Radiological and clinical results of laminectomy and posterior stabilization for severe thoracolumbar burst fracture : surgical technique for one-stage operation.

OBJECTIVE: This study aimed to show the possibility of neural canal enlargement and restoration of bony fragments through laminectomy and minimal facetectomy without pediculectomy or an anterior approach, and also to prove the adequacy of posterior stabilization of vertebral deformities after thoracolumbar bursting fracture.
METHODS: From January 2003 to June 2009, we experienced 45 patients with thoracolumbar burst fractures. All patients enrolled were presented with either a neural canal compromise of more than 40% with a Benzel-Larson Grade of VI, or more than 30% compromise with less than a Benzel-Larson Grade of V. Most important characteristic of our surgical procedure was repositioning retropulsed bone fragments using custom-designed instruments via laminectomy and minimal facetectomy without removing the fractured bone fragments. Beneath the dural sac, these custom-designed instruments could push the retropulsed bone fragments within the neural canal after the decompression and bone fragment repositioning.
RESULTS: The mean kyphotic deformities measured preoperatively and at follow-up within 12 months were 17.7 degrees (±6.4 degrees) and 9.6 degrees (±5.2 degrees), respectively. The mean midsagittal diameter improved from 8.8 mm (±2.8 mm) before surgery to 14.2 mm (±1.6 mm) at follow-up. The mean traumatic vertebral body height before surgery was 41.3% (±12.6%). At follow-up assessment within 12 months, this score showed a statistically significant increase to 68.3% (±12.8%). Neurological improvement occurred in all patients.
CONCLUSION: Though controversy exists in the treatment of severe thoracolumbar burst fracture, we achieved effective radiological and clinical results in the cases of burst fractures causing severe canal compromise and spinal deformity by using this novel custom-designed instruments, via posterior approach alone.