Fractures and fractures-dislocations of the lumbar spine. A retrospective study of 70 patients

A retrospective study was undertaken to analyse and compare the results of Harrington instrumentation with postural reduction and nursing in patients with fractures and fracture-dislocations of the lumbar spine. Thirty patients were treated by postural reduction and nursing, and 38 underwent early surgical reduction and internal fixation with Harrington instrumentation, together with a posterior fusion in three patients and an anterior fusion at the level of the fracture in another two patients. External splintage was used in only one patient in the series. At an average follow up of 5.9 years, bony deformity quantified by angulation, displacement and the vertebral wedge index was greater in the conservative group than in the group treated surgically. No significant difference was observed in comparing the rates of neurological recovery in the two groups. At follow up, patients with no symptoms had less severe bony deformity. Loss of fixation of Harrington instrumentation occurred in 46% of patients treated by this method. The incidence of other complications was not significantly different in the two groups. Despite the unacceptably high rate of local complications, Harrington instrumentation achieved better correction of bony deformity than postural reduction and nursing, prevented progression of deformity and decreased the incidence of symptoms at follow up. This study indicates that in these injuries bony deformity can be satisfactorily corrected by early Harrington instrumentation alone, without spinal fusion and bracing, provided an exacting surgical technique is employed.