Surgical Treatment Strategy And Clinical Efficacy For Thoracolumbar Burst Fractures With Spinal Canal Compromise Without Neurological Damage

Background:For thoracolumbar burst fractures with spinal canal compromise but no neurological deficit,is it necessary to perform additional laminectomy decompression after the currently accepted posterior pedicle-screw internal fixation?How to make the choice?The aim of this study was to explore the decision making among different surgical strategies(decompression/non-decompression)and their corresponding clinical efficacy.Methods:A total of 99 middle-aged patients were included who were diagnosed with thoracolumbar burst fractures from January 2013 to January 2015 and met the surgical indications.According to the choice of surgical methods,whether posterior pedicle internal fixation was combined with laminectomy decompression or not,the patients were divided into two groups:Group A-decompression group(47 cases)and Group B-non-decompression group(52 cases).The average age,gender,fracture type,and fracture segment of the two groups were compared.A retrospeetive analysis of the relevant intraoperative parameters,including the posterior vertebral body height of the fractured vertebral body,the ratio of the volume of the spinal canal,and the change of the Cobb angle,relative to the corresponding preoperative values,was conducted to analyze the reasons for choosing different surgical methods.The clinical efficacy and related parameters from the X-ray and CT follow-up observations 1 month,6 months,and 12 months after the surgery were reviewed.Results:All patients in this study had no complications such as wound infection or internal fixation failure.All patients had normal fracture healing with no bone nonunion.There was no significant difference in the basic data between the two groups.Compared the intraoperative findings after fixation with the preoperative data,in Group A(decompression group),the posterior vertebral body height of the fractured vertebral body was not significantly restored,the volume ratio of spinal canal was not significantly improved,and the Cobb angle was not signifieantly reduced(p>0.05).In eomparison,in Group B(non-decompression group),the posterior vertebral body height of the fractured vertebral body was significantly restored,the volume ratio of spinal canal was significantly increased,and the Cobb angle was significantly reduced(p<0.001).In the follow-up period,there were no significant changes in the posterior vertebral body height,spinal canal volume ratio,Cobb angle,or lo?Ver limb motor function score(AMS)for both groups.There was no significant difference in clinical efficacy between the two groups.Conclusion:For patients with thoracolumbar burst fractures with spinal canal compromise but no neurological damage,if when the posterior intraoperative fixation is performed,the spinal canal fractUre is partially recovered,the posterior vertebral body height of the injured vertebrae is significantly restored,the spinal canal volume ratio is significantly increased,and the large kyphosis i5 corrected,then the indirect decompression without the posterior laminectomy can be performed.For these patients,the indirect decompression with the posterior pedicle screw fixation should be selected as it introduces less trauma and instability to the spine.Compared with patients undergoing direct decompression with laminectomy,there is no significant difference in clinical efficacy and good clinical results can be obtained.