gms | German Medical Science

Objective: Dorsoventral stabilization of unstable fractures of the spine in cases of trauma has been established. Advantages of this technique are the good restoration of the spinal axis and the adequate decompression of the spinal canal. That allows an early mobilization of the patient with better conditions for rehabilitation. We report our experiences and analyzed the operative results and outcome in patients with traumatic unstable fractures of the thoracic and lumbar spine admitted to our institution.

Method: All patients with a traumatic unstable fracture of the thoracic or lumbar spine admitted to our institution in the period from 2007 to 2014 and treated with dorsoventral stabilization were analyzed. Number of patients, age, gender and neurological status were recorded. The fracture level and -localization, time point of operation after the trauma and the operative procedure were analyzed. Aditionally serious surgery complications were documented and a 12-month follow-up CT-scan was performed in all patients to evaluate the axial restoration of the spine.

Results: 141 patients with fractures of the spine underwent surgical spine procedure. 35 patients (17 male, 18 female) were treated with dorsoventral stabilization with internal fixation and vertebral body replacement. The average age was 37.8 years. In 17 patients neurological deficits were present. Analysis of fracture level showed 7 two level and 28 single level fractures. 9 located in the thoracic spine, 24 in the lumbar spine and 2 with combined fracture localizations. 27 patients were treated with dorsal internal fixation within 24 hours after admission, 8 patients underwent bi- or multilevel stabilization in the later course. An additional laminectomy was performed in 27 cases. A lesion of the spinal dura was deteceted in 14 cases and covered with sutures. The ventral mono- or bicorporale vertebral body replacement with a titanium cage took place between day 1 and day 436 after dorsal instrumentation (mean 11 day after exclusion of all patients treated > 30 days post dorsal instrumentation). Serious surgery complications, such as dislocated cages or root lesions occurred in 3 cases.

Conclusions: The dorsoventral stabilisation in patients with traumatic unstable fractures of the thoracic and lumbar spine shows good postoperative results and a low complication rate if performed by experienced surgeons. With an early ventral approach fragments of the fracture can better removed and the dural sac can better decompressed.