Treatment of fractures of the thoracolumbar spine by combined anteroposterior fixation using the Harms method

Abstract

Forty-three patients with fractures of the thoracolumbar spine submitted to surgical treatment using the Harms method (dorsoventral operations) were studied prospectively with a follow-up of at least 12 months and evaluated on the basis of clinical and radiologic parameters and in relation to their professional activities. Thirty-five patients (81.3%) were males and eight (18.7%) females, ranging in age from 17 to 67 years (mean 34.08 ± 11.51 years). Seven patients (16.2%) presented fractures of more than one vertebra, and associated lesions were present in 15 patients (34.8%). Monosegmental fixation was performed in 7 patients (16.3%), bisegmental fixation in 29 (67.4%), and trisegmental fixation in 7 (16.3%). No patient was submitted to any type of external immobilization during the postoperative period and all patients were allowed to sit up in bed and to walk as soon as their clinical conditions permitted. Thirty-nine patients were followed up for a period ranging from 12 to 36 months (mean 16.58 ± 6.83 months). Four patients died during the postoperative period (three of pulmonary embolism and one of septicemia). Forty-two patients sat up in bed between the 2nd and 6th postoperative day, and those who did not present a disabling lesion (Frankel D or E) or other associated lesions walked between the 4th and 10th postoperative day (mean 6.14 ± 6.06 days). The neurological signs and symptoms improved in 16 patients (37.3%), were unchanged in 26 (60.4%), and worsened in 1 (2.3%). Twenty-three patients (87.5%) who had no neurological damage (Frankel E) returned to their professional activities after respective periods of disability of 1 month (three patients), 2 months (four patients), 3 months (one patient), 4 months (seven patients), 5–7 months (five patients), 8–12 months (one patient), and more than 12 months (three patients). The ability to work of the 24 patients without neurological damage was 100% in 21, 50% in 2, and zero in 1. The ability to walk of this group of patients was 1–5 km for 4 and more than 5 km for the remaining 20 patients. The complications observed were death (four patients; three cases of pulmonary embolism and one case of septicemia), infection (two patients), Stevens-Johnson syndrome (one patient), and meningitis (one patient). The mean kyphosis of the fractured segment was 22.17°± 10.97° preoperatively, 8.55°± 6.9° postoperatively, and 10.30°± 8.84° on the occasion of late evaluation. No loss of correction occurred in 28 patients (71.8%), a 5° loss was observed in 3 patients (7.6%), a 6° loss in 3 (7.6%), a 7° loss in 3 (7.6%), and a loss of more than 10° in 2 (5.2%).

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