J Korean Neurosurg Soc.  2016 Mar;59(2):122-128. 10.3340/jkns.2016.59.2.122.

Single-Stage Posterior Subtotal Corpectomy and Circumferential Reconstruction for the Treatment of Unstable Thoracolumbar Burst Fractures

• Jo DJ
• Kim KT
• Kim SM
• Lee SH
• Cho MG
• Seo EM

• KMID: 2192041
• DOI: http://doi.org/10.3340/jkns.2016.59.2.122

Abstract

OBJECTIVE
To illustrate the technique of single-stage posterior subtotal corpectomy and circumferential reconstruction for the treatment of unstable thoracolumbar burst fractures and to evaluate the radiographical and clinical outcomes of patients treated using this technique.
METHODS
16 consecutive patients with unstable thoracolumbar burst fractures were treated with single-stage posterior subtotal corpectomy and circumferential reconstruction. The mean patient age was 54.8 years. The mean follower up period was 25 months. Five patients suffered from T12 fractures, 10 from L1, 1 from L2. The segmental kyphosis, neurologic status, visual analogue scale for back pain was evaluated before surgery and at follow up.
RESULTS
The segmental kyphotic angle improved from 18.5 degrees before surgery to -9.2 degrees at the last follow up. The mean correction angle was 28.9 degrees. The mean surgical time was 255 minutes, and a mean intraoperative blood loss was 1073 mL. Intraoperative complications included two dural tears, and a superficial wound infection. There were no other severe complications. The mean visual analog scale of back pain decreased from a mean value of 6.6 to 2 at the last follow up.
CONCLUSION
The single-stage posterior subtotal corpectomy and circumferential reconstruction achieved satisfactory kyphosis correction with direct visualization of the circumferentially decompressed spinal cord, as well as good fusion with less blood loss and complications. It is a safe and reliable surgical treatment option for unstable thoracolumbar burst fractures.

Keyword

Burst fracture; Posterior subtotal corpectomy; Circumferential reconstruction

MeSH Terms

Back Pain
Follow-Up Studies
Humans
Intraoperative Complications
Kyphosis
Operative Time
Spinal Cord
Tears
Visual Analog Scale
Wound Infection

Figure

• 

  Fig. 1 Preoperative and postoperative imaging of a 49-year-old male patient with L1 burst fracture. A : Preoperative lateral supine roentgenogram showing a L1 burst fracture with an angular segmental deformity of 35°. B and C : Preoperative sagittal and axial lumbar magnetic resonance imaging demonstrating a significant spinal canal encroachment by retropulsion of the fragments of the fracture vertebra. D and E : Photograph (D) and postoperative axial CT showing circumferential spinal canal clearance and anterior-lateral wall of vertebral body restored. F and G : Postoperative standing AP and lateral radiograph showing a correct position of the mesh cage and normal thoracolumbar alignment. Angular deformity was corrected and segmental height was restored. AP : anteriorposterior.

• 

  Fig. 2 The kyphotic angle was measured on lateral radiographs using the Cobb method. Regional angles (RAs) between the superior endplate of the vertebral body above the affected level and the inferior endplate of the vertebral body below the affected level were measured preoperatively (A) and after surgery (B).

• 

  Fig. 3 A lateral radiographs of a 72-year-old male with T12 burst fracture (A). He was treated using the single-stage posterior subtotal corpectomy and circumferential reconstruction. A postoperative lateral radiograph showed good sagittal alignment (B). During a visit to 18 months after surgery, lateral flexion (C) and extension (D) dynamic radiographs showed bony fusion at the fracture site.

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