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Abstract
Study Design
A retrospective analysis of the results of various methodologies for the surgical treatment of an unstable burst fracture with posterior column injuries.
Objectives
To compare the radiological and clinical results in unstable burst fractures, treated with various surgical methodologies (anterior, posterior and combined fusion), and to confirm their efficacy.
Literature Review Summary
Many authors recommended various surgical methods for the treatment of an unstable burst fracture, and of these, combined fusion is recommended for the preservation of stability.
Materials and Methods
A retrospective review of results was carried out on 22 patients, confirmed with an unstable burst fracture associated with a posterior column injury, between Nov. 1996 and Mar. 2003.
The preoperative plane x-ray, CT and MRI, and the last postoperative follow up plane X - ray and CT, in 22 unstable burst fracture patients, were reviewed. The authors looked for laminar fracture, facet injury and inter-spinous widening in the plane x-ray, canal compromise on the CT, and a posterior ligament injury and dural tear on the MRI. The neurological injury was evaluated using the Bardford and McBride criteria and the clinical result with the Denis' pain and work scale.
Results
In the anterior fusion group, the radiological findings showed 3 laminar fractures, 2 facet injuries, 7 inter-spinous widening and 8 posterior ligament injuries. In the posterior fusion group, they showed 5 laminar fractures, 4 facet injuries, 5 inter-spinous widening and 5 posterior ligament injuries. In the combined fusion group, they showed 5 laminar fractures, 4 facet injuries, 4 inter-spinous widening and 5 posterior ligament injuries. The average canal compromise was 54.3% in cases of anterior fusion, 20.9% of posterior fusion and 74% of the combined fusion groups. A dural tear was found in 1each of the anterior and posterior and 4 of the combined group. From the clinical results, improvements of the neurology in the anterior, posterior and combined groups were 2.0, 1.7 and 1.3 degrees, respectively. From the Denis' pain & work scale better than good degrees were shown in 3 of the anterior, 4 of the posterior and 2 of the combined groups.
Conclusions
In conclusion, there were no differences in the improvements of the neurology and clinical results according to the surgical methodology employed. However, the use of combined fusion is recommended for the preservation of stability in an unstable burst fracture with combined posterior ligament and bony injuries as well as with severe canal compromise.
REFERENCES
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Fig. 1.
In simple radiographs, it shows widening of interpedicular distance, collapse of anterior and middle column and interspinous widening.
Table 1.
Data analysis of all patients
A: Laminar fracture B: Posterior facet injury C: Inter-spinous widening D: Posterior ligament injury E: Canal compromise (%) F: Methods of operation (A; anterior fusion/P; posterior fusion/A+P; circumferential fusion) G: Preoperative neurologic status H: Postoperative neurologic status I: Pain and Work scale by Denis
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