Application of posterior plating and modifications in thoracolumbar spine injuries. Indication, techniques, and results.

Out of 281 patients with recent injuries to the thoracic and lumbar parts of the spine, 243 underwent posterior plating. Of these, 172 patients had an average follow-up of 3.2 years. The consecutive analysis of morphologic results led to modifications of the original Roy-Camille technique. In analogy to the system developed by Zielke for anterior derotation spondylodesis, plates were used in combination with VDS screws, threaded rods, and nuts, thus creating an implant with initial angle variability but final angle stability. The development of transpedicular reduction and cancellous bone grafting for the treatment of vertebral body fractures, later supplemented by transpedicular discectomy and intercorporal cancellous bone grafting, effected a significant improvement in the results of posterior plating. Although the use of traditional plating was followed by correction losses of 14 degrees, the loss could be reduced to less than 6 degrees by the new system, which nearly corresponds to the physiologic anatomy of the spine.