Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, 3 East Qingchun Road, Hangzhou 310016, China.
Med Hypotheses. 2010 Dec;75(6):550-2. doi: 10.1016/j.mehy.2010.07.026. Epub 2010 Aug 12.
Thoracolumbar burst fracture (TLBF) is a common type of spinal injuries and frequently causes spinal cord injury. The frequency of neurological deficits in all TLBF can reach up to 50-60%. The typical TLBF images seen on axial computerized tomography are the bone fragment projected into the spinal canal, which always persuade surgeons that the narrowed canal must compress the neural content and therefore is responsible for neurological deficits, with the corollary that surgical decompression of spinal canal is an essential therapeutic strategy for functional recovery. We hypothesize that in TLBF, traumatic canal stenosis is a predictive factor for neurological dysfunction and the surgical decompression is vital to the recovery of neurological function. After a review of the available evidences, we conclude that spinal canal stenosis is poorly correlated with neurological dysfunction in TLBF, and surgical decompression is not vital to the neurological recovery. Therefore, traumatic canal stenosis should not be an isolated indication for surgical decompression in TLBF.
胸腰椎爆裂性骨折（TLBF）是一种常见的脊柱损伤类型，常导致脊髓损伤。所有 TLBF 患者神经功能缺损的发生率可达 50-60%。轴向计算机断层扫描（CT）上典型的 TLBF 图像为骨碎片突入椎管，这总是使外科医生相信狭窄的椎管肯定会压迫神经组织，因此对神经功能缺损负责，其推论是椎管减压是功能恢复的重要治疗策略。我们假设在 TLBF 中，创伤性椎管狭窄是神经功能障碍的预测因素，手术减压对神经功能的恢复至关重要。在回顾现有证据后，我们得出结论，TLBF 中椎管狭窄与神经功能障碍相关性差，手术减压对神经恢复并非至关重要。因此，创伤性椎管狭窄不应成为 TLBF 手术减压的孤立指征。
