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Restorative Effect of Posterior Approach for the Thoracolumbar Burst Fracture
Il-Seung Choe, M.D., Sung-Choon Park, M.D., Dae-Hee Seo, M.D., Euy-Byung Chae, M.D., Yong-Ho Kim, M.D.1, Young-Soo Ha, M.D.
Department of Neurosurgery, Department of Anesthesiology and Pain Medicine1, Myongji Hospital, Kwandong University
흉요추 압박 분쇄 골절 환자에 대한 후방 접근법의 복원 효과
최일승,박성춘,서대희,채의병,김용호1,하영수
관동대학교 의과대학 신경외과학교실, 마취통증의학교실1
Abstract
Objective
This study was designed to evaluate the efficacy of the posterior decompression and fusion for the thoracolumbar burst fracture and to decide its operative indication.

Methods
Sixty five patients with thoracolumbar burst fracture who underwent posterior decompression and fusion were analysed retrospectively. All fractures were located between the first thoracic and the 5th lumbar vertebrae and were considered unstable fracture with respect to the three column model. Kyphotic angle, height of vertebra body, and diameter of spinal canal were measured preoperatively and postoperatively.

Results
The neurological function was improved statistically after operation. Preoperative mean kyphotic angle was 18.3 degrees and it was restored to 3.9 at the follow-up. Preoperative mean diameter of spinal canal was 8.6mm and it was restored to 11.5mm. Early surgery within 7 days had a better result than delayed surgery for the restoration of kyphotic angle and vertebral height. Three patients had a unsatisfactory results. Two of them had to underwent reoperation for stabilization due to aggravation of kyphosis and fracture of pedicle screws. One patient with paraplegia did not improved at all. These three patients presented with initial kyphosis of 20 degrees more or initial canal compromise of 65% more. There was no severe complication in patients whose spinal canal was compromised by 65% lesser, kyphotic angle was 20 degrees lesser, and lower extremities were not completely paralyzed.

Conclusion
Early surgery within 7 days is safer and more effective treatment than delayed surgery and patients with kyphotic angle 20 degrees lesser, and canal compromise 65% lesser show better outcome than those with kyphotic angle 20 degrees more, and canal compromise 65% more in thoracolumbar burst fractures.
Keywords: Burst fracture.Kyphosis.Posterior approach


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