Posterior Decompression Technique for Thoracolumbar Burst Fracture

Abstract

There is growing evidence that surgical reduction and fixation may enhance the chances of neurologic recovery in traumatic thoracolumbar (TL) fractures [1]. Although there seems to be no strong relation between the canal encroachment and the neurologic injury or recovery patterns [2], many surgeons feel that patients may benefit from clearance of the canal. The most common traumatic fracture type causing neurologic impairment in thoracolumbar (TL) junction is the burst fracture. In this fracture type, usually the upper endplate fails under the compressive forces in the intervertebral disc and burst out circumferentially. This typically causes a splaying of the pedicles and thrust of a bone fragment from the posterior wall section of the upper endplate into the vertebral canal. The amount of canal encroachment visible on CT or MR images may vary and is probably not directly related to the initial impact and compression on the dural sac or the neurologic damage. The most reliable way to remove all the encroaching fragments is a (partial) corpectomy via an anterior approach. However, this requires a highly invasive approach, which may not be feasible to perform on an emergency basis in frequently poly-traumatized patients. Evidence from cervical trauma studies (STASCIS) suggests that timing of surgery may be a crucial factor in the neurologic prognosis [3]. Surgical techniques, which allow the surgeon a quick reduction, decompression, and stable fixation may prove more beneficial than delayed surgery with more complete decompression.