Efficiency of Distraction and Ligamentotaxis in Posterior Spinal Instrumentation of Thoracolumbar Retropulsed Fractures

Abstract

AIM: To compare the efficiency of distraction and ligamentotaxis in posterior spinal instrumentation of thoracolumbar retropulsed fractures according to the grade of spinal canal compression and fracture levels. MATERIAL and METHODS: This study retrospectively reviewed 56 patients diagnosed with thoracolumbar fractures and significant fracture fragments retropulsed into the spinal canal who only underwent posterior instrumentation with distraction and ligamentotaxis, and compared groups according to the grade of spinal canal compression and fracture levels. The pre-and postoperative clinical outcomes were evaluated using Oswestry Disability Index and visual analog scale scores, and neuroimaging studies showed percentage of the spinal canal compression and fractured vertebral unit height. RESULTS: A total of 34 male (60.7%), and 22 female (39.3%) patients with a mean age of 46.25 years was enrolled in study. The percentage of spinal cord compression reduced significantly from 40.2% preoperatively to 26.8% postoperatively (+13.4%). The vertebral unit height increased significantly from 25.20 ± 3.2 mm to 31.85 ± 2.6 mm (+6.65 ± 2.7). The absolute spinal canal compression reduction was higher for grade II fractures (1/3 to 2/3 compression) (+13.3%) than for grade I fractures (up to 1/3) (+7.9%). Greater widening was observed at L1-L2 level (+16.2%) than at T11-T12 level (+10.2%). Statistically significant differences were found between the two groups according to the grade of canal compression and fracture levels in the mean pre-and postoperative spinal canal compression reduction. CONCLUSION: Indirect decompression techniques reduce retropulsed fragments, effectively improve the degree of spinal canal compression, and ensure safe laminectomy. The efficiency of distraction and ligamentotaxis after posterior spinal instrumentation correlated with the preoperative percentage of spinal canal compression and higher spinal canal area for fractures with a high preoperative stenosis.