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Combined Anterior and Posterior Surgery For Thoracolumbar Fractures

January 1, 2011 By Leave a Comment

In most cases of thoracolumbar burst fractures,  either anterior or posterior surgery alone is adequate. However, there are a number of situations where combined anterior and posterior approaches may be needed.

Most of the combined surgeries are performed in a staged fashion.

When primary surgery is posterior, anterior surgery may be indicated where a neural deficit, either new or persistent, is present and which has been found to be associated with residual canal compromise from retropulsed bony fragments. It may also be done if there  is progressive loss of correction that is related to continued collapse of the fractured vertebral body. [Read more...]

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Anterior Surgery For Thoracolumbar Fractures Of Spine

December 29, 2010 By Leave a Comment

Anterior surgery results in the most effective decompression of the spinal canal after burst fracture. Anterior surgery is indicated in patients with thoracolumbar fractures with an incomplete spinal cord injury
It is generally not indicated in patients without a neurologic deficit except in cases of patients with very severe kyphosis.

Supplementary posterior fixation is added in cases with massive posterior ligamentous disruption.

Anterior surgery is usually deferred in cases of retroperitoneal or intrathoracic injuries.

Technique

Decompression

The patient is placed in the lateral position with the left side up on a standard operating table.  The preparation and draping of the skin should include the iliac crest. [Read more...]

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Posterior Surgery For Thoracolumbar Burst Fractures

December 22, 2010 By Leave a Comment

Most of the surgeons perform posterior surgery to correct the kyphosis and stabilize the spine. It is also used for decompression but anterior surgery is preferred for that.

In patients who have an incomplete neurologic injury with spinal cord compression from retropulsed fragments, an anterior approach is preferred.

Exceptions are injuries at the T3 and T4 level, which can be difficult to approach anteriorly.

Vertebral body height loss > 50% or extensive comminution, pedicle screws are placed two levels above and below the fractured vertebra.

< 50% height loss, an attempt at short-segment stabilization is undertaken. [Read more...]

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Anteroposterior & Lateral Xrays Of Cervical Vertebrae Dislocation C5 Over C6

December 19, 2010 By Leave a Comment

A young male of 34 years was brought to casualty with history of fall from horse cart. He was quadriplegic [There was no power in any of the limbs]. On examination he was found to be in spinal shock.
c5-C6 dislocation of cervical vertebra

The xray showed dislocation of C5 over C6 vertebra. Vertebrae have been marked for better understanding.

The neck was stabilized with head halter traction and he was put on supportive treatment.

His MRI revealed a compression at C5-C6 level along with cord edema. [Read more...]

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Operative Treatment Of Thoracolumbar Burst Fractures

December 17, 2010 By Leave a Comment

Surgical treatment of the burst fractures involves decompression and stabilization. The spine can be approached through anterior and posterior approach. Both the routes have their own advantages and disadvantages.

Indications For Surgery In Thoracolumbar Burst Fractures

  • A progressive neurologic deficit
  • Presence of a posterior ligament complex injury
  • Neurologic deficit with or without an unstable fracture
  • Rapidly increasing kyphotic deformity.
  • Fractures in multiply injured patients
  • Those who are candidates for conservative treatment but refuse it or conservative treatment cannot be employed because of body habitus.

Posterior Surgery

Advantages

  • Avoids the morbidity of anterior exposure in patients who potentially have concomitant pulmonary or abdominal injuries.
  • Shorter operative times
  • Decreased blood loss
  • Functional outcomes are similar to those following anterior surgery

Disadvantages

Through posterior approach posterior instrumentation is done [Instrument used to fix the spine is posterior]. Posterior instrumentation alone cannot reconstitute anterior column support. Therefore the construct is somewhat weaker than anterior instrumentation when subjected to compressive forces. [Read more...]

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Non Operative Management Of Burst Fractures

December 15, 2010 By Leave a Comment

Stable burst fractures without neurological deficit can be managed by non operative means.

The use of non operative treatment should be should be decided by the presence of an intact posterior longitudnal ligament complex.

Rarely, a patient with a neurologic deficit or an unstable burst fracture but who is a candidate for surgery but medically unfit and needs to be considered for non operative management. [Read more...]

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How To Apply Hyperextension Cast

December 7, 2010 By 1 Comment

Hyperextension casting is used in non operative treatment of some compression and stable burst fractures. It is performed via following steps

1.Place the patient on a modified fracture table (Fig.A)

2. Suspend the patient on a narrow, midline, taut canvas support. The arms should be  to the side, knees flexed, and feet resting on the support to give the patient a sense of balance. [Read more...]

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Burst Fractures Of Thoracolumbar Spine

November 19, 2010 By Leave a Comment

Burst fractures usually occur as a result of higher-energy trauma.

Burst fractures result when the vertebral body is subjected to high axial loads or the vertebra is loaded in flexion.

These fractures result from motor vehicle accidents, falls from height, or crush injuries.

Mechanism Of Injury

The anterior cortex fails in compression, either or both the end plates get fractured The middle column also fractures, and a portion of the body gets retropulsed backward into the canal. The posterior elements may also get fractured.

Burst fractures may be subdivided by fracture pattern as follows [Read more...]

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What Is Balloon Kyphoplasty?

November 12, 2010 By 1 Comment

Balloon kyphoplasty evolved as the next step in the treatment of vertebral compression fractures after vertebroplasty. The procedure like vertebroplasty aims at restoration of the height of the vertebra.

The procedure is performed through small instruments that are inserted into the vertebral body through the pedicle of the vertebra.

In this procedure  a small balloon is inserted through the entry point and  is inflated to restore the height of a collapsed vertebral body and create a cavity inside . The balloon is deflated and withdrawn, and the remaining cavity is filled under low pressure with the cement. This process stabilizes the vertebra internally and facilitates pain relief and restores function. [Read more...]

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What Is Vertebroplasty?

November 5, 2010 By 1 Comment

Vertebroplasty are medical spinal procedure where the fractured vertebra is approached percutaneously [After making a small hole in the skin] and then injecting cement into the fractured vertebra . The procedure was introduced to relieve the pain of osteoporotic fractures. But the actual effectiveness is controversial.

Initial studies suggested that vertebroplasty provided effective relief of pain but the studies that followed could not achieve the initially published results. Two major studies have recently found  that vertebroplasty had no detectable benefit when compared with sham procedures. [Read more...]

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