Cotrel-Dubousset instrumentation and thoracolumbar spine trauma: a review of 55 cases

A series of 55 patients treated with posterior Cotrel-Dubousset instrumentation and osteosynthesis for unstable thoracolumbar spine fractures were reviewed. Follow-up averaged 48.3 months. The fractures were all unstable, with 27 classified as fracture-dislocations (FD) and 28 classified as flexion compression injuries or unstable burst fractures (FC/B). The study population was composed of 29 men and 26 women with an average age of 31 (range 20-45) years. Mechanisms of injuries included 35 motor vehicle accidents, 19 falls, and one blunt trauma. No case worsened as a result of surgery, and 31% of the cases improved an average of 0.5 Frankel grade (range 0-2). Sixty percent of patients were braced with a custom molded thoracolumbosacral orthosis (TLSO) fitted after surgical stabilization. Minor complications occurred in 45% of the cases (urinary tract infection most common). There was a singular deep wound infection and another iliac crest donor site infection. There were no instrument failures or pseudarthroses. Radiographic analysis showed the following improvements in fracture angle, vertebral body compression, and fracture displacement. The pattern of radiographic improvement in the FD and FC/B subgroups showed significant improvement in each parameter when comparing preoperative to immediate postoperative values. Of importance, the radiographic findings comparing 1 month to the final follow-up showed little to no deterioration. Cotrel-Dubousset instrumentation proved to be a highly effective device for immediate restabilization of unstable thoracolumbar injuries.