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. 2007 Oct;31(5):647-52.
doi: 10.1007/s00264-006-0241-5. Epub 2006 Oct 17.

The treatment for multilevel noncontiguous spinal fractures

Xiao Feng Lian  1 , Jie Zhao, Tie Sheng Hou, Jian Dong Yuan, Gen Yang Jin, Zhong Hai Li
Affiliations

The treatment for multilevel noncontiguous spinal fractures

Xiao Feng Lian et al. Int Orthop. 2007 Oct.

Abstract
in English, French

We report the outcome of 30 patients with multilevel noncontiguous spinal fractures treated between 2000 and 2005. Ten cases were treated conservatively (group A), eight cases were operated on at only one level (group B), and 12 cases were treated surgically at both levels (group C). All cases were followed up for 14-60 months (mean 32 months). Initial mobilisation with a wheelchair or crutches in group A was 9.2 +/- 1.1 weeks, which was significantly longer than groups B and C with 6.8+/-0.7 weeks and 3.1 +/- 0.4 weeks, respectively. Operative time and blood loss in group C were significantly more than group B. The neurological deficit improved in six cases in group A (60%), six in group B (75%) and eight in group C (80%). Correction of kyphotic deformity was significantly superior in groups C and B at the operated level, and increasing deformity occurred in groups A and B at the non-operated level. From the results we believe that three treatment strategies were suitable for multilevel noncontiguous spinal fractures, and individualised treatment should be used in these patients. In the patients treated surgically, the clinical and radiographic outcomes are much better.

Nous rapportons l’évolution de 30 patients avec des fractures étagées non contiguës du rachis traités entre 2000 et 2005 : 10 cas étaient traités conservativement (groupe A), 8 cas étaient opérés à un seul étage (groupe B), et 12 cas étaient opérés à plusieurs étages. Le suivi était de 14 à 60 mois (moyenne 32 mois). La mobilisation initiale, en chaise roulante ou avec des cannes, était significativement plus tardive que dans les groupes B et C. La durée opératoire et la perte de sang étaient plus importante dans le groupe C que dans le groupe B. Le déficit neurologique était amélioré dans 6 cas du groupe A (60%), 6 du groupe B (75%) et 8 du groupe C (80%). La correction de la cyphose était meilleure dans le groupe C et au niveau traité du groupe B tandis qu’une aggravation de la déformation était notée dans le groupe A et au niveau non opéré du groupe B. De ces résultats nous concluons que les trois traitements sont possibles mais qu’ils doivent être individualisés selon les patients. Les résultats cliniques et radiologiques sont meilleurs chez les patients opérés.

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Figures

Fig. 1
Fig. 1
A 55 year-old male was involved in a traffic accident which resulted in C2 and T3-4 fractures (case 15); his neurological deficit corresponding to T3-4 level. a Lateral view of cervical spine shows fracture of C2 (arrow). b Anterior-posterior view of thoracic spine showing fractures of T3-4 (arrow). c CT scan showing evidence of C2 fracture. d CT scan showing evidence of T4 fracture and spinal cord compression (arrow). e Post-operative radiograph of T3-4. f Lateral view of C2 after conservative treatment showing solid fusion (arrow)
Fig. 2
Fig. 2
A 23 year-old female with fractures of L1 and L4 resulting from a fall (case 29). a MRI of the lumbar spine showing fractures of L1 and L4. b Post-operative radiograph showing that two levels were operated on in a single stage. L4 was operated, posterially and L1 anteriorly
See this image and copyright information in PMC

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