ORTHOPAEDIC TREATMENT OF THORACO-LUMBAR FRACTURES USING BOËHLER IMMOBILISATION: REVIEW OF A CONTINUOUS SERIES OF 150 PATIENTS AT ONE YEAR FOLLOW-UP OR MORE

Abstract

Purpose: We report the clinical and radiological course in a continuous series of 194 patients treated by the same team between 1996 and 2001 for thoracolumbar fracture. Cotrel frame instrumentation and Boëhler corset immobilisation were used.

Material and methods: In this series of 65 women and 129 men, age range 16 – 77 years, we retained one year follow-up at least for inclusion in the study. More than 85% of the patients were retained for study and the final analysis concerned 150 patients who were contacted.

All patients were in Frankel class E. In compliance with the SOFCOT 1995 Symposium, the method described by Rosset and Laulin and the international classification described by Magerl were applied to pre-operative x-rays to search for the pathogenic mechanism involved. The radiological analysis was conducted on preoperative, immediate post-operative, 1-month, 3-month, and last follow-up x-rays. The course of spinal kyphosis and angular deformation of the trauma zone and the subjacent disc were analysed. In addition to the overall series, patients with limit therapeutic indications, according to the local kyphosis and trauma-induced regional angular deformation, were also studied.

Results: For the initial indication of choice, type A1 fracture, gain in reduction was minimal for the constraining treatment. For type A3 fractures, posterior displacement of the posterior wall was not a contraindication because the posterosuperior reduction could be achieved by ligamentotoxis in the majority of the cases The gain in correction of spinal kyphosis was greater in these patients. Nevertheless, for this type of fracture, spinal kyphosis greater than 15° was an implicit sign of a potential posterior distraction lesion where osteosynthesis might be indicated, especially since the USS fixator uses a parallel assembly and authorises short instrumentations.

Conclusion: The Boëhler technique is a safe, minimally invasive and low-cost method for the treatment of thoracolumbar spine fractures, which enabled 30% correction of the spinal kyphosis. This method retains its indications for type A fractures.