Surgical consideration for thoracolumbar burst fractures with spinal canal compromise without neurological deficit

Lijie Yuan; Shaofeng Yang; Yuan Luo; Dawei Song; Qi Yan; Cenhao Wu; Huilin Yang; Jun Zou

doi:10.1016/j.jot.2019.12.003

Surgical consideration for thoracolumbar burst fractures with spinal canal compromise without neurological deficit

J Orthop Translat. 2019 Dec 30:21:8-12. doi: 10.1016/j.jot.2019.12.003. eCollection 2020 Mar.

Authors

Lijie Yuan^{1

2}, Shaofeng Yang¹, Yuan Luo², Dawei Song¹, Qi Yan¹, Cenhao Wu¹, Huilin Yang¹, Jun Zou¹

Affiliations

¹ Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
² Department of Orthopaedic Surgery, Taicang Affiliated Hospital of Soochow University, Taicang, Jiangsu, China.

Abstract

Background: For thoracolumbar burst fractures with spinal canal compromise but no neurological deficit, is it necessary to perform additional laminectomy decompression after the currently accepted posterior pedicle-screw internal fixation?

Methods: Patients were divided into two groups: decompression group (Group A) and nondecompression group (Group B). A retrospective analysis of the posterior vertebral body height of the fractured vertebral body, the ratio of the volume of the spinal canal, and the change of the Cobb angle, relative to the corresponding preoperative values, was conducted to analyse the reasons for choosing different surgical methods.

Results: Compared the intraoperative findings after fixation with the preoperative data, in Group A, the posterior vertebral body height of the fractured vertebral body was not significantly restored, the volume ratio of the spinal canal was not significantly improved, and the Cobb angle was not significantly reduced (p > 0.05). In comparison, in Group B, the posterior vertebral body height of the fractured vertebral body was significantly restored, the volume ratio of spinal canal was significantly increased, and the Cobb angle was significantly reduced (p < 0.001).

Conclusion: For patients with thoracolumbar burst fractures with spinal canal compromise but no neurological deficit, if when the posterior intraoperative fixation is performed, the spinal canal fracture is partially recovered, the posterior vertebral body height of the injured vertebrae is significantly restored, the spinal canal volume ratio is significantly increased, and the large kyphosis is corrected, then the indirect decompression without the posterior laminectomy can be performed.

The translational potential of this article: This study contributes to offer treatment consideration for patients with thoracolumbar burst fracture without neurological symptoms.

Keywords: No neurological deficits; Spinal canal compromise; Spinal canal volume; Surgical approach; Thoracolumbar burst fracture; Vertebral body height.