Neurological outcome after surgery for thoracolumbar fractures

Summary

Surgical reconstruction and fusion form the treatment of choice for unstable thoracolumbar fractures. It remains difficult, however, to prove that surgical treatment provides an increased potential for neurological recovery. Also, the role of a decompressive laminectomy is still unclear. To address these issues, 93 consecutive cases of thoracolumbar fractures treated with dorsal instrumentation were reviewed. The neurological status at the time of admission and at a mean of 26 months postinjury was graded according to a modified Frankel scale. By using preoperative radiographs and computed tomography scans, we differentiated between fracture-dislocation lesions, dislocation lesions, flexion-distraction lesions, complete and incomplete burst fractures. Spinal stenosis was classified from grade 0 (no stenosis) to grade 3 (> 66% stenosis). All thoracolumbar fractures were treated with posterior instrumentation, using Dick's fixateur interne and Steffee's VSP plates and screws. During this procedure, laminectomy was performed in 33 patients (35%). In 17 cases (52% of the laminectomies), a surgically treatable lesion (dural tear, trapped nerve root, etc.) was found, especially in patients with a combination of a neurological deficit and a dislocation lesion, a fracture-dislocation lesion or a complete burst fracture with spinal stenosis grade 2 or 3. The neurological and functional outcome was excellent: none of the patients deteriorated, 68% made a complete neurological recovery, and 61% regained their previous level of activity.