[Thoracolumbar injuries. Surgical treatment of patients with neurological damage]

This article presents the neurological outcome after surgery of a series of 54 patients with damage to the spinal cord and/or cauda equina caused by thoracolumbar injuries. The fractures, dislocations or fracture-dislocations were all reduced and stabilized by a Harrington distraction device or transpedicular fixation system (posterior segment fixator). Peroperative inspection revealed that correction and distraction alone may be inadequate to achieve intraspinal decompression. Additional anterior decompression by posterolateral approach was necessary in 31 patients (57%). In this series there was an unexpected high rate of dural rents. Tears were found in 11 patients (20%) and nerve roots (cauda equina) appeared to have herniated through the tear in eight. Significant improvement of the neurological deficits was obtained in 81%. The improvement rate was much better in patients with incomplete lesions than among those with complete lesions. We are convinced that surgery improves the neurological outcome if carried out at the proper time, after sufficient decompression of the spinal cord and nerve roots, and repair of dural rents.