RESUMEN
This article presents an evaluation of fluoroscopy for indirect, posterior reduction and fixation of thoracolumbar burst fractures. A prospective study of 25 patients with thoracolumbar burst fractures who underwent C-arm machine-guided posterior indirect reduction and short segment fixation without fusion is described. No laminotomies were performed. All patients had a mean follow-up of 30.4 months. At postoperative review, the average anterior and posterior vertebral heights were corrected from 57.9% to 99.0% and 89.0% to 99.5%, respectively. The Cobb angle was corrected from 18.4 degrees to 0.17 degrees . The canal compromise ratio was improved from 35.2% to 8.6%. In all 25 cases, neurological status was intact at last follow-up. Fluoroscopy guidance is an effective method to accomplish indirect reduction and fixation. Reduction was confirmed on lateral fluoroscopic views by looking for a "one-line sign," which is the reconstitution of the posterior border of the vertebral body.
Asunto(s)
Fluoroscopía/métodos , Fijación Interna de Fracturas/métodos , Fracturas por Compresión/cirugía , Vértebras Lumbares/cirugía , Fracturas de la Columna Vertebral/cirugía , Fusión Vertebral/métodos , Vértebras Torácicas/cirugía , Adulto , Anciano , Tornillos Óseos , Femenino , Fijación Interna de Fracturas/instrumentación , Fracturas por Compresión/diagnóstico por imagen , Humanos , Vértebras Lumbares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Prospectivos , Fracturas de la Columna Vertebral/diagnóstico por imagen , Vértebras Torácicas/diagnóstico por imagen , Resultado del Tratamiento , Adulto JovenRESUMEN
STUDY DESIGN: Simulated translation of the C5 vertebra was performed in 20 embalmed cadaveric cervical spines, and cross-sectional areas of the C4-C5 and C5-C6 intervertebral foramina were measured and compared before and after translation of the C5 vertebra. OBJECTIVE: To determine the relationship of cross-sectional intervertebral foraminal areas to the degrees of vertebral translation. SUMMARY OF BACKGROUND DATA: The common feature of clinical instability and adjacent diseases of the cervical spine is malalignment of the cervical spine (i.e., there is ventral and dorsal translation of vertebral body with respect to the adjacent upper and lower vertebral body, respectively). To our knowledge, no previous study has analyzed the quantitative effect of vertebral translation on the size of the intervertebral foramina. METHODS: The cross-sectional areas of the intervertebral foramina at C4-C5 and C5-C6 were measured on computerized tomography. The images were then transferred to the personal computer, where consecutive dorsal translations of C5 vertebrae with a 1-mm increment from 1 to 5-mm displacements were performed using Microsoft paint software (Microsoft, Corp., Redmond, WA). National Institutes of Health (Bethesda, MD) Image J software (V1.33m) was then used to measure the areas of both sides of C4-C5 and C4-C6 foramina at normal and each displacement level in the computer. RESULTS: Following dorsal translation of C5 vertebra, anterolisthesis of C4 relative to C5 and retrolisthesis of C5 relative to C6 was noted. No significant difference was found between the measured values using Aquarius Image software (Microsoft, Corp.) on computerized tomography and National Institutes of Health image J software on the desktop computer (P > 0.05). When compared with normal values, there was an increase in the C4-C5 intervertebral foraminal area (i.e., 6%, 14%, 18%, 21%, and 26% with anterolisthesis of C4 relative to C5 following 1, 2, 3, 4, and 5-mm dorsal translation of the C5 vertebra, respectively). There was a 12% decrease in the C5-C6 intervertebral foraminal area, with each 1-mm incremental retrolisthesis of C5 relative to C6 vertebra. Statistically significant differences were found among residual cross-sectional foraminal areas following different degrees of dorsal translation (P < 0.05). CONCLUSION: There is a significant increase in size with anterolisthesis and decrease in size with retrolisthesis of upper and lower adjacent vertebral intervertebral foramina, respectively.