Treatment of complete fracture-dislocation of thoracolumbar spine

A retrospective study.

We present our surgical experience with 11 patients who had complete fracture-dislocation of thoracolumbar spine.

Complete fracture-dislocation of thoracolumbar spine is one of the most severe spine traumas and usually results in neurological dysfunction with spine deformity. Treatment of such cases is rarely described in the literature.

We treated 11 patients with complete fracture-dislocation of the thoracolumbar spine surgically using a posterior approach. Reduction and stabilization was achieved by means of pedicle screws with rods at the help of intraoperative traction. Dura tear was repaired by autologous fat graft. Armpit-pelvic traction was applied to the patient who could not receive operation in time.

Deformity correction was completely achieved in all the fracture-dislocations that were subjected to surgery within 3 weeks and was partly achieved in those subjected to surgery after 3 weeks. Cerebrospinal fluid leak were controlled well in 7 patients. Armpit-pelvic traction could partly ameliorate spine column shortening. Two patients with incomplete neurological deficit got their neurological function improved after surgery.

Although difficult, satisfactory reduction of complete lumbar fracture-dislocation can be achieved through pedicle instrumentation. Intraoperative traction is necessary for the reduction procedure. Preoperative duration should be not >3 weeks. For the patient who cannot receive spine surgery in a few days after injury, preoperative traction should be applied. Covering dura sac by autologous fat graft is recommended for all the patients.