| Outcome of Thoracolumbar Fracture-dislocation According to the Injury Mechanism |
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Koang Hum Bak, M.D., Jin Hwan Cheong, M.D., Choong Hyun Kim, M.D.,Seong Hoon Oh, M.D., Jae Min Kim, M.D. and Chul Burm Lee, M.D.1 |
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Department of Neurosurgery, Thoracic and Cardiovascular Surgery1, Hanyang University, Medical Collage, Seoul, Korea |
| 흉요추부 골절탈구 환자의 치료 경험과 손상 기전에 따른 예후 분석 |
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백광흠·정진환·김충현·오성훈·김재민·이철범1 |
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한양대학교 의과대학 신경외과학교실, 흉부외과학교실1 |
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| Abstract |
Objective
The fracture-dislocation is the most unstable spinal injury with failure of all three columns and presents catast- rophic neurological injury. The purpose of this study was to evaluate factors such as preoperative neurological status, causes of injury, time to operation, type of fracture-dislocation, and steroid therapy that might alter the prognosis of patients.
Methods
A retrospective analysis on 26 patients of thoracolumbar fracture-dislocation was performed. Fracture-dislocation was classified into three different categories according to Denis' classification: flextion-rotation in 15 patients, shear in 5 patients, and flextion-distraction in 6 patients. The neurological status was classified according to Frankel's classification: A in 9 patients, B in 6, C in 5, D in 4, E in 2. Posterior reduction and transpedicular screw fixation with fusion was used in 18 cases, corpectomy and interbody fusion through retroperitoneal approach was used in 2, combined approach was used in 6.
Results
Thirteen patients(54%) with neurological deficit improved after surgical treatment. Operations achieved reduction and neural decompression regardless of surgical approaches in most cases. The preoperative neurological status, type of fracture- dislocation, and interval between trauma and operation were closely correlated with the postoperative neurological status(p= 0.001). But the causes of injury, mega-dose steroid therapy were not correlated with the neurological outcome statistically(p>0.05).
Conclusion
Early surgical intervention should be considered for patients with thoracolumbar fracture-dislocation to achieve neurological improvement and early mobilization.
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