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Abstract
Objectives
To evaluate the relationships between spinal canal occlusion and neurologic deficits, and between spinal canal decompression and neurologic recovery in thoracolumbar burst fractures. Kyphotic deformities, based on the fracture types in short-segment instrumentation and fusion, were evaluated to determine effective operative methods.
Summary of Literature Review
In thoracolumbar burst fractures, the relationship between spinal canal occlusion and neurologic deficits remains controversial; and definitive guidelines for short-segment instrumentation and fusion have not been established.
Materials and Methods
Surgically treated thoracolumbar burst fractures (N=112) were analyzed retrospectively. Spinal canal occlusion in both neurologically intact and deficient groups, and neurologic recovery as a result of spinal canal decompression, were evaluated based on Frankel's grades. Kyphotic deformities based on the Denis classification and McCormack's load sharing classification were evaluated in 86 short-segment instrumentation patients.
Results
Spinal canal occlusion in the neurologically deficient group (51.8%) was significantly higher than that in the neurologically intact group (31.4%) (p<0.05). A lthough 29 patients who recovered neurologically and 25 who did not, demonstrated 20.4% and 19.5% of spinal canal decompression, respectively, it was not significant (p>0.05). Kyphotic deformities were increased significantly in Denis type A, B and groups with more than 7 points in the load sharing classification (p<0.05).
Conclusion
In thoracolumbar burst fractures, the degree of initial spinal canal occlusion was more significantly related with neurologic deficits than with postoperative spinal canal decompression. Extended instrumentation and fusion is recommended for reducing postoperative kyphotic deformities in Denis type A, B and groups with more than 7 points in the load sharing classification.
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Fig. 1.
Canal occlusion of neurologic intact group and neurologic deficit group. (-): neurologic intact group, (+): neurologic deficit group.
Fig. 2.
Radiographs of a 36-year-old female with T12 unstable bursting fracture by fall from height. Initial Frankel grade was D. The fracture was Denis type A and 7 points in the McCormack's load sharing classification. (A) Preoperative axial CT scan shows 62% of the spinal canal occlusion. (B) Postoperative axial CT scan shows 24% of decompression. Frankel grade was improved into E. (C) Initial kyphotic angle is 29°. (D) Postoperative kyphotic angle is corrected up to 13°. (E) 3 years follow-up radiograph shows 28° of kyphotic angle. Correction loss is 15°.
Table 1.
Change of canal occlusion in neurologic unrecovered 25 patients
Table 2.
Change of canal occlusion in neurologic recovered 29 patients
Table 3.
Change of kyphotic angle according to Denis type in 86 patients with short segment instrumentation and fusion
Table 4.
Change of kyphotic angle according to McCormack's load sharing classification in 86 patients with short segment instrumentation and fusion
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