Posterior transpedicular decompression for thoracolumbar burst fractures

To demonstrate the feasibility of spinal canal decompression through the posterior transpedicular approach in patients with thoracolumbar burst fractures.

We present 25 consecutive patients (19 men and 6 women; mean age 36 years; age range, 24-48 years) with incomplete neurological deficits (ASIA B and C) resulting from thoracolumbar burst fractures treated by posterior transpedicular spinal canal decompression and posterior segmental instrumented fusion. Canal compromise at presentation was 51.7 +/- 11.2%.

The mean surgical time was 122 minutes (range, 108-122 minutes), and the mean blood loss was 528 +/- 123 ml. Canal compromise improved to 15.3 +/- 7.8%. At a mean followup of 14 months (range, 6-18 months), fourteen patients improved to ASIA D and were able to walk with an orthosis; seven improved to ASIA C, and four had no improvement (ASIA B). Seven ASIA B and all ASIA C patients had immediate postoperative neurological improvement to ASIA C and ASIA D; two ASIA B patients improved to ASIA C within six weeks after the operation. Anterior decompression was necessary in two (8%) ASIA B patients who did not improve after the initial operation; these patients, subsequently improved to ASIA C. There were no intraoperative complications. Superficial wound infections occurred in two patients and were treated with wound care and antibiotics; deep infection occurred in one patient and was treated with debridement and antibiotics.

Posterior transpedicular spinal canal decompression and instrumentation is a reasonable alternative technique to anterior decompression procedures and circumferential fusion, providing for satisfactory canal decompression and neurological improvement.