Anterior fixation of thoracolumbar traumatic spinal injuries.

BACKGROUND

Traumatic spinal fractures require surgical treatment to restore the anatomical curvatures of the spine and release the nervous structures. However, uniform management guidelines have not been established and thus the literature includes papers focussing only on the posterior techniques as well as those assessing the anterior or anteroposterior approaches. This paper presents the outcomes of the treatment of spinal fractures with anterior and anteroposterior fixation.

MATERIAL AND METHODS

The study enrolled 48 patients. The age of the patients at the time of injury was 36.8 years on average and the mean follow-up period was 3.8 years. All the fractures were unstable and caused stenosis of the spinal canal lumen. We used anterior or combined anterior and posterior approaches with a titanium implant in all the cases. Radiological assessment involved determination of the monosegmental and bisegmental Cobb angle, and the neurological status was evaluated according to the Frankel classification.

RESULTS

The mean post-traumatic monosegmental angle was -17.1°, compared to -9.1° post-operatively and -9.2° at followup. The bisegmental angle was -12.7° at baseline, -7.9° post-operatively, and -8° in the follow-up period. Neurological assessment showed no neurological deficits in 27 patients while 2 persons had complete limb paralysis and the other 19 patients had various degrees of neurological deficits. The last follow-up examination did not show any improvement with respect to the neurological status of the patients with complete paralysis. However, an improvement of at least 1 Frankel group was noted in 15 patients with partial neurological deficits.

CONCLUSIONS

1. The most common causes of traumatic spinal injuries are falls from a height and road accidents. 2. fractures occur most often at the thoracolumbar junction of the spine. 2. Anteroposterior fixation with release of the spinal canal and spinal fusion is a beneficial treatment method. 3. Apart from vertebral body mesh, treating lumbar spine fractures requires the additional use of vertebral body screws or transpedicular posterior fixation. 4. Anterior fixation ensures the restoration of the physiological curvatures of the spine and stabilizes the spine until a complete bone union is achieved, preventing the loss of correction during the follow-up period.