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KMID : 0381219940260010019
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Journal of RIMSK
1994 Volume.26 No. 1 p.19 ~ p.30
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Treatment of Unstable Thoracolumbar Fracture-Results of Posterior Decompression and Stabilization with Cotrel-Dubousset Instrument -
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강기서
정영복/태석기/이은우/김부섭
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Abstract
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Twenty two patients with thracolumbar fractures had been treated with posterior decompression, reduction and stabilization from September 1988 to December 1991 Duration of follow-up were twelve to forty months. Eight patients(Group I) who had a
spinal
cord injury were treated by posterior decompression, pedicle screw instrumentation and arthrodesis with iliac bone. Fourteen patients(Group 2) who had no neurological impairment were treated with the same method as the Group I but without
decompression.
The patients were evaluated by clinical examination and lateral radiographs to compare the changes in vertebral height and local kyphosis in two groups. In all patient, preoperative computed tomograhy showed bony fragment compressing the anterior
aspect
of spinal cord. There was no neurlogical or vascular injury due to pedicle screws fixation.
@ES The following results were obtained:
@EN 1) Burst fracture was the most common type of injury(Burst type B-64%).
2) Neural canal encroachement was 69% in Group I and 38.5% in Group 2.
3) Loss of reduction(Kyphosis) were 9.6 degrees in group I and 5.2 degrees in group 2.
4) Loss of vertebral height after reduction was 20.5% in group I and 13.4% in group 2.
5) Significant neurologic recovery was found in patients managed by laminectomy and pedicle screw instrumentation, eighty three percent of cases improved to at least one more next Frankel subgroup.
6) Neural canal encroachment was significantly reduced after postenrior instrumentation, and the reduction rate was 32.2%.
Our current management of a patient who has an acute injury of the thoracolumbar spine with incomplete motor loss consists of posterior decompression, reduction by pedicle screw instrumentation and limited arthrodesis with iliac bone in
instrumented
level High rate of loss of reduction and increased local kyphosis in Group l suggests that posterior decompression and pedicle screw fixation may not be adequate to preserve the reduction but it did not always heralds a clinical failure. It can
be
preventable by long segment instrumentation or anterior fusion or long term immoilization.
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KEYWORD
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