[Analysis of safety and effect of the technique of reconstructing anterior and middle columns by single posterior approach].

Abstract

To explore the safety and effect of the technique of reconstructing anterior and middle column by posterior approach in treatment of lumbar burst fractures.
From July 2005 to January 2007, 22 patients of lumbar burst fractures (18 males and 4 females, the age was from 28- to 57-years-old with an average of 42.7 years) were treated as the following surgical procedures: based on the routinal posterior approach, one of the transverse process of the injured vertebral was incised to get access to the lateral side of the injured vertebral body. After cleaning of all the displaced fracture fragments and decompressing the spinal canal, the titanium mesh packed with autografts were implanted from lateral side to reconstruct the anterior and middle column. The above and below adjacent vertebral body were fixed by transpedicular screws. The operative time, intraoperative blood loss, vertebral height, degree of kyphotic deformity and comprised spinal canal were recorded.
The average operative time was 3.5 h (2.8-5.8 h) and the average blood loss was 820 ml (650-2100 ml). All the patients were followed up with an average 17.2 months (from 12 to 28 months). The height of the injured vertebral body were restored from (23.70 +/- 9.31)% preoperative to (95.77 +/- 1.93 )% postoperative (P<0.05). The natural spinal curvatures and spinal canal were restored. Three cases were involved in transient iatrogenic nerve root injury. And 1 case was involved in the loosening of the connected rod of the pedicle screw system at 3 months after operation.
The technique of implanting the titanium mesh by posterior approach was effective and safe enough to reconstruct the anterior and middle column in treating lumbar burst fracture. With this technique, good results could be achieved.