Analysis of the spinal canal dimensions and neurological symptoms dynamics in surgical treatment of burst fractures of the thoracic and lumbar spine

Authors

  • Vladimir A. Radchenko Sytenko Institute of Spine and Joint Pathology, Kharkiv, Ukraine
  • Konstantin A. Popsuyshapka Sytenko Institute of Spine and Joint Pathology, Kharkiv, Ukraine
  • Sergii A. Teslenko Sytenko Institute of Spine and Joint Pathology, Kharkiv, Ukraine

DOI:

https://doi.org/10.25305/unj.127792

Keywords:

burst fracture of the spine, spinal stenosis

Abstract

Objective. To estimate the spinal channel dimensions and neurological symptomes dynamics in surgical treatment of burst fractures of thoracic and lumbar spine.

Materials and methods. There were studied 99 patients with traumatic injuries of the thoracic and lumbar spine. A retrospective study of disease history was conducted: clinical examination data, computed tomography, before and after treatment. There was performed the analysis of the patients with uncomplicated and complicated burst fractures of the thoracic and lumbar spine. They were surgically treated using the back short transpedicular fixation, posterior long transpedicular fixation with or without laminectomy, combined anterior-posterior spondylodesis at 360°, and three-column reconstruction of the spine through posterior approach.

Results. The average volume of recovering of the lumen of the vertebral canal in the group of patients with short six-screw fixation is 8.8% and reaches its maximum after a year or more after complete rebuilding of bone tissue.

In the group with eight-screw fixation, the overall average degree of narrowing (stenosis) of the spinal canal after the injury was 44.9%. After surgery, restoration of the lumen of the vertebral channel was 7.5%. Restoration of the lumen of the vertebral canal during the year and more amounted to 21.55%. The average degree of stenosis of the spinal canal in the group with anterior-posterior spondylodesis used before the operation was 63.5% of the norm, and in the group of patients, in which the method of three-column spine reconstruction through posterior approach was used the degree of the spinal canal narrowing reached 96%.

Conclusion. In patients with complicated injuries as the complete violation of the conduction of the spinal cord or roots of the cauda equina of A type – the lower paraplegia immediately after injury, their neurological symptoms were the most severe and in the early postoperative period did not change. The patients with partial neurological symptoms of type B, C, D by the ASIA scale may have a favorable outcome in the case of surgical treatment. The patients with more severe neurological symptoms such as B, C have the most effective recovery within a year or more. Patients with type D neurological symptoms are the most effectively recovered in the first two weeks after surgery, and further gradual recovery occurs during the year.

Author Biographies

Vladimir A. Radchenko, Sytenko Institute of Spine and Joint Pathology, Kharkiv

Department of Instrumental and Minimally Invasive Spine Surgery

Konstantin A. Popsuyshapka, Sytenko Institute of Spine and Joint Pathology, Kharkiv

Department of Instrumental and Minimally Invasive Spine Surgery

Sergii A. Teslenko, Sytenko Institute of Spine and Joint Pathology, Kharkiv

Department of Instrumental and Minimally Invasive Spine Surgery

References

1. Radchenko VA, Popsuyshapka KA, Babalyan YA, Teslenko SA. Burst fractures of the thoracolumbar spine (Part I): literature review. Ukrainian Neurosurgical Journal. 2017;(4):10-7. [CrossRef]

2. Panjabi MM, Kifune M, Wen L, Arand M, Oxland TR, Lin RM, Yoon WS, Vasavada A. Dynamic canal encroachment during thoracolumbar burst fractures. J Spinal Disord. 1995 Feb;8(1):39-48. [CrossRef] [PubMed]

3. Boerger TO, Limb D, Dickson RA. Does ‘canal clearance’ affect neurological outcome after thoracolumbar burst fractures? J Bone Joint Surg Br. 2000 Jul;82(5):629-35. Review. [CrossRef] [PubMed]

4. Limb D, Shaw DL, Dickson RA. Neurological injury in thoracolumbar burst fractures. J Bone Joint Surg Br. 1995 Sep;77(5):774-7. [CrossRef] [PubMed]

5. Shaw DL, Limb D, Dickson RA. Neurological injury in thoracolumbar burst fractures: a biomechanical study. J Bone Joint Surg Br. 1996;78:161.

