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Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 92

Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 92. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | Thoracolumbar Spinal Injuries Chapter 31 909 of the disappointing results they cannot recommend the additional transpedicular cancellous bone grafting as an interbody fusion technique after posterior stabilization in cases of complete or incomplete burst injury to the vertebral body. Similarly Alanay et al. 1 concluded that short-segment transpedicular instrumentation of thoracolumbar burst fractures is associated with a high rate of failure that cannot be decreased by additional transpedicular intracorporeal grafting. Posterior Reduction and Multisegmental Stabilization Multilevel stabilization is indicated for the very unstable thoracolumbar luxation fractures Type C lesions which usually cannot be accurately reduced and stabilized with a short two-level construct. Usually fixation of two to three segments above and below the injury is recommended for a stable fixation. Unstable fractures of the thoracic spine that need to be stabilized are often combined with a significant thorax trauma or a polytrauma. In these patients an early posterior stabilization with additional bone grafting allows for 1 a stable fixation of the spine with restoration of the dorsal tension band function 2 the possibility of early and orthosis-free mobilization in the intensive care unit or later in a center of rehabilitation and finally 3 bony fusion. Fracture dislocations usually require multilevel spinal stabilization Anterior Approach From the biomechanical point of view it is obvious that the damaged spine has to be treated according to the injury mechanism and the site of injury. In a flexion injury e.g. Chance fracture with fracture of the pedicles and the vertebral body stabilization can be performed by a dorsal approach and restores the tension band function until bony healing has occurred. Similarly the biomechanics of the anterior column has to be considered in the case of a burst fracture. About 80 of the axial load of an intact spine is supported by the anterior column. When