The Clinical Application Of Treating Thoracolumbar Burst Fractures With Vertebral Lamina Fenestration

Objective: Thoracic and lumbar are the most common sites of injury in spinal trauma for the characteristics of the spinal anatomy. Spinal trauma often involved the anterior column, central, and posterior column, which often led to the loss of spinal stability, and often accompanied by nerve injury. The purpose of spinal fracture treatment is to restore the physiological state of the spine and restore spinal canal volume, reconstruction of spinal stability. Internal fixation should be done to ensure the effect of the Spinal canal decompression and reduction of vertebral body. The approaches of surgical treatment of spinal fractures commonly included anterior approach and posterior approach. The advantages of anterior approach can avoid the injury of posterior column and directly reach the Injury vertebral and complete the decompression and reconstruction of anterior and central column. But the surgery is complex and difficult with more blood loss and greater trauma,and thus its application is limited. Posterior short segment pedicle fixation of thoracic and lumbar fractures is simple and easily to achieve the desired reduction. The aim of the subject is to explore the feasibility and superiority of posterior short segment pedicle screw fixation without fusion, small window laminectomy, and with foot-shaped device of self-made to make the fracture fragments broken into the vertebral canal reduction to treat the thoracolumbar burst fractures.Methods:According to preoperative examination, we design and application of posterior spinal small-window laminectomy, apply foot-shaped device of self-made to reset and collapse the fracture fragments explore the spinal canal and nerve roots, complete spinal decompression and posterior short segment pedicle screw fixation without fusion, which can retain the most of spinal column stability after completion of spinal decompression,reduce the gap within the vertebral body and strengthen the bearing capability of the anterior column of vertebrae. Patients should wear the waist brace in Activities and remove screw and rod fixation system after operation, then restore the natural thoracic spine morphology and function and complete the natural process of the reconstruction of thoracolumbar fractures Results: we compared the ratio of preoperative injury vertebral body height and normal vertebral body height, Cobb's Angle, Occupancy rate of spinal canal and spinal cord injury by Frankel classification with postoperative Indicators mentioned above of the 47 thoracolumbar burst fractures follow-up patients. The ratio of preoperative injury vertebral body height and normal vertebral body height was 51.6%,Cobb angle was 25.6°, the average occupancy rate of spinal canal was 35.4% The ratio of postoperative injury vertebral body height and normal vertebral body height was 96.5%, Cobb Angle average3.4°, Occupancy rate of spinal canal was 4.2%. After 1.5 years follow-up, we found the injury vertebral body height and normal vertebral body height was 93.5%, Cobb angle was 5.2°and the average Occupancy rate of spinal canal was 35.4%., postoperative and postoperative 1.5 years after follow-up groups compared with the preoperative group had obviously significance (P< 0.05) by Statistical treatment (t-test), but postoperative follow-up 1.5 year groups compared with postoperative group had no obviously significance (P> 0.05). By Frankel classification, postoperative nerve spinal cord injury can improve 1～2 grade compared with the preoperative group. Conclusion: Thoracolumbar burst fractures by posterior short segment pedicle screw fixation without fusion, small window laminectomy and fracture reduction was not only to reserve the posterior-column structures in maximum extent but also directly complete fracture reduction and, spinal decompression. while reduce the gap within the vertebral bodies and strengthen the bearing capacity of the anterior column of vertebral bodies, reduce the loss of vertebral height and eventually restore the natural thoracic spine morphology and function, avoid the degeneration of adjacent vertebral bodies. Moreover, this surgery has with the advantages of small surgical trauma, less blood loss, simple operations, quick recovery and fewer complications. this technique is a surgical option to treat thoracolumbar burst fracture.