Therapeutic Concept and Results of Operative Treatment in Acute Trauma of the Thoracic and Lumbar Spine: The Hannover Experience

Abstract

Summary: A therapeutic concept for the treatment of acute thoracolumbar spinal injury includes an early closed reduction as the first step. In cases with a surgical indication in the lower thoracic area as well as in the lumbar spine, the posterior approach is preferred. Following decompression of the spinal cord, a transpedicular lifting of the upper endplate is done and the fractured vertebra is filled with corticocancellous bone chips. Stabilization is achieved with an internal fixator usually over two motion segments only. Subsequently, autologous corticocancellous bone is added between lamina and between the transverse processes. In the thoracic spine proper, the anterior approach is more advantageous. Following spondylectomy (removal of the vertebral body whole or in part), an intercorporal spinal arthrodesis is performed utilizing a solid bone graft and plates. Seventy-six patients with 78 fractures and subluxations of the thoracolumbar spine were reexamined for an average of 3 years and 4 months after their operation. Of the patients with an incomplete cord injury (Frankel B–D) 60% improved at least one Frankel grade and an additional nine patients improved within their group. Clinical deterioration did not occur. Irrespective of the localization, the radiologically determined loss of correction following an anterior approach was an average of 7° whereas the settling after posterior approach averaged 9°. The sagittal index of the affected vertebra improved from 0.59 preoperatively to 0.80 postoperatively. All spinal arthrodeses healed with osseous reorganization. Twelve postoperative computer tomographies were analyzed (11 after a posterior decompression), and showed a decrease of the spinal canal compromise from 65% preoperatively to 11% following surgery.