Spinal canal decompression in traumatic thoracolumbar burst fractures: posterior distraction rods versus transpedicular screw fixation

Abstract

Although the benefit of spinal canal decompression of traumatic thoracolumbar burst fractures is controversial, it remains a desirable procedure, as many reports describe improved neurologic outcome with spinal canal reconstruction. The optimal type of posterior instrumentation for reconstructing the spinal canal is unclear. This study focused on the efficacy of posterior distraction rods versus transpedicular screw fixation implants in decompressing the spinal canal and on the relationship between the amount of canal decompression and subsequent neurologic recovery. A medical records review was conducted to identify all patients surgically treated for traumatic burst fractures of the thoracolumbar spine from January 1, 1987 to June 30, 1989. Sixty-seven patients were selected by this review, and, of these, 30 had had both preoperative and postoperative CT scans. We could find no bias among patients who received both preoperative and postoperative CT scans as compared to those who did not, therefore the 30 patients were considered to be a random sample of the total population of 67. A retrospective study was then conducted on the 30 patients with surgically treated burst fractures--15 treated with posterior distraction rods and 15 treated with AO Fixator Interne transpedicular screw fixation implants. Preoperative and postoperative spinal canal cross-sectional areas were measured directly from the scaled CT scans. The area of most severe compromise was compared with an internal standard defined as the next, caudal, uncompromised spinal level, and the percentage of preoperative and postoperative canal compromise was calculated.(ABSTRACT TRUNCATED AT 250 WORDS)