Residual mobility of instrumented and non-fused segments in thoracolumbar spine fractures

Abstract

The surgical management of thoracolumbar fractures presents potential benefits. However, the surgery solve the instability by fusion of mobile segments. We incorporate in our treatment algorithms, the use of restricted arthrodesis at injured levels, regardless of longer instrumentations, as well as the use of non-fused transitory stabilizations, based on the conviction that in non-fused segments without traumatic disc injury, mobility persists once the instrumentation is removed. The goals of this study were to compare the mobility of non-fused segments after hardware removal to a normal range of motion and to find prognostic pre-op imaging patterns. We reviewed 21 consecutive patients who underwent surgery with preservation of mobile segments (non-fused segments included in the construction) in order to recover mobility after removal of instrumentation, performed between 1995 and 2001. All patients were treated by indirect reduction with posterior transpedicular instrumentation. Clinical and radiological outcome was analyzed after an average follow-up of 46.6 months. Satisfactory subjective outcome results were obtained in 94.7%. The dynamic radiological follow-up study showed 75% (21 segments) with normal or decreased range of motion (ROM) and 25% (7 segments) without mobility. The non-fused segments with hardware removal before 10 months of evolution presented a normal or decreased mobility in 83.2% while the segments with hardware removal after 10 months showed 68.8% of mobility. The intervertebral disc (IVD)'s with normal initial MRI morphology preserved their mobility in 81.9%. Complications occurred in four patients: two superficial wound infections and two patients presented a late fracture of one USS Schanz. The results of this study prove that in thoracolumbar fractures, non-fused spinal segments included in pedicular instrumentation maintained mobility in a high percentage once the hardware is removed. 75% of the segments presented a normal or decreased ROM.

Fig. 1.

a Anteroposterior (AP) and b lateral radiographs A1 L1 and A3 L3 fracture

Fig. 2.

a AP and b lateral post-operative radiographs

Fig. 3.

a AP, b extension and c flexion radiographs (73 months)

Fig. 4.

a Anteroposterior (AP) and b lateral radiographs B2 L1 fractures

Fig. 5.

Sagittal T2 MRI

Fig. 6.

a AP and b lateral radiographs (3 months)

Fig. 7.

a Extension and b flexion lateral radiographs (66 months)