Surgical indication and long-term following-up results of thoracolumbar vertebral fractures

Objective To explore the surgical indication of and the effect of spinal canal circum decompression, bone graft and internal fixation on thoracolumbar vertebral fractures. Methods A total of 176 patients, suffering from thoracolumbar vertebral fractures, were treated with the operation of hypo circum or half circum decompression, combined with intertransverse, intervertebral and transpedicular internal pyramid bone grafts.The severity of spinal canal stenosis of the injured vertebrae was calculated and the recovery degree of the sagittal diameter of the vertebral canal was determined respectively according to the CT films obtained before operation and in various time intervals of following up. The data were analyzed by paired Student's t test. Results A total of 97 patients were followed up for 23.2 months averagely. For the patients with incomplete spinal cord injury, the ASIA was improved for 1 3 grades in 64 patients and didn't change in 7 patients. For the rest 26 patients with complete spinal cord injury, the function of spinal nerve root recovered partially. The severity of spinal canal stenosis of the injured vertebrae was 44.7% averagely before operation, and the spinal canal diameter recovered completely after operation. The spinal canal remolding occurred after 1 year. And there existed no significant difference between the remolded spinal canal diameter and the normal spinal canal diameter. Conclusions Surgical treatment should be carried out for the majority of the patients with incomplete spinal cord injury, also for the patients with unstable burst fracture even without neurological deficit in order to prevent later complications. The spinal canal remolding appears generally in 1 year after circum decompression. And the remolded spinal canal diameter is similar to the normal ones. Transpedicular bone grafting in vertebra body benefits to prevent the vertebra body from collapse after operation.