Abstract
Objectives: To assess the effectiveness of the two different types of C-D instrumentation constructs on the unstable thoracolumbar and lumbar spine fractures.
Material and Method: 45 fractures in 42 patients(age range, 18 to 57 years) were treated with C-D instrumentation and posterolateral fusion, and were followed up over 2 years(26±72 months). The level of injuries were T12 in 6 cases, L1 in 15, L2 in 12, L3 in 3, L3-4 in 6, and L4-5 in 3. The fracture types were bursting in 21, flexion-distraction in 15, fracture-dislocation in 9. Three had both L1 flexion-distraction and L3 bursting fractures. 9 had incomplete paralysis. Vertebral height and kyphosis angle were measured. All fractures were reduced by normally contoured rod handling without distraction or compression, and the vertebrae one above and one below the fractured spine were fused posterolaterally. 9 had posterior decompression surgery including reduction of retropulsed fragment. In 21 cases long rodding(group-I : over three level stabilization) and in 18 cases short rodding(group-II : one above and below) were performed.
Results: Fracture consolidation was achieved at 6.5 months (5±10 months). Overall fusion rate was 78.6%: 75% in Group-I and 83.3% in Group-II. In group-I average kyphosis at preop, immediate and fi nal postop follow-up were 20.3°, 7° and 11.4°, respectively, while in group-II those were 14.7°, 2.4° and 8.4°, respectively. The losses of correction in group-I and group-II were 4.4° and 5.7°. In group-I and group-II anterior body height losses at preop, immediate postop and fi nal follow-up were 45.6%, 14.6%, 17.1% and 40.3%, 15.8%, 23.7%, respecitvely. Complications were : screw breakage in group-I and II were 3 and 6 cases : plug dislodgement in 3 cases of group-I, and hook dislodgement in 3 of group-II.
Conclusion: Long rodding and posterior fusion is preferably recommended to minimize the loss of reduction.
The abstracts were prepared by Professor Jegan Krishnan. Correspondence should be addressed to him at the Flinders Medical Centre, Bedford Park 5047, Australia.
