Burst fractures of the thoracolumbar spine (Part II): literature review
DOI:
https://doi.org/10.25305/unj.113533Keywords:
thoracic spine, lumbar spine, burst fracture, diagnosis, classification, treatmentAbstract
The modern view on the treatment of burst fractures in the lower thoracic and lumbar spine depends on the morphology of the damage and the neurological status, the general condition of the patient, and the surgeon’s preferences and skills. The treatment of A-type damages with vertebral body fragmentation up to 50% and the whole posterior support complex (by Margel classification), a conservative treatment method can be used, but with a predictable development of residual deformation of the spine. The use of surgical methods provides a good correction of spine deformity and gives a good functional result already in the early postoperative period.
The type AB injuries with vertebral body fragmentation up to 50%, with damage to the posterior support complex and posterior longitudinal ligament, with spinal stenosis up to 50%, without damage to the root of the arch (by Marerl classification) could be treated by a short posterior transpedicular fixation, preferably with 6 screws, without anterior reconstruction, but with a possible risk of loss of correction.
For damages of types A3.3, A3.1, and A3.2 with an LSS score over 7 without a severe neurological deficit or with it, a long 8-screw fixation is the most useful.
In the treatment of a complete uncomplicated burst fracture of the vertebral body of A 3.3 type, anterior decompression and anterior spondylodesis is the method of choice in the treatment of this pathology.
Reconstruction of the three columns of the spine from the posterior approach has advantages over the anteroposterior one only in patients with burst fractures with rotation (AS type) with complete or partial neurologic symptoms.
There is no unanimity regarding the use of different methods of fixation, which actuate to carry out our own research in this area.
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