Unstable fractures of the thoracolumbar spine: a 10-year experience at Sacré-Coeur Hospital.
UNLABELLED: In a 10-year period, 108 unstable fractures involving the thoracolumbar junction (T11 to L2) were treated. This study evaluates the influence of the different treatments on the rate of complication, reduction of the fracture, and neurological recovery. METHODS: mechanism of injury, initial treatment and delay, neurologic deficit, operative findings, and duration of hospitalization were recorded. X-rays were reviewed for classification of fracture, measurement of deformity, and for instability scoring according to White and Panjabi's criteria. Seventy-seven patients were examined and nine more interviewed by telephone. RESULTS: a flexion-rotation injury occurred in 65% and a burst-fracture in 29%. A laminectomy was performed in 30 patients and Harrington instrumentation and fusion in 71 patients. Sixteen patients were treated conservatively. Fifty-five patients presented either a complete or partial neurological deficit. Seventy-five complications were noted and were more frequent in the laminectomy group. The instrumented group showed a clear tendency for earlier ambulation and discharge and pain level was found to be less. An increased residual deformity was found in patients treated by laminectomy, short fusion, and by nonsurgical modality. The neurologic recovery in the laminectomy and the nonlaminectomy group was not significantly different. Spinal realignment was better in the group where an instrumentation of five levels or more was performed and where posterior elements were not removed by laminectomy.