Surgical Treatment in Thoracolumbar and Lumbar Burst Fractures - Report of 157 Cases

Between June 1982 and May 1989, 157 patients with thoracolumbar and lumber burst fractures were operated on at Chang Gung Memorial Hospital. Among them, 114 of 124 patients undergoing posterior surgery were Harrington-rod stabilization; 33 patients underwent anterior or combined anterior and posterior surgery. The indications for surgery were unstable burst fracture and / or with progressive neurologic deficit. The surgical approaches were either posterior only, posterior surgery followed by anterior surgery, or anterior surgery with or without posterior surgery. The indication for anterior surgery first is incomplete neurologic deficit with neural canal encroachment more than 50%. The indications of anterior surgery after the posterior surgery are canal size smaller than 1cm, free fragments within the canal or marked osseous defect of the vertebral body anteriorly. The average age of patients at the time of injury was 35.6 years (range 14 to 60 years). One hundred and twenty-eight patients have been followed for an average of 3 years (range one to 8.3 years). Sixty-two per cent of the injuries were the result of a fall from height. The most common site of injury was at L1(45%). By denis’ classification, type B fracture (90 patients) accounted for 71% of the injuries. Of the 42% of patients presenting with mixed conus medullaris and cauda equine lesions, 41% had complete recovery of bowel and bladder function at follow-up. Twenty-two percent of patients had pure cauda equiina lesions at initial jnjury, and 66% of them had return of sphincter function. The average kyphosis angle at preoperation, immediate postoperation and at follow-up were 20.55°±9.96°, 8.58°±8.99°and 11.25°±8.14°. Overall, 57% of the patients in the posterior surgery group and 82% in the anterior or combined anterior and posterior surgery group showed an average neurologic recovery of more than one grade on the Frankel scale. Sixty-six patients presented neurological functions at or less than Frankel c (the non-ambulatory group); 24 became independent walkers during the follow-up period.