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