Summary
Twenty-five cases of unstable fractures and fracture-dislocations of the spine are reviewed. They were treated at the Catholic Medical College and Centre in a 3-year period, 1975 to 1978.
1. Eleven of the 25 patients were treated by anterior interbody fusion performed at 6 to 8 weeks from injury or initial surgery.
2. Eleven patients had neurological deficits, 3 with incomplete lesions and 8 with complete lesions. Open reduction and decompression laminectomies were performed on patients having neurological deficits prior to anterior interbody fusion. Two patients with incomplete paraplegia showed marked neurological recovery whilst one with complete paraplegia regained some sensation.
3. Solid clinical fusion was obtained in all but one patient within four months of interbody fusion.
4. Amongst the 18 patients with kyphosis at the time of admission 10 had a final improvement of their kyphosis ranging from 3 to 10 degrees (average 6 degrees). Three had no change and 5 demonstrated a mild increase of kyphosis (average 4 degrees).
5. Pain was relieved in 21 patients out of 25.
The advantages of this technique include effective stabilization, prevention of late deformity and relatively early mobilization without internal fixation.
Résumé
Présentation de 25 cas de fractures instables et de fractures-luxation du rachis, traitées au «Catholic Medical College and Centre» durant une période de 3 ans, de 1975 à 1978.
1. Onze de ces 25 patients ont été traités par arthrodèse vertèbrale antérieure pratiquée 6 à 8 semaines après le traumatisme ou l'intervention chirurgicale initiale.
2. Onze malades présentaient des lésions neurologiques, 3 paraplégies incomplètes et 8 complètes. Ils ont subi une réduction à ciel ouvert et une laminectomie de décompression préalablement à l'arthrodèse antérieure. Deux malades avec une paraplégie incomplète présentèrent une récupération notable et un avec paraplégie complète retrouva une certaine sensibilité.
3. Une fusion cliniquement solide fut obtenue chez tous les opérés, sauf un, dans un délai de 4 mois après l'arthrodèse.
4. Parmi les 18 patients présentant une déformation en cyphose au moment de l'admission, 10 furent améliorés, leur cyphose ayant diminué de 3° à 6° (en moyenne de 6°). Trois sont restés inchangés et cinq aggravés (en moyenne de 4°).
5. Vingt-et-un malades sur 25 ont été soulagés de leurs douleurs.
Les avantages de cette technique sont les suivants: stabilisation efficace, prévention des déformations résiduelles et mobilisation relativement précoce sans ostéosynthèse.
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Moon, MS., Kim, I., Woo, YK. et al. Anterior interbody fusion in fractures and fracture-dislocations of the spine. International Orthopaedics 5, 143–149 (1981). https://doi.org/10.1007/BF00267845
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DOI: https://doi.org/10.1007/BF00267845