European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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In view of the current level of knowledge and the numerous treatment possibilities, none of the existing classification systems of thoracic and lumbar injuries is completely satisfactory. As a result of more than a decade of consideration of the subject matter and a review of 1445 consecutive thoracolumbar injuries, a comprehensive classification of thoracic and lumbar injuries is proposed. The classification is primarily based on pathomorphological criteria. ⋯ Stable type A1 fractures accounted for 34.7% of the total. Some injury patterns are typical for certain sections of the thoracolumbar spine and others for age groups. The neurological deficit, ranging from complete paraplegia to a single root lesion, was evaluated in 1212 cases.(ABSTRACT TRUNCATED AT 400 WORDS)
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The potential for clinical instability following thoracolumbar fractures has evoked a progressive increase in interest in the surgical treatment of unstable thoracolumbar fractures. From September 1988 to October 1991, 44 thoracolumbar burst fractures were treated surgically by the AO Spinal Internal Fixator at the Orthopaedics and Traumatology Clinics of Ankara Social Security Hospital. Mean follow-up period was 28.8 (range 12-48) months. ⋯ Also, postoperatively 15.9% of improvement was obtained in the mean kyphosis angle. The mean compression angle, which was 19.5 degrees preoperatively, was corrected by 12.3 degrees and came to an average of 7.1 degrees postoperatively. In light of these data, it is suggested that the AO Spinal Internal Fixator effectively restores three-dimensional alignment of the spine and provides a rigid fixation.
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Fifty patients with thoracolumbar fractures were treated by internal fixation using the Dick fixator. In the first 22 patients (group 1) this was accompanied by posterior intertransverse grafting. The technique was then modified in the following 28 patients (group 2) to include transpedicular elevation of the depressed vertebral end plate and grafting of the vertebral body, in an attempt to reduce the postoperative loss of correction of the kyphotic deformity. ⋯ There was no difference in the complication rate between the two groups and no complication attributable to transpedicular bone grafting. The radiological results postoperatively and at a mean follow-up period of 9 months were assessed by measurement of the kyphosis angle, anterior vertebral height, anterior displacement, scoliosis, and reduction in cross-sectional area of the spinal canal. In group 1 the mean preoperative kyphosis angle and anterior vertebral height were 8 degrees and 21 mm; postoperatively these values were -12 degrees (lordosis) and 27 mm; and at follow-up they were -4 degrees and 24 mm.(ABSTRACT TRUNCATED AT 250 WORDS)
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An anatomical study of the cervical spinal cord and root to investigate the mechanism of paralysis of the arm after posterior decompression was performed using 14 cadavers of Japanese adults. It revealed that in the intervertebral foramen, extradural portions of the anterior and posterior roots of the cervical spinal cord lay separately in caudal-rostral relation, and the anterior root passed through the narrowest portion of the foramen isolatedly, i.e. the superior notch of the superior articular process. After laminectomy, a posteromedial shift of the dura-root junction occurred in combination with the posterior enlargement of the dual tube, and it showed two effects on the roots, one a relaxing effect on rootlets and the other, a traction effect on the extradural portion of a root. ⋯ With anchoring of the anterior root inside the foramen, a traction injury of the anterior root develops. The predominance of paralysis at the middle cervical level could be explained by the higher degree of anterior protrusion of the superior articular process and the more frequent degenerative changes here than at other levels. These factors might inhibit the gliding abilities of the roots inside the foramina, with the formation of perineural fibrosis, predisposing the roots to damage by the traction force.
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Surgical treatment of unstable traumatic injuries of the cervical spine can be carried out by a posterior or anterior approach, with different advantages and disadvantages. Twenty patients were treated with anterior decompression, interbody fusion with autogenous iliac bone graft, and osteosynthesis with a Louis anterior plate. The screws were inserted in the vertebral body without reaching the posterior vertebral wall. ⋯ Anterior plate instrumentation has proved itself mechanically adequate, even if it is less stable than posterior constructs. The advantages of anterior surgery compared to those of posterior surgery are such that several specific risks are acceptable. Posterior surgery is nevertheless indicated if the lesion cannot be reduced preoperatively under closed conditions.