Abstract:
INTRODUCTION:Surgical treatment for thoracolumbar union instability represents a challenge, due to the difficult access to this area of the spine, and to the extreme variability of morphological and biomechanical lesions observed. AIM:To describe the indications and clinical and neuroradiological results obtained with procedures of anterior or combined spinal fusion-instrumentation used for the treatment of instable thoracolumbar lesions. PATIENTS AND METHODS:17 patients with thoracolumbar instability were treated surgically, being followed-up at least for one year. Causes of instability were classified in three groups: (i) fractures or fracture-luxations (n = 7), (ii) pathologic fractures following tumoral invasion (n = 6) and (iii) infectious or degenerative spondylodiscitis (n = 5). In order to carry out the substitution of the injured vertebral body an anterior approach to the thoracolumbar union was performed in all cases, using a modified technique of thoracophrenolaparotomy in which the diaphragmatic dome was not incised. Depending on the number of columns of Denis damaged, the vertebral corpectomy was followed by either an anterolateral or a combined spinal fusion-instrumentation. RESULTS:Pain in standing position was eliminated postoperatively in 83%. Neurological deficits were improved in 50% of cases. Surgical mortality was null and transient postoperative complications occurred in 11.7% of patients, but no lung atelectasis or respiratory infections were observed. CONCLUSIONS:Chronic pain associated to thoracolumbar instability can be treated successfully by substitution of the damaged vertebral body followed by anterior or combined spinal fusion-instrumentation. Thoracophrenolaparotomy without division of the diaphragm is feasible and it reduces the morbidity associated to postoperative respiratory complications.
journal_name
Rev Neuroljournal_title
Revista de neurologiaauthors
Pascual-Garvi JM,García-Navarrete E,Ruiz-Grande F,Duarte J,Martínez-Chacón JL,Meilán-Paz ML,Castrillo-Cazón C,Fernández-Fresno L,Manzanares-Soler R,Sola RGsubject
Has Abstractpub_date
2005-01-01 00:00:00pages
3-18issue
1eissn
0210-0010issn
1576-6578pii
rn2004430journal_volume
40pub_type
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