Posterior stabilization of thoracic, lumbar, and sacral injuries

While new spine-stabilizing devices are beginning to appear as alternative methods of providing operative spine stability, a careful review of those methods used by the Spine Injury Service at Northwestern University was undertaken. The method of stabilization most frequently used was the Harrington distraction rod device. With the coming of the Luque rod "segmental instrumentation" technique, improved spine stability was attained, although the attributes of the Harrington distraction system could not be substituted by the Luque system. A natural spin-off was the combination of the Harrington and the Luque methods of internal fixation. This has been a significant addition to the spine surgeon's surgical armamentarium. Still there are problems of implant stability, for which the Jacobs AO rods were developed, and the need for better correction of the spine's malposition following fracture (Edwards system). Because of the concern for the placement of sublaminar wires beneath the lamina, particularly in the area of the very narrow thoracic neural canal, the "Wisconsin" system of spinous process wires was developed. The discussion in this chapter is limited to the statistical data gathered from the management of 646 fracture-dislocations of the spine, of which 374 were surgically managed. As noted in Table 39-3, there are hazards to the instrumentation of the thoracic, lumbar, and sacral spine. In this surgical group, neurologic deterioration occurred in 2.39%; however, there was evidence of significant "risk-benefit" in surgery, with 15.22% of surgical patients demonstrating neurologic improvement after surgery of at least one Frankel grade. When compared with those patients managed conservatively, 6.57% demonstrated neurologic improvement, whereas only 0.34% demonstrated neurologic deterioration.