Management of traumatic thoracolumbar fractures. Case series

Abstract

Background: The thoracolumbar spine fractures are among the most severe injuries of the human skeleton, especially in younger patients, where they are often related to high energy trauma such as traffic accidents or falls from a great height. The objective of the study is to review our management of traumatic thoracolumbar fractures in young patients.
Materials and methods: A cases series study was performed, including review of medical records of 28 patients treated from 2008 to 2013, ranked by Magerl-AO, Load-Sharing, TLICS, conservative and surgical treatment, monitoring and radiological functional according to the scale of the SF-36.
Results: 12 men, 16 women, median follow-up of 3.1 years, mean age of 36.8 years. According Magerl-AO: A1 6 types, 12 types A3, 2 types A4, 4 types 4 types B2 and C2. According LoadSharing: 9 score greater than 6. According TLICS: 6 with less than 4 rating and 10 with the highest score to 5. Radiographically: preoperative kyphosis of 12.3º and 16.7º and the last control 9.7 and 5º for conservative and surgical respectively. The average preoperative wedging was 30.9%, the ultimate control of 6.6 and 6% respectively conservative and surgical. Conservative treatment in 6 patients and surgical in 22 patients, five short fixation without fusion and 17 long fixation with fusion. According to the SF-36, the average was 73 points for conservative management and surgical treatment 60.1.
Discussion: According Load-Sharing Burst fractures, surgical treatment with short instrumentation ithout fusion is an effective method to achieve the desired sagittal alignment stability and preserving the function of the segments. In unstable fractures while the long osterior instrumentation provides good results sacrifice function of adjacent segments that could be preserved with combined anterior and posterior instrumentation.
Evidence level: IV.