Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
권호 표지
DOI QR코드

DOI QR Code

Three-column reconstruction through the posterior approach alone for the treatment of a severe lumbar burst fracture in Korea: a case report

  • Woo Seok Kim (Department of Traumatology, Gachon University Gil Medical Center) ;
  • Tae Seok Jeong (Department of Traumatology, Gachon University Gil Medical Center) ;
  • Woo Kyung Kim (Department of Traumatology, Gachon University Gil Medical Center)
  • Received : 2022.11.24
  • Accepted : 2023.03.06
  • Published : 2023.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Generally, patients with severe burst fractures, instability, or neurological deficits require surgical treatment. In most cases, circumferential reconstruction is performed. Surgical methods for three-column reconstruction include anterior, lateral, and posterior approaches. In cases involving an anterior or lateral approach, collaboration with general or thoracic surgeons may be necessary because the adjacent anatomical structures are unfamiliar to spinal surgeons. Risks include vascular or lumbar plexus injuries and cage displacement, and in most cases, additional posterior fusion surgery is required. However, the posterior approach is the most common and anatomically familiar approach for surgeons performing spinal surgery. We present a case in which three-column reconstruction was performed using only the posterior approach to treat a patient with a severe lumbar burst fracture.

Keywords

References

  1. Dai LY, Jiang LS, Jiang SD. Anterior-only stabilization using plating with bone structural autograft versus titanium mesh cages for two- or three-column thoracolumbar burst fractures: a prospective randomized study. Spine (Phila Pa 1976) 2009;34:1429-35. https://doi.org/10.1097/BRS.0b013e3181a4e667
  2. Wood KB, Li W, Lebl DR, Ploumis A. Management of thoracolumbar spine fractures. Spine J 2014;14:145-64. https://doi.org/10.1016/j.spinee.2012.10.041
  3. Adkins DE, Sandhu FA, Voyadzis JM. Minimally invasive lateral approach to the thoracolumbar junction for corpectomy. J Clin Neurosci 2013;20:1289-94. https://doi.org/10.1016/j.jocn.2012.09.051
  4. Heary RF, Kumar S. Decision-making in burst fractures of the thoracolumbar and lumbar spine. Indian J Orthop 2007;41:268-76. https://doi.org/10.4103/0019-5413.36986
  5. McDonough PW, Davis R, Tribus C, Zdeblick TA. The management of acute thoracolumbar burst fractures with anterior corpectomy and Z-plate fixation. Spine (Phila Pa 1976) 2004;29:1901-9. https://doi.org/10.1097/01.brs.0000137059.03557.1d
  6. Heary RF, Kheterpal A, Mammis A, Kumar S. Stackable carbon fiber cages for thoracolumbar interbody fusion after corpectomy: long-term outcome analysis. Neurosurgery 2011;68:810-9. https://doi.org/10.1227/NEU.0b013e3182077a9f
  7. Schnake KJ, Stavridis SI, Krampe S, Kandziora F. Additional anterior plating enhances fusion in anteroposteriorly stabilized thoracolumbar fractures. Injury 2014;45:792-8. https://doi.org/10.1016/j.injury.2013.11.011
  8. Ayberk G, Ozveren MF, Altundal N, et al. Three column stabilization through posterior approach alone: transpedicular placement of distractable cage with transpedicular screw fixation. Neurol Med Chir (Tokyo) 2008;48:8-14. https://doi.org/10.2176/nmc.48.8
  9. Brau SA, Delamarter RB, Schiffman ML, Williams LA, Watkins RG. Vascular injury during anterior lumbar surgery. Spine J 2004;4:409-12. https://doi.org/10.1016/j.spinee.2003.12.003
  10. Fantini GA, Pappou IP, Girardi FP, Sandhu HS, Cammisa FP Jr. Major vascular injury during anterior lumbar spinal surgery: incidence, risk factors, and management. Spine (Phila Pa 1976) 2007;32:2751-8. https://doi.org/10.1097/BRS.0b013e31815a996e
  11. Talia AJ, Wong ML, Lau HC, Kaye AH. Comparison of the different surgical approaches for lumbar interbody fusion. J Clin Neurosci 2015;22:243-51. https://doi.org/10.1016/j.jocn.2014.08.008
  12. Alluri R, Mok JK, Vaishnav A, et al. Intraoperative neuro-monitoring during lateral lumbar interbody fusion. Neurospine 2021;18:430-6. https://doi.org/10.14245/ns.2142440.220
  13. Metcalfe S, Gbejuade H, Patel NR. The posterior transpedicular approach for circumferential decompression and instrumented stabilization with titanium cage vertebrectomy reconstruction for spinal tumors: consecutive case series of 50 patients. Spine (Phila Pa 1976) 2012;37:1375-83. https://doi.org/10.1097/BRS.0b013e318250a172
  14. Peters T, Chinthakunta SR, Hussain M, Khalil S. Pedicle screw configuration for thoracolumbar burst fracture treatment: short versus long posterior fixation constructs with and without anterior column augmentation. Asian Spine J 2014;8:35-43. https://doi.org/10.4184/asj.2014.8.1.35