نتايج درمان جراحي زودرس و تاخيري در شكستگي هاي ناپايدار انفجاري پشتي كمري

Outcome of early and late surgery of Thoraco-lumbar Unstable Burst Fractures

Background and Aim: Indirect reduction and posterior instrumentation with short –segment pedicle screw is the method of choice for treatment of unstable burst thoraco-lumbar fractures. The literature regarding the time of surgery and its effect on outcome of thoraco-lumbar unstable burst fractures is sparse. The aim of this study is to evaluate the efficacy of early and late surgery on the outcome of thoraco – lumber unstable burst fractures. Materials and Methods: Patients with unstable burst thoraco-lumbar fractures were included in this prospective review of patients treated with indirect reduction and short - segment pedicle screw fixation between 2000-2004.The mean follow up period was 42 months (range from 16 to 66 months). Radiographic analysis was evaluated pre and post-operatively and clinical evaluation was performed postoperatively and at follow - up review . Results: The mean time of surgery was 11 days after injury (form 2 to 33 days). 35 patients underwent early surgery (2-15 days after injury) (Group A) and 15 patients had late surgery (15-33 days after injury) (Group B). In group A the anterior vertebral height (A.V.H) was improved from a median preoperative of 20.5 mm to 39.5 mm (37% correction), and sagittal alignment (S.A) was improved from a mean preoperative kyphosis of 20.4 degrees to 1/5 degrees. In group B the anterior vertebral height (A.V.H) was improved from a mean preoperative of 20.3mm to 28/2 mm (24.5 % correction) and sagittal alignment (S.A) was improved from a mean preoperative Kyphosis of 20.5 degrees to 8.4 degrees. At final follow – up observation a mean kyphosis of 4 degrees was increased in group B. Conclusion: Early indirect reduction and posterior stabilization (with short - segment pedicle screw) of unstable burst thoraco - lumbar fractures allows a satisfactory reduction and correction of deformity.