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Surgical Treatment of Unstable Thoracic Spine Injuries

Posted on: 05/29/2008
Severe injuries to the thoracic spine occur with some car accidents. These high-energy injuries cause significant trauma to the spine. Surgery is needed to restore the vertebrae to a stable position. A major goal of treatment is to foster as much neurologic recovery as possible. In some cases, preventing paralysis may not be possible.

It's not clear yet what kind of stabilization procedure is best for these traumatic spinal injuries. Rods placed alongside the spine have been used with disappointing results. Plates and screws along the posterior (back of the) vertebra give better correction.

In this study, screws were placed through the pedicles of the vertebrae. The pedicle is the area of the vertebra that is between the upper and lower spinal (facet) joints. Sometimes it is called the pars articularis.

The pedicle is stiffer than the vertebral body. It provides a place where the screws are less likely to pull out of the bone. Stainless steel screws were used because of their ability to resist fatigue failure while the bone graft healed. A large diameter screw 50 to 80 per cent the length of the vertebral body was selected.

Screws were placed in every pedicle on both sides of the vertebrae. The screws spanned from two to three segments above the area of injury to several segments below the lowest area of instability.

Using pedicle screws as anchors made it possible for the surgeon to distract, rotate, and place the broken and displaced vertebrae in proper alignment. Once the screws were in place, a rod to span the entire length of the surgical site helped unlock the overlapping facets.

The spinal deformity was reduced and maintained in 15 of the 18 patients treated with posterior-only pedicle screws. There were very few complications after the operation. This approach avoids doing an additional anterior or combined anterior/posterior fusion of the spine. Local bone graft is used to obtain a posterior-lateral fusion only.

Studies of the surgical treatment of serious, unstable thoracic spinal injuries are very limited. This study did not compare one technique to another. The authors just reported on this one method. Only short-term follow-up results are available.

So far, it looks like the use of posterior-only pedicle screws to stabilize the thoracic spine is a successful treatment option. Correction of the spine position and prevention of deformity was possible with this technique.

Samuel Abraham Joseph, Jr, MD, et al. The Successful Short-Term Treatment of Flexion-Distraction Injuries of the Thoracic Spine Using Posterior-Only Pedicle Screw Instrumentation. In Journal of Spinal Disorders & Techniques. May 2008. Vol. 21. No. 3. Pp. 192-198.

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