Veraltete thorakolumbale Frakturen mit Gibbusbildung

Summary

Indications

Remote thoracolumbar gibbosity with painful functional disturbances.

Contraindications

Severe osteoporosis.

Poor general health.

Positioning and Anaesthesia

Initially prone, using a supporting frame, followed by right lateral decubitus.

General anaesthesia.

Surgical Technique

Straightening of gibbosity in one sitting using a posterior and an anterior incision. After resection of the involved vertebrae and the neighbouring intervertebral discs wedge-shaped interlaminar resection of the respective neural arches, transection of the partes interarticulares, correction of the malposition with a bone spreader, and posterior fixation with pedicle screws and rods. Completion of surgery by anterior autogenous fibula graft.

Postoperative Management

Two-hourly control of motoricity and sensitivity.

Prevention of intestinal atony and urinary retention by i. v. administration of Prostigmin.

Removal of urinary catheter after 2 days.

Initially daily chest radiographs.

Patient allowed out of bed after removal of the thorax drain within the first week, and without a brace.

No routine implant removal.

Possible Complications

Injury of lung, intestine, ureter, major vessels, lumbar plexus, dura and sympathetic trunk.

Haemo-or/and chylothorax.

Infection.

Results

Twelve patients were operated between 1990 and 1995. In 4 patients a rigid rodscrew system was used which led to 2 fatigue fractures of the implant. Despite this bony consolidation was achieved in all patients. 6 patients were symptomfree and 4 were markedly improved, increase of symptoms in 1 patient who suffered the initial fracture during a suicide attempt.

Mean duration of surgery: 4 1/2 h.

Complications: 1 severe blood loss (3600 ml): 1 haemothorax requiring aspiration, 2 implant fractures, 1 transient loss of sensitivity in the distribution of the fibularis nerve, and 1 dura leak.

Implant removal was performed 4 times.