6. Wessberg P, Wang Y, Irstam L, Nordwall A. The effect of surgery and remodelling on spinal canal measurements after thoracolumbar burst fractures. Eur Spine J. 2001 Feb;10(1):55-63. [CrossRef] [PubMed] [PubMed Central]

7. Meves R, Avanzi O. Correlation among canal compromise, neurologic deficit, and injury severity in thoracolumbar burst fractures. Spine (Phila Pa 1976). 2006 Aug 15;31(18):2137-41. [CrossRef] [PubMed]

8. Vaccaro AR, Oner C, Kepler CK, Dvorak M, Schnake K, Bellabarba C, Reinhold M, Aarabi B, Kandziora F, Chapman J, Shanmuganathan R, Fehlings M, Vialle L; AOSpine Spinal Cord Injury & Trauma Knowledge Forum. AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976). 2013 Nov 1;38(23):2028-37. [CrossRef] [PubMed]

9. International Standards for Neurological Classification of Spinal Cord Injured [Internet]. American Spinal Injury Association; 1982 [modified 2015 November; cited 2017 August 11]. Available from: http://asia-spinalinjury.org/wp-content/uploads/2016/02/International_Stds_Diagram_Worksheet.pdf

10. Keynan O, Fisher CG, Vaccaro A, Fehlings MG, Oner FC, Dietz J, Kwon B, Rampersaud R, Bono C, France J, Dvorak M. Radiographic measurement parameters in thoracolumbar fractures: a systematic review and consensus statement of the spine trauma study group. Spine (Phila Pa 1976). 2006 Mar 1;31(5):E156-65. Review. [CrossRef] [PubMed]

11. Pham MH, Tuchman A, Chen TC, Acosta FL, Hsieh PC, Liu JC. Transpedicular Corpectomy and Cage Placement in the Treatment of Traumatic Lumbar Burst Fractures. Clin Spine Surg. 2017 Oct;30(8):360-366. [CrossRef] [PubMed]

12. Zahra B, Jodoin A, Maurais G, Parent S, Mac-Thiong JM. Treatment of thoracolumbar burst fractures by means of anterior fusion and cage. J Spinal Disord Tech. 2012 Feb;25(1):30-7. [CrossRef] [PubMed]

13. Haiyun Y, Rui G, Shucai D, Zhanhua J, Xiaolin Z, Xin L, Xue W, Gongyi L, Jiankun L. Three-column reconstruction through single posterior approach for the treatment of unstable thoracolumbar fracture. Spine (Phila Pa 1976). 2010 Apr 15;35(8):E295-302. [CrossRef] [PubMed]

14. Radcliff K, Su BW, Kepler CK, Rubin T, Shimer AL, Rihn JA, Harrop JA, Albert TJ, Vaccaro AR. Correlation of posterior ligamentous complex injury and neurological injury to loss of vertebral body height, kyphosis, and canal compromise. Spine (Phila Pa 1976). 2012 Jun 1;37(13):1142-50. [CrossRef] [PubMed]

15. Pizones J, Sбnchez-Mariscal F, Zъсiga L, Бlvarez P, Izquierdo E. Prospective analysis of magnetic resonance imaging accuracy in diagnosing traumatic injuries of the posterior ligamentous complex of the thoracolumbar spine. Spine (Phila Pa 1976). 2013 Apr 20;38(9):745-51. [CrossRef] [PubMed]

Published

2018-06-15

How to Cite

Radchenko, V. A., Popsuyshapka, K. A., & Teslenko, S. A. (2018). Analysis of the spinal canal dimensions and neurological symptoms dynamics in surgical treatment of burst fractures of the thoracic and lumbar spine. Ukrainian Neurosurgical Journal, (2), 47–60. https://doi.org/10.25305/unj.127792

Issue

Section

Original articles