Abstract

Aims: Thoracolumbar fractures, especially when disintegration of the bony fragments occur, require surgery. However, no specific operative approach has so far been given precedence. We herewith propose a variant surgical procedure which may be indicated for the above purpose.

Methods: The suggested technique should be carried out in a single stage, by posterior approach only. Following the generation of an appropriate access and evacuation of the bone debris, a titanium mesh cage should be inserted, using an original manipulation, shown in the enclosed video and which will cause minimal or no damage to the neural elements.

Results: Fourteen patients were submitted to our variant operation, seven with Type A (according to the Aospine classification) fracture (three with two simultaneous fractures). Three suffered from C type fractures; Most patients presented with a preserved neurological status; Three were paraplegic on admission (Frankel grade A). The most marking benefits of this technique included optimal height restoration, immediate stability, and direct canal decompression. All patients except one improved in the postoperative period, by at least one grade on Frankel scale.

Conclusion: The proposed procedure variant fulfilled most of our expectations, to the benefit of the patients. In addition, the duration of the surgery was shorter than that of the A-P procedure. Our technique could be further extended to fractures above and below the T11-L2 segment, and also include patients with Frankel grade A lesions.