Modified surgery for acute thoracolumbar fractures: a prospective report

Objectives The treatment of acute thoracolumbar fractures is a demanding and fine surgical challenge. Conventional procedures are not always satisfactory enough because of postoperative complications of failure of posterior instrumentation or lumbodorsal pain etc. This prospective outcome study was undertaken to investigate the improvement of the surgical treatment effect on acute thoracolumbar fractures by performing modified surgeries. Methods Nineteen patients with acute thoracolumbar fractures and associated incomplete neurologic deficit, subjected to the methods of transpedicular intracorporeal hydroxyapatite grafting and pedicle screw fixation through paraspinal approach, were reviewed after a minimum follow-up of 2 years. Nineteen patients all suffered from a single thoracolumbar fracture. The mean preoperative ratio of the height of the anterior border was 57.2%, kyphosis degree was 21.6°, and occupancy of canales spinalis was 30.5%. The radiographic parameters were evaluated, and clinical records were reviewed. Results The average operating time was 112.4 min, and the mean blood loss was 123.7 ml. The neurologic function of all 19 patients was improved by at least one American Spine Injury Association grade, with 17 (89.5%) having complete neurologic recovery. The mean height of injured spine was corrected from 57.2% to 88.4% at the most recent follow-up, and the kyphosis was corrected from 21.6° to 4.8°. There was only one patient (5.3%) who complained that the operative area was a little painful, and the remaining patients did not claim pain in waist and back. Conclusions Transpedicular intracorporeal hydroxyapatite grafting and pedicle screw fixation through paraspinal approach could provide reliable neurologic improvement in patients with incomplete neurologic deficit, and could prevent the development of kyphosis. Furthermore, it has the obvious advantages of less invasion and blood loss, and decreases the risks of postoperative lumbodorsal pain.