[Anterolateral instrumentation and vertebral body replacement for thoracolumbar segment fractures].

INTRODUCTION

Acute traumatic lesions of the thoracolumbar segment and spinal cord are a serious cause of disability and death. The diagnosis may be delayed and non-standardized or inappropriate with the resulting increase in problems; one of the great treatment advances has been the anterior and anterolateral surgical approach.

OBJECTIVE

Perform a clinical-radiological assessment of patients with a diagnosis of thoracolumbar segment fracture who underwent anterolateral instrumentation and vertebral body replacement with a cage and graft, and compare their pre- and postoperative status.

MATERIAL AND

METHODS

An observational, longitudinal, cross-sectional, retrospective, descriptive, open study was conducted of four patients enrolled between July and December 2001; all of them had a diagnosis of thoracolumbar segment fracture and underwent decompression treatment, vertebral body replacement and anterolateral instrumentation; they all presented at the Emergency Service.

RESULTS

The patients were seen in the outpatient service at postoperative month 2. An important improvement was observed in the two patients over 60 years of age (63 and 69 years old), who went from preoperative ASIA "D" to postoperative ASIA "E", muscle strength was 4/5, and they had independent gait without claudication. Since their bone healing was appropriate, the Jewett constructs were removed at 4 months. Thoracolumbar segment lesions are common in patients of productive ages and a delayed diagnosis and stabilization with internal fixation further compromise the spinal canal. Our study shows that more patients may benefit from an appropriate surgical management as well as from a multidisciplinary team approach.