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Clinical results of posterior stabilization without decompression for thoracolumbar burst fractures: is decompression necessary?

Neurosurgical Review volume 35, pages 447–455 (2012)Cite this article

Abstract

The purpose of this study is to investigate the clinical outcome of posterior stabilization without decompression for thoracolumbar burst fractures. Thirty-one consecutive cases of thoracolumbar fractures involving T11–L2 stabilized by a pedicle screw system were reviewed. Neither reduction of the height of a fractured body nor any decompression procedure was added during surgery. Twenty-two patients had incomplete paraplegia; one patient had complete paraplegia. Neurological recovery and remodeling of the spinal canal were evaluated. Neurological status was evaluated at the time of injury, just before and after surgery, and at final follow-up. The degree of spinal canal compromise was assessed using axial CT scan images. The duration of follow-up averaged 39.6 months. The mean spinal canal compromise at the time of injury was 41.6%, and no significant correlation was observed between the degree of canal compromise and the severity of the neurological deficit. Within 2–3 weeks, spinal canal remodeling had started in all patients whose spinal canal compromise was more than 30%, and canal compromise had decreased significantly 3–4 weeks after injury. Seventeen of 22 patients with incomplete paraplegia had already shown partial neurological recovery even before surgery. At the final follow-up, all patients with incomplete paraplegia had improved by at least one modified Frankel grade. This study suggests that the effect of decompressing thoracolumbar fractures with neurological deficits remains unclear and questions the need to operate simply to remove retropulsed bone fragments. Posterior stabilization without decompression should constitute appropriate surgical treatment for these fractures.

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Acknowledgements

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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  1. Department of Orthopaedic Surgery, Matsudo City Hospital, 4005 Kamihongo, Matsudo City, Chiba, 271-8511, Japan

    Tomohiro Miyashita, Hiromi Ataka & Takaaki Tanno

Authors
  1. Tomohiro Miyashita
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  2. Hiromi Ataka
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  3. Takaaki Tanno
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Correspondence to Takaaki Tanno.

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Comments

Meic H. Schmidt, William T. Couldwell, Salt Lake City, USA

In this article by Miyashita et al., the clinical results of posterior stabilization without decompression for thoracolumbar burst fractures are described. This is a clinical outcome studies of 31 consecutive patients with fractures from T11 through L2. All patients were stabilized with the pedicle screw systems. However, interestingly, there was no reduction performed, and not any decompression was added to the surgical procedure. Neurological status was evaluated at the time of injury, just before and after surgery, and at final follow-up. The follow-up averaged 39.6 months.

The paper demonstrates that there was no significant correlation between the degree of canal compromise and severity of neurological deficit. In addition, it showed that there was no significant correlation between recovery and the degree of spinal canal compromise at the time of injury. Interestingly, they also document that spinal column remodeling started as early as 2 to 3 weeks after injury. Although the literature has reports that spinal canal remodeling does take place over a year, we were surprised as to how early spinal canal remodeling can start. Also, patients with incomplete paraplegia frequently also showed improvement even before surgery and continued to improve even without decompression.

Clearly, this paper confirms many prior findings, including that the degree of spinal canal compromise does not necessarily correlate with neurological deficit and recovery. Thus, I think clearly in neurologically intact patients, spinal column decompression is likely unnecessary. Overall, in patients with incomplete motor deficits, I think that this study does not allow for conclusive evidence that decompression is not useful, but certainly questions the need. Currently, at our institution at the University of Utah, the majority of patients with incomplete neurological deficits with burst fractures will undergo spinal canal decompression. A prospective randomized study will be necessary in order to conclusively demonstrate whether spinal canal decompression will be useful for patients with incomplete neurological deficits.

Overall, this article is a nicely written clinical outcome study, which adds to the literature. I would encourage the group to design a prospective randomized study to confirm their findings.

This work was presented at the International Society for the Study of the Lumbar Spine 34th Annual Meeting, Hong Kong, China, June 14, 2007.

The device(s)/drug(s) are FDA-approved or approved by corresponding national agencies for this indication.

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Miyashita, T., Ataka, H. & Tanno, T. Clinical results of posterior stabilization without decompression for thoracolumbar burst fractures: is decompression necessary?. Neurosurg Rev 35, 447–455 (2012). https://doi.org/10.1007/s10143-011-0363-0

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  • DOI: https://doi.org/10.1007/s10143-011-0363-0

Keywords

  • Clinical result
  • Posterior stabilization
  • Thoracolumbar burst fracture
  • Decompression procedure