THE ROLE OF POSTERIOR INSTRUMENTATION ON CANAL COMPROMISE İN THE TREATMENT OF BURST FRACTURES OF THORACOLUMBAR SPINE
Journal Title: Journal of Turkish Spinal Surgery - Year 1994, Vol 5, Issue 2
Abstract
Background: Recent studies demonstrated the importance of the Posterior Longitudinal Ligament (PLL) and posterior annulus in the decompression of the medullary canal by reducing intracanal fragment. Aim: Purpose of this study is to demonstrate the effects of canal compromise amount to the canal clearance by posterior distraction and ligamentotaxis. Material and Method: There were 16 patients (7 vjomen and 9 men) with average age of 37.2 years (range 15-56). Ali patients had preoperative and postoperative CT seans which revealed narrowing of the medullary canal less than 30% in 1; 30-50% in 4 and more than 50% in 11 cases preoperatively. Postoperative narrovving of the medullary canal revealed 0-15% in 6, 15-30% in 3 and more than 30% in 7 patients. The patients were oper-ated with in 4 hours to 18 days (av. 1.8 days) of the injury. 9 patients undervvent posterior, and 7 patients, com-bined anterior and posterior surgery. The average follow-up was 30.4 months. At follow-up examination 3 patinets Frankei A remained unehanged, 1 of 2 Frankel C patients remained unehanged and one improved to grade D, 2 of 6 grade D patients improved to grade E; 2 remained unehanged, and one deteriorated to grade C; 5 patients did not have neurological deficits postoperatively. Conclusion: Our results demonstrated that iigamentotaxis achieved by distraction was successful in cases which medullary canal compromise was less than 35%, vvhereas in cases vvhich medullary canal compromise was more than 35%, it was not successful and residual bone fragments stili remained in the canal leading to vari-ous degrees of canal compromise. The possible cause forthis may be that posterior longitudinal ligament 1 (PLL) and posterior annulus could have been ruptured in cases with more than 30% canal compromise. We think that preoperative MRI might be helpful to evaluate PLL and posterior annulus. If this is not possible, anterior surgery should be chosen.
Authors and Affiliations
Haluk BERK, Devrim AKSEKİ, Kadir YALDIZ, Emin ALICI
Keywords
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