Background: Spinal injury is a severe, common injury in surgical emergency. In Vietnam, there are only few studies on fixing thoracolumbar spine. Objectives: To assess and to provide some preliminary remarks on the results of emergency surgery fixing thoracolumbar spine, performed in Viet Duc Hospital. Subjects and method: A descriptive, prospective study was conducted on 31 patients with thoracolumbar spinal injury (22 males, 9 females, the average age 35 years old), operated in Viet Duc hospital from January, 2005 to July, 2006. Results:Patients with thoracolumbar spinal injury was common seen in working ages. 45.2% of them were farmers. 21/31 patients caused by falls. For non-complete paralysis patients, emergency surgery was required as soon as possible. The most of patients recovered completely. For thoracolumbar spinal injury, Burst-fracture and non complete paralysis, surgery with anterior way should be performed to release cord compression and bone graft. For cases of Burst-fracture, no paralysis, surgery with anterior way helped bone fractures were easy to heal, avoiding postoperative humpback recurrence. Conclusion: Combined surgery with 2 ways (before and after) guaranteed fixing spine, making bone healing was more better in case of rupture of vertebrae, releasing directly spinal cord and facilitating to the best recovery of the spinal cord.
Spinal Injuries/ surgery ; Thoracic Vertebrae/ injuries ; surgery ; Lumbar Vertebrae/ injuries ; surgery ; Fractures ; Bone Emergencies ;

OBJECTIVETo investigate appropriate ways for screw placement of pedicle of vertebral arch in the horizontal plane.

METHODSFifteen preserved thoracolumbar spine specimens (T(11)-L(5)) were used and divided into three groups at random. Firstly four anatomic parameters indicating screw positions in the horizontal plane were measured. Secondly the methods of Roy-camille, Magerl, and authors' segmental differences were used to place successively the screws of the pedicles with 5 mm, 6 mm, and 7 mm in diameter. Coincidences between the drilling point, drilling direction and pedicle axis, and ruptures of the pedicle as well as the length of the screw in the vertebral body were observed.

RESULTSFour anatomic parameters at various segments showed significant differences (P<0.05). The drilling point by the Roy-camille's method deviated medial to pedicle axis in most segments, and its drilling direction did not coincide well with most E-angles of the pedicles. The drilling point by Magerl's method coincided relatively well with pedicle axis in lumbar vertebrae, but there were still some differences between its drilling direction and E-angles of the pedicles. The method of segmental differences coincided the best with the pedicle axis. The lengths of screw in the vertebra were relatively long by both Magerl and segmental difference methods. When 5 mm diametral screw was used by the three methods, the rupture rate was very low. When 6 mm and 7 mm diametral screws were placed, the rupture rate was accordingly increased. Of the three methods, Roy-camille's method showed a relatively high rupture rate, while the method of segmental differences a comparatively low rupture rate. Various degrees of rupture of the pedicle of vertebral arch were found at the juncture of the thoracic and lumbar vertebrae when 6 mm or 7 mm diametral screws was used by any screw placement method. In contrast, the rupture was seldom seen at the lower lumbar vertebrae when 7 mm diametral screws were used.

CONCLUSIONSThe segmental difference method is proved to have the anatomic safety and screw biomechanical stability. It is appropriate to choose different diametral screws, different drilling points and directions according to different segments of the vertebra.

Adult ; Bone Screws ; Cervical Vertebrae ; injuries ; Humans ; Lumbar Vertebrae ; injuries ; Spinal Injuries ; surgery

The authors report clinical results of twenty-three traumatic thoracolumbar burst fractures treated by internal fixation with Kaneda device after anterior decompression during recent three years. Thoracolumbar injuries made up 28.9% of total spinal injuries and the burst fractures treated by anterior decompression and stabilization with Kaneda device constituted 19.0% of all spinal injuries. The burst fractures occurred most frequently at the age of twenties and thirties. The main causes of injury were fall and vehicle accident. Superior end-plate fracture type was most common according to the types of burst fracture. The first and the second lumbar vertebrae were frequently involved. No patient showed neurological deterioration after surgery. Conus medullaris lesions in burst fractures of the thoracolumbar junction have a high potentiality for functional recovery because the lesions are not due to discontinuity or severe crush injury but due to simple compression by bony fragments. The Kaneda device offered enough stability to enable early ambulation with good alignment and solid fusion.
Conus Snail ; Decompression* ; Early Ambulation ; Humans ; Lumbar Vertebrae ; Spinal Injuries

