Medical & Clinical Research

Author(s): Nissim Ohana, Dimitri Sheinis and Daniel Benharroch

Background: Treatment of thoracolumbar fractures often requires surgery, but there is no consensus as to the preferred method. The results of a nuanced surgical procedure use a posterior approach and aimed at preserving the integrity of the neural elements.

Methods: The files of 14 patients who underwent surgery for complex thoracolumbar fractures at a single tertiary hospital during a four-year period were reviewed. During a single-stage procedure, performed via a posterior approach, a titanium mesh cage was inserted into the vertebral cavity using a maneuver which protected the nerve roots. Outcome measures included neurological status, sagittal profile of the spine, spinal stability, height restoration and decompression.

Results: Seven patients presented with Type A fractures according to the AOSpine classification, three of them with two simultaneous fractures. One patient suffered from a type B fracture and three patients from type C fractures. While most patients displayed a preserved neurological status, three were paraplegic on admission (Frankel grade A). The suggested procedure has allowed for direct canal decompression and has resulted in immediate stability and optimal height restitution. The spinal profile has also improved.

Conclusion: The nerve sparing procedure offered considerable benefits to the patients. Additionally, the technique may be applied also to fractures above and below the T11-L2 segment, and to patients with Frankel grade A lesion.