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 ;

Cervical Vertebrae ; injuries ; Humans ; Spinal Injuries ; diagnosis ; therapy ; Thoracic Vertebrae ; 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

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

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

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

Humans ; Spinal Fractures ; classification ; diagnosis ; therapy ; Thoracic Vertebrae ; injuries ; surgery

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

OBJECTIVETo investigate the feasibility and the efficacy of video-assisted thoracoscopic surgery in treating thoracolumbar fractures.

METHODSFrom October 2000 to December 2009, the data of 44 patients with thoracolumbar fractures were retrospetively analyzed. All patients were treated with anterior decompression, auto-iliac bone graft and anterior internal fixation system. They were divided into thoracoscopic group (23 cases, treated with video-assisted thoracoscopic surgery) and traditional group (21 cases, treated with traditional anterior approach surgery). In the thoracoscopic group, there were 15 males and 8 females with an average age of 41.4 years (ranged, 19 to 76); and in the traditional group, there were 14 males and 7 females with an average age of 39.3 years (ranged, 20 to 74). All patients were followed up from 6 to 36 months with an average of 18 months. The operative time, volume of the blood loss, the decreased value of the occupation ratio of spinal canal (OR), the corrected and loss degree of Cobb angle, the improved condition of ASIA classification were compared between two groups.

RESULTSIn traditional group, operative time, volume of the blood loss, the decreased value of the occupation ratio of spinal canal (OR), the corrected and loss degree of Cobb angle, the improved grade of ASIA classification were (150.0 +/- 19.4) min, (970.0 +/- 72.0) ml, (35.5 +/- 6.4)%, (25.1 +/- 4.8) degrees, (1.0 +/- 0.7) degrees, (1.8 +/- 0.9) grades, respectively; and in thoracoscopic group, the above items were (170.0 +/- 20.8) min, (650.0 +/- 65.4) ml, (33.2 +/- 8.0)%, (23.6 +/- 5.4) degrees, (1.1 +/- 0.8) degrees, (2.0 +/- 1.1) grades, respectively. There was significant difference in volume of the blood loss between two groups (P < 0.05); there was no significant difference in operative time, the decreased value of the occupation ratio of spinal canal (OR), the corrected and loss degree of Cobb angle,the improved grade of ASIA classification between two groups (P > 0.05). The rate of fusion of all patients was 100%.

CONCLUSIONCompared with the traditional anterior approach surgery, video-assisted thoracoscopic surgery has advantages of little incision,less blood loss, less trauma, can obtain same clinical outcome and is a safe,effective method in treating thoracolumbar fractures.

Adult ; Aged ; Female ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Spinal Injuries ; surgery ; Thoracic Surgery, Video-Assisted ; methods ; Thoracic Vertebrae ; injuries ; surgery