[Transpedicular stabilization in fractures of the thoracolumbar spine. II]

Proceeding from the literature survey and on the basis of his own experience the author presents a current concept review of the problems of the transpedicular stabilization in fractures of the thoracolumbar spine. Individual chapters are devoted to the biomechanics and transpedicular screw placement, classification of implants and to the transpedicular operations on the injured vertebral body. Based on both his own experience and survey of the literature the author recommends the following: in order to increase the stability of osteosynthesis to place transpedicular screw in anteromedial direction (Magerl approach) close to the anterior cortex of the vertebral body or (in case of osteoporosis) to perforate it by tip of the screw. in fractures with the compression of vertebral body (mainly in case of burst fractures) to perform transpedicular reduction and cancellous bone grafting after Daniaux and Dick. Out of the implants so far used the author considers the best Fixateur interne (Dick) allowing facultless reduction as well as a longterm stabilization of the fracture.