Surgical Management of Lumbar and Thoracolumbar Spinal Fractures: Indications, Surgical Technique and Evaluation on a Series of 64 Patients Treated with Percutaneous Posterior Osteosynthesis Combined with Kyphoplasty or Anterior Arthrodesis

摘要

Introduction: Fractures of the lumbar spine and thoracolumbar junction are common in spinal trauma. The aim of this work is to analyze the nature of the indications, the morbidity as well as the results of these treatment regimens. Patients and Methods: A retrospective, single-center study, based on a review of 64 patients with lumbar spine and thoracolumbar junction fractures (T10-L2) without neurological disorders, was collected in the neurosurgery department of the North Hospital and University Hospital (CHU), Marseille over a period of 2 years from January 2015 to December 2016. Posterior percutaneous osteosynthesis were more or less associated with kyphoplasty preceded anterior arthrodesis. Clinical and radiological endpoints were collected at least 6 months later. Results: The mean follow-up was 9.5 months (6 - 24). The clinical evaluation found a mean VAS at last follow-up at 14/100 (0 - 30) and an average Oswestry score at the last follow-up at 88%. The initial average vertebral kyphosis went from 13° to 4° at the last follow-up with a correction loss of 1°, an absolute gain of 8°. No postoperative neurological complications were noted in our series. Conclusion: The implementation of a two-step therapeutic strategy with anterior reconstruction in Magerl’s lumbar spine or A3.3 thoracolumbar junction fractures allows effective and long-lasting correction of lumbar lordosis and thoracic kyphosis, and obtaining a balanced spine in the sagittal plane. Our functional results are close to normal, with low morbidity and a low complication rate.