Surgical treatment of Denis type B thoracolumbar burst fracture with neurological deficiency by paraspinal approach

We aimed to describe the surgical technique and clinical outcomes of paraspinal-approach reduction and fixation (PARF) in a group of patients with Denis type B thoracolumbar burst fracture (TLBF) with neurological deficiencies. A total of 62 patients with Denis B TLBF with neurological deficiencies were included in this study between January 2009 and December 2011. Clinical evaluations including the Frankel scale, pain visual analog scale (VAS) and radiological assessment (CT scans for fragment reduction and X-ray for the Cobb angle, adjacent superior and inferior intervertebral disc height, and vertebral canal diameter) were performed preoperatively and at 3 days, 6 months, and 1 and 2 years postoperatively. All patients underwent successful PARF, and were followed-up for at least 2 years. Average surgical time, blood loss and incision length were recorded. The sagittal vertebral canal diameter was significantly enlarged. The canal stenosis index was also improved. Kyphosis was corrected and remained at 8.6±1.4o (P>0.05) 1 year postoperatively. Adjacent disc heights remained constant. Average Frankel grades were significantly improved at the end of follow-up. All 62 patients were neurologically assessed. Pain scores decreased at 6 months postoperatively, compared to before surgery (P<0.05). PARF provided excellent reduction for traumatic segmental kyphosis, and resulted in significant spinal canal clearance, which restored and maintained the vertebral body height of patients with Denis B TLBF with neurological deficits.

本研究旨在描述椎旁入路复位固定术（paraspinal-approach reduction and fixation, PARF）治疗合并神经功能缺损的Denis B型胸腰椎爆裂骨折（thoracolumbar burst fracture, TLBF）患者的手术技术与临床结局。本研究纳入2009年1月至2011年12月期间收治的62例合并神经功能缺损的Denis B型TLBF患者。分别于术前、术后3天、6个月及1、2年开展临床评估与影像学检查：临床评估包括Frankel分级（Frankel scale）、疼痛视觉模拟评分（visual analog scale, VAS）；影像学检查则针对骨块复位情况行CT扫描，针对Cobb角、相邻上下椎间盘高度及椎管直径行X线检查。所有患者均成功接受PARF治疗，且随访时长至少2年。研究记录了患者的平均手术时长、失血量及切口长度。结果显示，患者矢状位椎管直径显著增大，椎管狭窄指数亦得到改善；后凸畸形得到矫正，术后1年时维持在8.6±1.4°（P>0.05）；邻近椎间盘高度保持稳定。随访期末患者的平均Frankel分级显著提升，全部62例患者均完成神经功能评估。与术前相比，术后6个月时患者的疼痛评分显著降低（P<0.05）。PARF可对创伤性节段性后凸畸形实现优异复位，可有效实现椎管减压，能够恢复并维持合并神经功能缺损的Denis B型TLBF患者的椎体高度。