Dorsal stabilization of fractures of the thoracic and lumbar spine by external fixator--technique and outcome
Pizanis, A.; Mutschler, W.
Zentralblatt für Chirurgie 123(8): 936-943
1998
ISSN/ISBN: 0044-409X PMID: 9757539 Document Number: 490240
Posterior stabilization by internal fixator is used as a frequent procedure for the surgical treatment of thoracolumbar spine fractures. The technique of internal fixator stabilization and its results regarding the correction of spinal posture and spinal canal clearance are described. By transpedicular spongiosal filling of the reduced vertebral body, a complete consolidation can be achieved. Occurring correction losses of the spinal alignment are mainly attributed to the collapse of intervertebral segments, thereby suggesting insufficient anterior fusion and support after transpedicular intercorporal cancellous bone grafting. Spinal canal narrowings can only be cleared partially through posterior approach and indirect reduction by internal fixator. In abscence of neurological deficits, residual spinal canal encroachments can be tolerated after surgery, since remodelling phenomenons occur subsequently. However, symptomatic spinal cord compression requires a more efficient decompression technique by direct posterior approach, risking manipulation damage of neural structures. The limited possibilities of internal fixator technique demand the discerning consideration of alternative anterior or combined anterior-posterior procedures for the planning of surgical treatment. For spinal fractures with pronounced destruction of the anterior column and associated intervertebral disc ruptures, an interbody fusion by anterior approach should be performed. In case of additional posterior or transverse instability, a supplemental stabilization by internal fixator is necessary. For severe spinal canal encroachments at thoracic spine level with symptomatic or imminent spinal cord compression, the most efficient decompression by an anterior approach is preferred.