Posterior Partial Corpectomy For Treatment Of Stiff Irreducible Lower Lumbar Burst Fracture Combined With Nerve Injury

Objective: To investigate the effect of posterior partial corpectomy in the treatment of stiff irreducible lower lumbar burst fracture combined with nerve injury.Methods: From March 2014 to October 2018,the clinical data of 28 patients with stiff irreducible lower lumbar burst fracture combined with nerve injury who were treated with posterior partial corpectomy were analyzed retrospectively,record general information about the patient's gender,age,injury mechanism,major fracture segment,nerve injury,and lord sharing classification(LSC).The main evaluation indicators of this study were operation time,intraoperative bleeding volume,visual analogue scale(VAS),height ratio of anterior edge of injured vertebral body and Cobb's angle before surgery,at 1 week after surgery and at the last follow-up.The measurement data is represented by ?x ± s.Repeated measurement analysis of variance was used to analyze the visual analogue scale(VAS),height ratio of anterior edge of injured vertebral body and Cobb's angle before surgery,at 1 week after surgery and at the last follow-up,and P <0.05 was considered statistically significant.At the same time,the patient's American Spinal Injury Association(ASIA)neurological function classification were evaluated.Results: Of the 28 patients included in the study,19 were male and 9 were female;aged 17-55(38.8 ± 12.1)years old;load sharing score(LSC)of 6-9(7.2±1.1);high fall injury of 7 cases,traffic injury of 15,bruise injury of 6;L3 fracture in 18 cases,L4 fracture in 7,L5 fracture of 3,including 6 with compression fracture of adjacent vertebral body;cauda equina nerve injury in 10 cases nerve root injury in 4,both cauda equine and nerve root injury in 14.The time from injury to operation was 2-7(3.4±1.4)d.All the operations were completed successfully.The operation time was(163.9 ± 22.4)min,and the intraoperative bleeding volume was(652.1±95.5)mL.No complications such as blood vessel,nerve and abdominal organ damage and aggravation of nerve damage occurred during the operation.Postoperative complications included 1 case of incision infection,1 case of fat liquefaction in the incision,and 4 cases of cerebrospinal fluid leakage.All patients were followed up for 12-30 months,with an average of 16.7 months.The visual analogue scale(VAS),height ratio of anterior edge of injured vertebral body and Cobb's angle were significantly improved compared with those at pre-operation,all with a statistical significance(P<0.05).According to ASIA classification,1 case in grade A at pre-operation was still in grade A;4 in grade B at pre-operation,3 recovered to grade C,1 to grade D;15 in grade C at pre-operation,11 to grade D,4 to grade E;8 in grade D at pre-operation,4 still in grade D,4 to grade E.Conclusion: Posterior partial corpectomy can effectively decompress the spinal canal,relax the nerves,is satisfactory for the treatment of stiff irreducible lower lumbar burst fracture combined with nerve injury.