The authors report clinical results of twenty-three traumatic thoracolumbar burst fractures treated by internal fixation with Kaneda device after anterior decompression during recent three years. Thoracolumbar injuries made up 28.9% of total spinal injuries and the burst fractures treated by anterior decompression and stabilization with Kaneda device constituted 19.0% of all spinal injuries. The burst fractures occurred most frequently at the age of twenties and thirties. The main causes of injury were fall and vehicle accident. Superior end-plate fracture type was most common according to the types of burst fracture. The first and the second lumbar vertebrae were frequently involved. No patient showed neurological deterioration after surgery. Conus medullaris lesions in burst fractures of the thoracolumbar junction have a high potentiality for functional recovery because the lesions are not due to discontinuity or severe crush injury but due to simple compression by bony fragments. The Kaneda device offered enough stability to enable early ambulation with good alignment and solid fusion.
Conus Snail ; Decompression* ; Early Ambulation ; Humans ; Lumbar Vertebrae ; Spinal Injuries

OBJECTIVETo explore the advantages and indications of the paraspinal approach by anatomical study and clinical application.

METHODSThe anatomical data and clinical practice of 27 cases were analyzed to explore the accurate approach between the paraspinal muscles and the structure of ambient tissues, as well as the results of clinical application of paraspinal approach. The operation time, blood loss, incision length, radiographic result (Cobb angle, height of anterior edge of the vertebrae) were compared with those in 24 cases treated by traditional approach.

RESULTSComplete exposure of the facets could be easily performed by identifying natural cleavage plane between the multifidus and longissimus muscles. The natural muscular cleavage was (1.47+/-0.23) cm lateral to the midline for females, and (1.64+/-0.35) cm for males at T(12) level. The distance was (3.3+/-0.6) cm lateral to the midline for females, and (3.7+/-1.0) cm for males at L(4) level. In paraspinal approach group, the operation time was (76.2+/-15.7) min, blood loss was (91.6+/-16.9) ml and incision length was (7.6+/-0.8) cm. In traditional approach group, the operation time was (121.4+/-19.6) min, blood loss was (218.7+/-32.3) ml and incision length was (17.4+/-2.1) cm. To compare paraspinal approach with traditional approach, the operation time, blood loss and incision length had statistical difference (P less than 0.05) and the radiographic result (Cobb angle, height of anterior edge of the vertebrae) had no statistical difference (P larger than 0.05).

CONCLUSIONSWhen the paraspinal approach is performed through natural cleavage plane between the multifidus and longissimus muscles, there are no wide muscular disinsertions, leaving the supraspinous and interspinous ligaments intact. The distance of natural cleavage to the midline is different at T(12) and L(4) planes. By this approach, the facet joints can be explored easily and completely, and a clear surgical field will be available for the placement of pedicle screws. As a minimally invasive approach, it can be widely used in thoracolumbar spine surgery.

Female ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Spinal Fractures ; surgery ; Thoracic Vertebrae ; injuries ; surgery ; Time Factors

OBJECTIVETo investigate the mechanism associated with thoracolumbar burst fractures.

METHODSStress distribution of the spine in the upright, flexion and extension positions was analyzed using a three-dimensional finite element model of the spinal motion segment.

RESULTSStress concentration was noted at the pedicle and posterosuperior part of the vertebral body near the pedicle.

CONCLUSIONStress concentration of the spine may be implicated in the biomechanical mechanism underlying thoracolumbar burst fractures.

Biomechanical Phenomena ; Imaging, Three-Dimensional ; Lumbar Vertebrae ; injuries ; Models, Biological ; Spinal Fractures ; etiology ; Thoracic Vertebrae ; injuries

Humans ; Lumbar Vertebrae ; injuries ; Spinal Fractures ; classification ; surgery ; Thoracic Vertebrae ; injuries

OBJECTIVETo investigate the damage characteristics and biomechanical mechanisms of the thoracolumbar vertebral bursh fracture during the impact loading.

