[Multi-level traumatic lesions of the thoracic and lumbar spine. Value of the Cotrel-Dubousset instrumentation].

Trauma of the spine involving several thoracic and lumbar vertebrae is rare (4 case in 250 spine operated in our unit from 1985 to 1990) and require difficult therapeutic decisions. The patients has one or more unstable fractures which could require 4 screw-plates that would be mechanically unsatisfactory, or an unstable fracture combined with other stable lesions requiring a mixed orthopaedic and surgical treatment that would lead to long term decubitus with a corset. The Cotrel-Dubousset system makes it possible to approach each lesion separately with segmentary instrumentation. Using different combinations of the implants we were able to obtain a construction which was both technically and mechanically satisfactory and allowed recovery of the sagittal spinal curvatures without external contention. A single operation treating all the different lesions was sufficient in 3 Frankel E patients, allowing them to return to their former activities in 3 to 6 months. The material was removed at about 20 months allowing good spinal mobility.