[논문]Radiological and Clinical Results of Laminectomy and Posterior Stabilization for Severe Thoracolumbar Burst Fracture : Surgical Technique for One-Stage Operation

Kim, Myeong-Soo; Eun, Jong-Pil; Park, Jeong-Soo

doi:10.3340/jkns.2011.50.3.224

Radiological and Clinical Results of Laminectomy and Posterior Stabilization for Severe Thoracolumbar Burst Fracture : Surgical Technique for One-Stage Operation 원문보기

Journal of Korean Neurosurgical Society = 대한신경외과학회지, v.50 no.3, 2011년, pp.224 - 230

Kim, Myeong-Soo (Department of Neurosurgery, Research Institute of Clinical Medicine, Institute for Medical Science, Chonbuk National University Medical School) , Eun, Jong-Pil (Department of Neurosurgery, Research Institute of Clinical Medicine, Institute for Medical Science, Chonbuk National University Medical School) , Park, Jeong-Soo (Department of Neurosurgery, Research Institute of Clinical Medicine, Institute for Medical Science, Chonbuk National University Medical School)

Abstract ▼ AI-Helper

Objective : This study aimed to show the possibility of neural canal enlargement and restoration of bony fragments through laminectomy and minimal facetectomy without pediculectomy or an anterior approach, and also to prove the adequacy of posterior stabilization of vertebral deformities after thoracolumbar bursting fracture. Methods : From January 2003 to June 2009, we experienced 45 patients with thoracolumbar burst fractures. All patients enrolled were presented with either a neural canal compromise of more than 40% with a Benzel-Larson Grade of VI, or more than 30% compromise with less than a Benzel-Larson Grade of V. Most important characteristic of our surgical procedure was repositioning retropulsed bone fragments using custom-designed instruments via laminectomy and minimal facetectomy without removing the fractured bone fragments. Beneath the dural sac, these custom-designed instruments could push the retropulsed bone fragments within the neural canal after the decompression and bone fragment repositioning. Results : The mean kyphotic deformities measured preoperatively and at follow-up within 12 months were 17.7 degrees (${\pm}6.4$ degrees) and 9.6 degrees (${\pm}5.2$ degrees), respectively. The mean midsagittal diameter improved from 8.8 mm (${\pm}2.8$ mm) before surgery to 14.2 mm (${\pm}1.6$ mm) at follow-up. The mean traumatic vertebral body height before surgery was 41.3% (${\pm}12.6%$). At follow-up assessment within 12 months, this score showed a statistically significant increase to 68.3% (${\pm}12.8%$). Neurological improvement occurred in all patients. Conclusion : Though controversy exists in the treatment of severe thoracolumbar burst fracture, we achieved effective radiological and clinical results in the cases of burst fractures causing severe canal compromise and spinal deformity by using this novel custom-designed instruments, via posterior approach alone.

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가설 설정

1. A : The fractured vertebral body angle of kyphotic deformity is measured as the angle between the upper margin of the vertebral body and the lower margin of the vertebral body. B : The vertebral body height was determined using the formula=2F/(A+B)×100, where F is the height of the fractured vertebral body, A is the height of the upper vertebral body, and B is the height of the lower vertebral body.

제안 방법

In this study, we demonstrated to some extent the feasibility and relative safety of this technique for directly reducing the retropulsed bone fragments after posterior, indirect reduction and stabilization. In the modified transpedicular approach by Kaya and Aydin²⁴⁾, they described drilling a hole in the pedicles in a burst fracture and removing the retropulsed bone fragments that was inserted for minimal structure damage.
Long-term follow-up evaluations ranging from 12 to 72 months after the operation were consisted of re-grading the patients’ neurological statuses according to the Benzel-Larson Grading system and radiographic analyses.
We analyzed each patient’s operation records, progression notes, reports of preoperative and postoperative radiological studies, and follow-up evaluation notes from outpatients clinic.

대상 데이터

From January 2003 to June 2009, we enrolled 45 patients with thoracolumbar burst fractures in this study retrospectively. We also used our surgical procedure on those patients with a Benzel-Larson Grade of VI and neural canal encroachment greater than 40% on axial computed tomography (CT).
Photographs of the instruments (A and B : custom-designed). The instrument is made of one piece of stainless steel, and is 20 cm long with double foot plates, blunt blades and angled from the shaft. The shaft has a flat portion at its center for the surgeon’s finger.
This study included 25 male and 20 female patients whose mean age at the time of injury was 39.5±14.4 (SD) years (range;16-75 years).

데이터처리

The data were analyzed by the paired samples t-test from the SPSS software package, version 13.0 (SPSS Inc., Chicago, IL, USA). A p value less than 0.

이론/모형

To evaluate the patients’ myelopathic dysfunction, we employed the Benzel-Larson Grading system (Table 1)3).

성능/효과

In the modified transpedicular approach by Kaya and Aydin²⁴⁾, they described drilling a hole in the pedicles in a burst fracture and removing the retropulsed bone fragments that was inserted for minimal structure damage. They concluded the modified transpedicular approach, drilling a hole in the pedicles, might reduce the loss of posterior column continuity and increase structural stability. Numerous papers have been described the results of a variety of treatment options, but no previous study has been considered the posterior approach alone, with a procedure to push the retropulsed bone fragments into the burst vertebral body for canal enlargement and restoration of vertebral height.

후속연구

Besides, it would be premature for us to advocate for this procedure based on the small number of patients in this study. An additional study, with a larger group of patients and a comparison group treated with a different technique, should be performed.

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