[Treatment of unstable thoracic and lumbar spinal fractures with Cotrel-Dubousset instruments]

The present study is a retrospective analysis of first experiences of fracture treatment with the Cotrel-Dubousset instrumentation technique. Thirty-five unstable spine fractures were treated with the CD implant at the University of Louisville--Level I Trauma Center--between June, 1985 and August, 1987. There were 17 burst fractures, 12 compression fractures and 2 fracture dislocations, 2 flexion distraction fractures and 2 flexion rotation injuries. Twenty patients underwent anterior cord decompression and strut grafting followed by posterior CD instrumentation and posterolateral fusion. Fifteen patients had posterior CD instrumentation and fusion alone. No neurological deterioration after the procedure was observed, 5 patients improved neurologically. In eleven cases bracing after the operation was unnecessary. Hospital stay varied between 6 and 35 days (mean 20 days). Follow-up ranged from 12 to 30 months, mean follow-up was 19 months. The loss of correction in the sagittal plane varied between 0 and 20 degrees (mean 5.6) at final follow-up. Complications due to the implant have not been observed except an avulsion of an upper thoracic hook, which did not effect the clinical or radiographic result. The high stability of the implant provides a decreased risk of neurological deterioration, posttraumatic kyphosis as well as early rehabilitation.