Treatment of Thoracolumbar Fracture with Anterior Approach

Heui-Jeon Park; In-Gu Kim

doi:10.4184/jkss.2001.8.3.419

Journal List > J Korean Soc Spine Surg > v.8(3) > 1035975

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Park and Kim: Treatment of Thoracolumbar Fracture with Anterior Approach

Original Article

Journal of Korean Spine Surg 2001;8(3):419-422.

Published online: 21 February 2001

DOI: https://doi.org/10.4184/jkss.2001.8.3.419

Treatment of Thoracolumbar Fracture with Anterior Approach

Heui-Jeon Park, M.D., In-Gu Kim, M.D.

Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University, Wonju, Korea

Address reprint requests to Heui-Jeon Park, M.D. Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University #162 Ilsan-dong, Wonju, Kangwon-do 220-050, Korea Tel : 82-33-741-1352, Fax : 82-33-741-1358, E-mail : Par73@wonju.yonsei.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The anterior approach to the spine offers several unique solution to problems posed by patients with thoracolumbar injuries. The major weight- bearing elements of the spine are anterior and this is the area where injured elements impinging on the spinal cord can cause significant but reversible damage. The two primary areas of concern for surgeons treating these patients are restoration of mechanical stability of the spinal column and restoration or preservation of neurologic function. Indications for anterior decompression, 1)a large retropulsed fragment with significant(>50%) canal compromise, 2)anterior column comminution and marked kyphosis, and a time lapse of greater than 10 days from the time of injury. A nterior approaches are also recommended for the late treatment of symptomatic posttraumatic kyphosis that causes pain or neurologic deficit. The flexion- compression injuries addressed with anterior decompression and strut graft fusion require additional stability for satisfactory healing with maintenance of position assured during bone graft incorporation. A nterior instrumentation is most effective when balanced by an intact posterior ligamentous tension band. The anterior approach is more superior in canal clearance and effective in restoring bladder and bowel function.

Keywords: Thoracolumbar spine, Fracture, A nterior approach

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Fig. 1-A.

The retroperitoneal approach to the first lumbar vertebra from the left through an incision overlying the twelfth rib. Fig. 1-B. Orientation to the spinal canal is facilitated by tracing the course of the twelfth intercostal nerve. After removal of the left pedicle of the first lumbar vertebra, the retropulsed vertebral-body fragments of a burst fracture of the first lumbar vertebra are seen compressing the thecal sac. Fig. 1-C. The vertebral body fragments are removed with a high-speed burr until the base of the opposite pedicle is visualized. Fig. 1-D. An iliac-crest tricortical strut graft is locked in place using bone tamps. Each end is countersunk into the vertebral body above and below.

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