Aspects of surgical treatment of thoraco-lumbar vertebrae fractures

Abstract

Introduction: Vertebrae fractures of the thoracic and lumbar region are severe injuries that can seriously compromise the functional outcome, rarely the vital one of transmitters, leading to invalidity. Purpose and Objectives: to evaluate the results of different methods of surgery, to highlight the most optimal solutions and successful treatment of thoraco-lumbar spinal trauma. Materials and methods: the study is based on the analysis of demographic, imaging and clinical results of 36 patients with dorsal-lumbar fractures of the spine admitted to the Vertebra logy Clinic of the SCTO PMSI Hospital. Data analysis was performed using International Spine Tango Module program. Patients were devided into 2 groups of patients based on the surgical treatment they underwent. I group: patients that had PSF (posterior screw fixation) - 72,2 % (n=26); II group: patients with AF (anterior fusion) + PSF - 27,8% (n=10). Results: Identified causes of the thoraco-lumbar spinal trauma were catatrauma- 69.4% (n = 25), road accident - 19.4% (n = 7), falling from the height of their body - 11.2% (n = 4). Among the most frequently injured vertebrae are T hl2, LI and L2. The average age of patients at the time of trauma was 34 years (18 to 68 years. Male / female ratio is 1.6/1 (22 men, 14 women). Pre-traumatic VAS score was calculated retrospectively and showed an average of 89.7 (62- 100). The VAS score calculated 9 months postoperative was 74.8 (18-100). On admission, 11 patients were found with neurological deficit (Frankel / ASIA D). The neurological deficit regressed in 10 patients (Frankel / ASIA E), one patient still presents minor problems with the pelvic organ functioning. Radiological results: Consolidation was observed radiographically in all of the cases in AF + PSF group. A case of pseudoarthrosis accompanied by the damage of the construction was found in the group of PSF. Complications: early complications requiring revision surgery occurred in 3 cases, late complications presented in one case. Conclusions: using combined approach allows higher stability of the affected segment during the postoperative period and minimum risk of degradation of this construction. Both variants of surgical corrections of traumatic deformities of the dorsal-lumbar spine ensured the achievement of good clinical results with no statistical difference between them.