METHODSFrom September 2008 to October 2009, 10 fresh human thoracolumbar spine specimens were collected for experimental model and divided into two groups. Biomechanical static and dynamic impact strength test were performed respectively in two groups. The static and dynamic data from thoracolumbar vertebrae shock response in different loads were observated.

RESULTSThoracolumbar yield load was (5 280.00 +/- 354.2) N, yield displacement was (13.32 +/- 2.07) mm, the limit load was(6 590.00 +/- 249.20) N, ultimate displacement was (20.60 +/- 2.57) mm, load speed was 0.02 g, and the average limit load of dynamic mechanical properties of thoracic and lumbar vertebrae was (14 425.60 +/- 1101.52) N, the average reaction time load was (17.29 +/- 2.04) ms, the average of acceleration was (36.80 +/- 2.81) g, the dynamic displacement was (45.11 +/- 1.13) mm.

CONCLUSIONThoracolumbar vertebral burst fracture is a serious injury caused by the release of high-energy moment, the role of biomechanical forces are in a pattern of pulse change, thoracic and lumbar vertebrae present with the viscoelastic properties of biological materials.

Biomechanical Phenomena ; Cadaver ; Humans ; Lumbar Vertebrae ; injuries ; Spinal Fractures ; metabolism ; physiopathology ; Stress, Mechanical ; Thoracic Vertebrae ; injuries

External Fixators ; Humans ; Lumbar Vertebrae ; injuries ; Manipulation, Orthopedic ; Spinal Fractures ; therapy ; Thoracic Vertebrae ; injuries

OBJECTIVE: To systematically evaluate the efficacy and safety of anterior decompression and posterior decompression in the treatment of thoracolumbar fractures with spinal cord injury, so as to provide a good scientific basis for more effective treatment of thoracolumbar fractures with spinal cord injury. METHODS: A clinical data about comparative study of anterior decompression and posterior decompression in the treatment of thoracolumbar fractures with spinal cord injury was searched and collected. The databases of Pubmed, Embase, Cochrane Library, CNKI, CBM, Wanfang Medical Network were searched by computer. Artificially collected journals included Spine, European Spine Journal, The Journal of Bone and Joint Surgery. Two spine surgeons independently screened the literature according to established inclusion and exclusion criteria and assessed the quality of the included studies. Meta-analysis was performed on the data using Review Manager 5.3 software, the indicators included operative time, intraoperative blood loss, postoperative tactile score, postoperative motor score, postoperative vertebral height, hospitalization time, neurological function recovery, efficiency of treatment, postoperative complications. RESULTS: Fifteen randomized controlled trials (RCTs) were enrolled in a total of 1 360 patients, including 680 anterior decompression and 680 posterior decompression. The results of Meta-analysis showed that the anterior decompression group had longer operation time [MD=80.09, 95% CI(36.83, 123.34), P=0.000 3], more intraoperative blood loss [MD=225.21, 95%CI(171.07, 279.35), <0.000 01], longer hospitalization time [MD=2.31, 95% CI(0.32, 4.31), P=0.02]. And the postoperative tactile score [MD=13.39, 95% CI(9.86, 16.92), <0.000 01], postoperative motor score [MD=13.15, 95% CI(7.02, 19.29), <0.000 1], vertebral height [MD=1.36, 95% CI(0.79, 1.92), <0.000 01] in anterior decompression were higher than that in posterior decompression. There was no statistically significant differences in the efficacy of treatment [OR=1.14, 95% CI(0.56, 2.31), P=0.72], neurological recovery [OR=0.87, 95% CI(0.57, 1.33), P=0.52] between two groups. CONCLUSIONS Compared with posterior decompression, the anterior decompression has the advantages of longer operating time, more intraoperative blood loss, longer hospitalization time, higher postoperative tactile score, higher postoperative motor score, and higher injury vertebral height, But there was no significant difference in the treatment efficiency and nerve function recovery between two groups.
Decompression, Surgical ; Humans ; Lumbar Vertebrae ; Spinal Cord Injuries ; Spinal Fractures ; Thoracic Vertebrae ; Treatment Outcome