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Indirect long segment stabilisation by posterior approach for unstable burst compression fractures of thoracolumbar spine in adults

Author: 
Dr. Mehamil Abdul Najeeb Jameela, K.V., Dr. Sathish Balaji, E., Prof. Dr. Vijayanarasimman and Dr. Lionel john
Subject Area: 
Health Sciences
Abstract: 

Thoracolumbar spine fractures are common injuries that can result in significant disability, deformity and neurological deficit. Controversies exist regarding the appropriate radiological investigations, the indications for surgical management and the timing, approach and type of surgery. This study provides an overview of the epidemiology, biomechanical principles, radiological and clinical evaluation, classification and management principles for burst fractures in thoracolumbar spine operated by posterior approach. Biomechanically the thoracolumbar spine is predisposed to a higher incidence of spinal injuries. Computed tomography provides adequate bony detail for assessing spinal stability while magnetic resonance imaging shows injuries to soft tissues (posterior ligamentous complex [PLC]) and neurological structures. Different classification systems exist and the most recent is the AO spine knowledge forum classification of thoracolumbar trauma. Treatment includes both nonoperative and operative methods and selected based on the degree of bony injury, neurological involvement, presence of associated injuries and the integrity of the PLC. Significant advances in imaging have helped in the better understanding of thoracolumbar fractures, including information on canal morphology and injury to soft tissue structures. The ideal classification that is simple, comprehensive and guides management is still elusive. Involvement of three columns, progressive neurological deficit, significant kyphosis and canal compromise with neurological deficit are accepted indications for surgical stabilization through anterior, posterior or combined approaches.

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