1055/s-2005-872551
Original Article

© Georg Thieme Verlag Stuttgart · New York

Operative Treatment of Thoracolumbar Spine Fractures

F. C. Bakker1 , M. J. M. Segers2 , P. Patka3 , H. J. T. M. Haarman1
  • 1Department of Trauma Surgery, VU University Medical Center, Amsterdam, The Netherlands
  • 2Department of Surgery, Hospital St. Antonius, Nieuwegein, The Netherlands
  • 3Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
Further Information

Publication History

Publication Date:
01 December 2005 (online)

Abstract

Thoracolumbar spine fractures are increasingly treated operatively. Advances in surgical techniques, including minimal invasive procedures, the improvement of implants and instruments, and better anaesthesiologic management have contributed to this development. However evidence based guidelines to decide which spinal injuries benefit from operative treatment are still lacking. Especially the treatment of burst fractures is still controversial. A basic understanding of the pathophysiologic mechanisms, a good interpretation of X-rays and CT, and a correct classification of these injuries are therefore important factors in making a well-founded decision whether to operate or not. When operative treatment is indicated one has to decide on the best approach, depending on the level of the injury, the fracture type, narrowing of the spinal canal and/or neurological symptoms, as well as the general condition of the patient and the experience of the surgeon.

References

  • 1 Alanay A, Acaroglu E, Yazici M. et al . Short-segment pedicle instrumentation of thoracolumbar burst fractures: does transpedicular intracorporeal grafting prevent early failure?.  Spine. 2001;  26 213-217
  • 2 Albert T J, Levine M J, An H S, Cotler J M, Balderston R A. Concomitant noncontiguous thoracolumbar and sacral fractures.  Spine. 1993;  18 1285-1291
  • 3 Amiot L P, Lang K, Putzier M. et al . Comparative results between conventional and computer-assisted pedicle screw installation in the thoracic, lumbar, and sacral spine.  Spine. 2000;  25 606-614
  • 4 Arand M, Hartwig E, Hebold D. et al . Präzisionsanalyse navigationsgestützt implantierter thorakaler und lumbaler Pedikelschrauben. Eine prospektive klinische Studie.  Unfallchirurg. 2001;  104 1076-1081
  • 5 Bakker F C, Patka P, Haarman H J. Combined repair of a traumatic rupture of the aorta and anterior stabilization of a thoracic spine fracture: a case report.  J Trauma. 1996;  40 128-129
  • 6 Beisse R, Potulski M, Beger J, Bühren V. Development and clinical application of a thoracoscopically implantable anterior plate for treatment of thoracolumbar fractures and instability.  Orthopäde. 2002;  31 413-422
  • 7 Blauth M, Bastian L, Knop C. et al . Interobserverreliabilität bei der Klassifikation von thorakolumbalen Wirbelsäulenverletzungen.  Orthopäde. 1999;  28 662-681
  • 8 Boerger T O, Limb D, Dickson R A. Does “canal clearance” affect neurological outcome after thoracolumbar burst fractures?.  J Bone Joint Surg [Br]. 2000;  82 629-935
  • 9 Braakman R, Fontijne W P, Zeegers R. et al . Neurological deficit in injuries of the thoracic and lumbar spine. A consecutive series of 70 patients.  Acta Neurochir (Wien). 1991;  111 11-17
  • 10 Cantor J B, Lebwohl N H, Garvey T. et al . Nonoperative management of stable thoracolumbar burst fractures with early ambulation and bracing.  Spine. 1993;  18 971-976
