The operative management of thoracic and lumbar spine injuries

One hundred and three consecutive patients, 67 (65.0%) males and 36 (35.0%) females with a mean age of 41.2 years (range 15-84 years), operated upon for thoracic and lumbar spine injuries at the neurosurgical department of the University of Ulm in Gtinzburg between January 1990 and December 1994 inclusive, were studied to evaluate the efficacy and outcome of operative treatment. The follow-up period was between 8 and 36 months with a mean of 14.2 months. The most frequent cause of injury was road traffic accidents (31 patients; 30.0%), followed by domestic (27 patients; 26.2%) and industrial (18 patients; 17.6%) accidents, sporting activities (16 patients; 15.5%), suicidal attempts (7 patients; 6.8%) and pathological fractures (4 patients; 3.9%). The commonest site of injury was the thoracolumbar junction with 66.9 % of all injury levels. Nine patients (8.6%) had multiple level injuries being contiguous in 5 (4.9%) and non-contiguous in 4 (3.9%) of them. Magerl's type A injuries dominated (86.4%) over type B (5.8%) and type C (7.8%) injuries. Neurological deficits were found in 34 patients (33.0 %). Frankel grade B (1.0%) were the least, then grade A (7.8%), grade C (8.7%), grade D (15.5%) and grade E (67.0%). Intraoperative myelography was done in 34 patients (33.0%), MRI in 7 (6.8%), conventional tomography in 45 patients (43.7%) in addition to plain X-rays and CT- scans that were done routinely in all patients. Deformities were seen in 86 patients (84.5%), the kyphotic predominating (80.6%) over the scoliotic type (3.9%). Translational displacement was seen in 8 patients (7.8%). A kyphotic angle greater than 5° was found in 72 patients (69.9%). Eighty four patients (81.6%) had spinal canal narrowing, posteriorly displaced fracture fragments being the commonest cause. Ten patients (9.7%) were operated within the first 24 hours from their injury while another 9 (8.7% patients were operated within the next 24 hours (between 24 and 48 hours). Only angle stable transpedicular screw-rod fixator systems were used, the Kluger ( Leverkusen-Germany ) transpedicular screw system and the Dick ( Umkirch-Germany )„fixateur inteme“ being used in 61 (59.2%) and 37 patients (35.9%) respectively.