Treatment of thoracolumbar burst fractures by vertebral shortening

Abstract.

Burst fractures may be stable or unstable, so the choice of treatment may be controversial; almost all cases are surgical type. Deciding on the best method and approach is difficult, due to the many possible options and the fact that good results are achieved in only 60–70% of cases. The main problems to be resolved are the residual kyphosis or the recurrence due to loss of reduction. This is a prospective, observational, longitudinal and descriptive study of six patients – two men and four women, mean age 46 years – who scored 7 or more points according to the load distribution classification, and were treated with vertebral shortening by a posterior approach and transpedicular fixation with INO plates. Follow-up was for a period of 2 years, and included evaluating pre- and postoperative stability and kyphosis among other data. The results showed a reduction in the mean fracture angle from 17° preoperatively to 1° postoperatively. Full stability was achieved in five patients, and incomplete stability in one patient, who recovered with the use of a corset. There was evidence of arthrodesis in all six patients within 9 months. The use of an anterior approach to treat burst fractures is well recognized; however, treatment with vertebral shortening using a posterior approach has the advantages of less bleeding, shorter surgical time and less residual kyphosis, as a result of putting together two flat surfaces of healthy bone. The residual kyphosis in the present series, after the 2-year follow up, was less than 1°, which is lower than the 5°–10° reported in the literature.

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