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The effect of surgery and remodelling on spinal canal measurements after thoracolumbar burst fractures.

Journal article
Authors Per Wessberg
Youxing Wang
Lars Irstam
Anders Nordwall
Published in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
Volume 10
Issue 1
Pages 55-63
ISSN 0940-6719
Publication year 2001
Published at Institute of Surgical Sciences, Department of Orthopaedics
Institute of Selected Clinical Sciences, Department of Radiology
Pages 55-63
Language en
Links www.ncbi.nlm.nih.gov/entrez/query.f...
Keywords Follow-Up Studies, Humans, Internal Fixators, Lumbar Vertebrae, injuries, Spinal Canal, diagnostic imaging, pathology, Spinal Fractures, complications, surgery, Spinal Stenosis, diagnostic imaging, etiology, pathology, Thoracic Vertebrae, injuries, Time Factors, Tomography, X-Ray Computed
Subject categories Neurosurgery, Orthopaedics, Orthopedics, Radiology

Abstract

Bone fragments in the spinal canal after thoracolumbar spine injuries causing spinal canal narrowing is a frequent phenomenon. Efforts to remove such fragments are often considered. The purpose of the present study was to evaluate the effects of surgery on spinal canal dimensions, as well as the subsequent effect of natural remodelling, previously described by other authors. A base material of 157 patients operated consecutively for unstable thoracolumbar spine fractures at Sahlgrenska University Hospital in Gothenburg during the years 1980-1988 were evaluated, with a minimum of 5-years follow-up. Of these, 115 had suffered burst fractures. Usually the Harrington distraction rod system was employed. Patients underwent computed tomography (CT) preoperatively, postoperatively and at follow-up. From digitized CT scans, cross-sectional area (CSA) and mid-sagittal diameter (MSD) of the spinal canal at the level of injury were determined. The results showed that the preoperative CSA of the spinal canal was reduced to 1.4 cm2 or 49% of normal, after injury. Postoperatively it was widened to 2.0 cm2 or 72% of normal. At the time of follow-up, the CSA had improved further, to 2.6 cm2 or 87%. The extent of widening by surgery depended on the extent of initial narrowing, but not on fragment removal. Remodelling was dependent on the amount of bone left after surgery. The study shows that canal enlargement during surgery is caused by indirect effects when the spine is distracted and put into lordosis. Remodelling will occur if there is residual narrowing. Acute intervention into the spinal canal, as well as subsequent surgery because of residual bone, should be avoided.

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