  • 11 Chow G H, Nelson B J, Gebhard J S. et al . Functional outcome of thoracolumbar burst fractures managed with hyperextension casting or bracing and early mobilization.  Spine. 1996;  21 2170-2175
  • 12 Dai L Y. Remodeling of the spinal canal after thoracolumbar burst fractures.  Clin Orthop. 2001;  382 119-123
  • 13 Daniaux H. Transpedikuläre Reposition und Spongiosaplastik bei Wirbelkörperbrüchen der unteren Brust- und Lendenwirbelsäule.  Unfallchirurg. 1986;  89 197-213
  • 14 de Klerk L W, Fontijne W P, Stijnen T. et al . Spontaneous remodeling of the spinal canal after conservative management of thoracolumbar burst fractures.  Spine. 1998;  23 1057-260
  • 15 Denis F, Armstrong G W, Searls K. et al . Acute thoracolumbar burst fractures in the absence of neurologic deficit. A comparison between operative and nonoperative treatment.  Clin Orthop. 1984;  189 142-149
  • 16 Denis F. Spinal instability as defined by the three-column spine concept in acute spinal trauma.  Clin Orthop. 1984;  189 65-76
  • 17 Fehlings M G, Sekhon L H, Tator C. The role and timing of decompression in acute spinal cord injury: what do we know? What should we do.  Spine. 2001;  26 (Suppl) S101-S110
  • 18 Gertzbein S D. Neurologic deterioration in patients with thoracic and lumbar fractures after admission to the hospital.  Spine. 1994;  19 1723-1725
  • 19 Gertzbein S D. Scoliosis Research Society. Multicenter spine fracture study.  Spine. 1992;  17 528-540
  • 20 Haas N, Blauth M, Tscherne H. Anterior plating in thoracolumbar spine injuries. Indication, technique, and results.  Spine. 1991;  16 (Suppl) S100-S111
  • 21 Hamilton A, Webb J K. The role of anterior surgery for vertebral fractures with and without cord compression.  Clin Orthop. 1994;  300 79-89
  • 22 Hartman M B, Chrin A M, Rechtine G R. Non-operative treatment of thoracolumbar fractures.  Paraplegia. 1995;  33 73-76
  • 23 Hawighorst H, Berger M F, Moulin P. et al . MRT bei spinoligamentären Verletzungen.  Orthopäde. 2001;  30 565-579
  • 24 Junge A, Gotzen L, von Garrel T. et al . Die monosegmentale Fixateur interne-Instrumentation und Fusion in der Behandlung von Frakturen der thorakolumbalen Wirbelsäule. Indikation, Technik und Ergebnisse.  Unfallchirurg. 1997;  100 880-887
  • 25 Kaneda K, Taneichi H, Abumi K. et al . Anterior decompression and stabilization with the Kaneda device for thoracolumbar burst fractures associated with neurological deficits.  J Bone Joint Surg [Am]. 1997;  79 69-83
  • 26 Knop C, Blauth M, Buhren V. et al . Operative Behandlung von Verletzungen des thorakolumbalen Übergangs. Teil 2: Operation und röntgenologische Befunde.  Unfallchirurg. 2000;  103 1032-1047
  • 27 Knop C, Blauth M, Buhren V. et al . Operative Behandlung von Verletzungen des thorakolumbalen Übergangs. Teil 1: Epidemiologie.  Unfallchirurg. 1999;  102 924-935
  • 28 Knop C, Fabian H F, Bastian L. et al . Late results of thoracolumbar fractures after posterior instrumentation and transpedicular bone grafting.  Spine. 2001;  26 88-99
  • 29 Kossmann T, Ertel W, Platz A. Die kombinierte Operation von Frakturen des thorakolumbalen Übergangs mit der Inlay-Span-Technik.  Orthopäde. 1999;  28 432-440
  • 30 Kuner E H, Schlickewei W, Hauser U. et al . Zur Wiederherstellung der lichten Weite des Spinalkanals durch Fixateur-interne-Instrumentation und Remodeling.  Chirurg. 1996;  67 531-538
  • 31 Laine T, Lund T, Ylikoski M. et al . Accuracy of pedicle screw insertion with and without computer assistance: a randomised controlled clinical study in 100 consecutive patients.  Eur Spine J. 2000;  9 235-240
