A Study on Anterior Decompression and Stabilisation of Dorsolumbar Spine Burst Fractures and Caries Spine

Raja Durai, S (2009) A Study on Anterior Decompression and Stabilisation of Dorsolumbar Spine Burst Fractures and Caries Spine. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Spine is one of the intriguing regions in Orthopeadics where treatment for its pathology has drawn much controversy. Before the dawn of 20th century spine injuries were treated non-operatively. Later Harrington revolutionized spine care and rehabilitation with introduction of posterior instrumentation. Since then surgical techniques and instruments have proliferated to improve anatomical reduction and alignment of spinal column. But neurological recovery remained mostly unchanged over the results of non operative treatment. However root function and spinal cord function , in selected patients can be improved with appropriate surgery. Dorsolumbar region constitutes the second most common site for spine fractures and burst fractures constitute 60% of dorsolumbar fractures. Though the treatment of burst fractures associated with neurological injury is controversial, many investigators have reported favourable results with anterior decompression and stabilization surgery. The other major pathology of spine for which anterior decompression and stabilization surgery is favoured at present is Caries spine. AIM: To evaluate the effectiveness of anterior decompression and stabilisazion of dorsolumbar spine in terms of 1. Neurological recovery, 2. Kyphotic angle correction, 3. Bone graft fusion, 4. Pain scale of denis, and 5. Work scale of denis. MATERIALS AND METHODS: Twenty two patients who were operated with anterior decompression and stabilization of thoracolumbar spine pathology in Govt. General Hospital, Chennai with follow up of minimum six months were included in the study. Among those operated with anterior decompression and stabilization, Dorsolumbar burst fractures - 12 cases, Caries spine - 10 cases. The interval from injury to surgery was an average 18 days in burst fracture pts. The average duration of caries spine with which they presented to us was 3.2 months. Inclusion Criteria- We included cases of burst fracture affecting dorsal and lumbar vertebrae presenting with neurologic deficit and canal compromise >50%. Tuberculous spondylitis affecting dorsal and lumbar vertebra are also included. The indication for surgery were neurologic deficit, vertebral body destruction with significant angulation with or without cold abscess. All caries spine patients took ATT for a minimum period of 6 months. Exclusion Criteria - Patients with no neurologic deficit and those with severe medical comorbidities were excluded from the study. RESULTS: All the patients included in the study had preoperative neurologic deficits. In trauma spine, out of 12 cases, 5 cases, (41.6%) with incomplete spinal cord, injury improved to Frankel grade D/E neurology (walking with/without support). Out of 5 cases, one case had injury at D-12 level other had injury below L1 level. 7 cases (58.3%) with complete spinal cord injury remained the same at follow up. CONCLUSION: Anterior decompression and stablisation with anterior instrumentation with single rod system, - definitely improves neurology in incomplete spinal cord injury patients and most of caries spine patients. - though the kyphotic correction achieved is low, functionally (pain & work scale wise) patient has little difficulty.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Anterior Decompression ; Stabilisation ; Dorsolumbar Spine Burst Fractures ; Caries Spine.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 14 Sep 2017 02:29
Last Modified: 14 Sep 2017 02:29
URI: http://repository-tnmgrmu.ac.in/id/eprint/3087

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