Dorso-lumbar spine fractures: recumbent vs. operative treatment

Internal fixation of fractures of the dorsal-lumbar spine with early ambulation is evaluated in this study of 100 patients with 106 fractures: 34 being treated by recumbency, 13 with Meurig-Williams plates, and 59 with Harrington rods. Fracture reduction in the recumbent group was 14 per cent unsatisfactory, 82 percent satisfactory, and only one case anatomical. Following plating, 38 per cent were unsatisfactory and 61 per cent satisfactory. Harrington rod reduction and internal fixation resulted in 67 per cent anatomical, 31 per cent satisfactory, and 2 per cent unsatisfactory. neurologic improvement in partial lesions was 53 per cent with Harrington rods and 44 per cent with recumbent treatment. For paraplegic patients the time required for wheelchair ambulation was reduced from 10.5 weeks with recumbent treatment to 5.3 weeks with Harrington instrumentation. Ambulatory candidate rehabilitation time was decreased from 7.1 weeks to 2.5 weeks. Complications were reduced from 18 per cent in the recumbent group to 7 per cent in the Harrington rod group. By using the three above-three below, rod long-fuse short approach rather than the two above-two below with fusion over the length of the rods technique, the number of anatomical reductions was increased from 70 per cent to 82 per cent and the length of the fusion decreased from 4.8 levels to 1.4 levels.