The Clinical Application Of Lateral Extracavitary Approach In The Treatment Of Thoracolumbar Burst Fractures

Objective Explore the outcome of lateral extracavitary approach to anterior lateral decompression and bone fusion and internal fixation operation for thoracolumbar burst fracture with nerve injury in the correction and maintenance of kyphosis,the recovery and maintenance of vertebral height,the decompression effect of spinal canal,the improvement of neurological function and the clinical effect of treatment.Methods To analyse the clinical data of twenty-two patients of thoracolumbar(T11-L2)burst fracture with nerve injury of lateral extracavitary approach to anterior lateral decompression and bone fusion and Internal fixation operation.There have or not have secondary kyphosis,vertebral height loss and internal fixation failure.Compared the radiographic data of kyphosis angle,vertebral height compression percentage and spinal canal encroachment rate.All data was collected pre-operation,post-operation and last follow-up.According to clinical manifestations,comparison of pre-operation and post-operation in recovery of neurological function assessed by the ASIA(American Spinal Cord Injury Association)classification.The lower back pain score of JOA(Japanese Orthopaedic Association)was evaluated pre-operation,post-operation and last follow-up.The improvement rates in post-operative and final follow-up were work out,and the excellent and good rates of post-operative and final follow-up were compared.Results All 22 cases were followed up after operation for(18±7.2)months.Severe abdominal pain and abdominal distension occurred in 1 cases after operation,and improved after symptomatic treatment.2 patients suffered from sensory disturbance of the intercostal nerve area,1 cases recovered after the treatment with neurotrophic drugs,and 1 cases improved.All patients were no other complications occur.On the change of radiographic index,the kyphosis angle in pre-operative was(20.53±4.05)°,in post-operation days was(5.94±1.08)°,in last follow-up was(6.56±0.98)°.The difference was statistically significant before and after operation(P=0.01).Same difference at the last follow-up and preoperative comparison(P=0.01).There was no significant difference between the last follow-up and post-operative(P=0.08).The percentage of vertebral height compression in pre-operative was(51.18±7.67)%,post-operation days was(91.77±2.31)%,in last follow-up was(90.55±4.28)%.At the post-operative,there was a significant difference compared with pre-operative(P=0.01).Between the last follow-up and pre-operative also a significant difference(P=0.01).No significant difference between the last follow-up and post-operative(P=0.14).The spinal canal encroachment rate in Pre-operative was(34.82±5.14)%,post-operation days was(3.16±0.58)%,in last follow-up was(3.30±0.48)%.A significant difference between the post-operative and pre-operative(P=0.01).In the same sense,the last follow-up compared with pre-operative(P=0.01).To the contrary,no significant difference between the last follow-up and post-operative(P=0.13).No secondary kyphosis,high vertebral height loss and internal fixation failure were found in all patients after the operation and follow-up.The ASIA score of patients there are 2 patients with complete injury,12 patients received 1 levels of improved and 8patients obtained 2 levels.The improvement rate of JOA score was improved in different degree expect 2 patients with complete injure,postoperative patients with excellent and good were 14 cases and 19 were followed up at the last follow-up.The excellent and good rate of post-operation was 63.65%,the excellent and good rate of the last follow-up was 86.36%,obviously improve between them.Conclusion The operation of lateral extracavitary approach to anterior lateral decompression and bone fusion and Internal fixationis relatively simple in anatomical approach,to avoid injury to the thoracic cavity,abdominal organs,reduce surgical complications.It also can correct spinal kyphosis,restore maintain vertebral height effectively,decompress the spinal canal completely and column reconstruction titanium mesh in anterior and posterior fixation to enhance spinal stability,satisfactory recovery in never function in the treatment of thoracolumbar burst fracture with nerve injury,which was an effective surgery.