gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

Dorsal transpedicular stabilization of fractures of the thoracic and lumbar spine: an analysis of 145 patients

Dorsale transpedikuläre Stabilisierung thorakaler und lumbaler Wirbelsäulenfrakturen: eine Analyse von 145 Patienten

Meeting Abstract

Suche in Medline nach

  • corresponding author J. Oertel - Klinik für Neurochirurgie, Krankenhaus Hannover Nordstadt, Klinikum Hannover
  • H. Schroeder - Klinik für Neurochirurgie, Ernst-Moritz-Arndt-Universität, Greifswald
  • M. Gaab - Klinik für Neurochirurgie, Krankenhaus Hannover Nordstadt, Klinikum Hannover

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc09.05.-11.02

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2005/05dgnc0047.shtml

Veröffentlicht: 4. Mai 2005

© 2005 Oertel et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

The optimal treatment of thoracic and lumbar fractures remains controversial. While many authors recommend dorsal instrumentation with an internal fixator, others favour an anterior approach.

To evaluate the posterior approach and to identify conditions under which an anterior approach should be preferred, 145 consecutive patients with unstable thoracic and lumbar fractures who underwent dorsal instrumentation with an internal fixator were analyzed. Clinical data were recorded prospectively with respect to fracture type, neurological findings, operative complications, spinal deformation correction, and long-term outcome. All fractures were located between the 7th thoracic and the 5th lumbar vertebrae and were considered to be unstable with respect to the three column model.

Eighty-three patients (57%) received surgery within the first seven days after the trauma. Postoperatively, 98% of the patients (50 out of 51 patients) with a radicular lesion or an incomplete transverse syndrome improved. Stable fracture consolidation after fixator removal was obtained in 98% (142 of 145 patients). The preoperative kyphosis angle decreased from an average of 10.1° to 7.4° at three years follow-up. Major operative complications consisted of two isolated nerve root lesions (1.3%), two deep wound infections with need of fixator removal (1.3%), and mallocation of two pedicle screws with need for another procedure in two patients (1.3%). Three patients (2%) suffered from insufficient bony fusion with increase of kyphotic deformation and required subsequent anterior stabilization. These three patients presented with an initial kyphosis or wedge angle of 20° or higher.

Dorsal stabilization with the internal fixator is a safe and reliable treatment for unstable fractures of the lower thoracic and lumbar spine. The authors recommend this procedure because of its low-invasiveness in conjunction with satisfactory reconstruction and stabilization. However, an anterior approach should be considered in fractures with initial kyphotic deformation or wedge angle of 20 or more degrees.