  • 32 Magerl F, Aebi M, Gertzbein S D, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries.  Eur Spine J. 1994;  3 184-201
  • 33 McCormack T, Karaikovic E, Gaines R W. The load sharing classification of spine fractures.  Spine. 1994;  19 1741-1744
  • 34 McLain R F, Benson D R. Urgent surgical stabilization of spinal fractures in polytrauma patients.  Spine. 1999;  24 1646-1654
  • 35 Miyakoshi N, Abe E, Shimada Y. et al . Anterior decompression with single segmental spinal interbody fusion for lumbar burst fracture.  Spine. 1999;  24 67-73
  • 36 Oner F C, van der Rijt R R, Ramos L M. et al . Changes in the disc space after fractures of the thoracolumbar spine.  J Bone Joint Surg [Br]. 1998;  80 833-839
  • 37 Oner F C, van Gils A P, Dhert W J. et al . MRI findings of thoracolumbar spine fractures: a categorisation based on MRI examinations of 100 fractures.  Skeletal Radiol. 1999;  28 433-443
  • 38 Panjabi M M, Oxland T R, Kifune M, Arand M, Wen L, Chen A. Validity of the three-column theory of thoracolumbar fractures. A biomechanic investigation.  Spine. 1995;  20 1122-1127
  • 39 Perrouin-Verbe B, Lenne-Aurier K, Robert R. et al . Post-traumatic syringomyelia and post-traumatic spinal canal stenosis: a direct relationship: review of 75 patients with a spinal cord injury.  Spinal Cord. 1998;  36 137-143
  • 40 Potulski M, Beisse R, Bühren V. Die thorakoskopisch gesteuerte Behandlung der „vorderen Säule”. Technik und Ergebnisse.  Orthopäde. 1999;  28 723-730
  • 41 Rosenberg N, Lenger R, Weisz I. et al . Neurological deficit in a consecutive series of vertebral fracture patients with bony fragments within spinal canal.  Spinal Cord. 1997;  35 92-95
  • 42 Schlegel J, Bayley J, Yuan H. et al . Timing of surgical decompression and fixation of acute spinal fractures.  J Orthop Trauma. 1996;  10 323-330
  • 43 Shen W J, Liu T J, Shen Y S. Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit.  Spine. 2001;  26 1038-1045
  • 44 Shen W J, Shen Y S. Nonsurgical treatment of three-column thoracolumbar junction burst fractures without neurologic deficit.  Spine. 1999;  24 412-415
  • 45 Shono Y, McAfee P C, Cunningham B W. Experimental study of thoracolumbar burst fractures. A radiographic and biomechanical analysis of anterior and posterior instrumentation systems.  Spine. 1994;  19 1711-1722
  • 46 Sjoström L, Karlstrom G, Pech P. et al . Indirect spinal canal decompression in burst fractures treated with pedicle screw instrumentation.  Spine. 1996;  21 113-123
  • 47 Soreff J, Axdorph G, Bylund P. et al . Treatment of patients with unstable fractures of the thoracic and lumbar spine: a follow-up study of surgical and conservative treatment.  Acta Orthop Scand. 1982;  53 369-381
  • 48 Speth M J, Oner F C, Kadic M A. et al . Recurrent kyphosis after posterior stabilization of thoracolumbar fractures. 24 cases treated with a Dick internal fixator followed for 1.5-4 years.  Acta Orthop Scand. 1995;  66 406-410
  • 49 Wälchli B, Heini P, Berlemann U. Korrekturverlust nach dorsaler Stabilisierung von Berstungsfrakturen des thorakolumbalen Übergangs. Die Rolle der transpedikulären Spongiosaplastik.  Unfallchirurg. 2001;  104 742-747
  • 50 White A A, Panjabi M M. Clinical Biomechanics of the Spine. Second Edition. JB Lippincott, Philadelphia 1990

Dr. Fred C. Bakker

Department of Trauma Surgery · VU University Medical Center

P.O. Box 70 57

1007 MB Amsterdam

The Netherlands

Phone: +31/20/4 44 45 54

Fax: +31/20/4 44 02 74

Email: fc.bakker@vumc.nl