Surgical timing prevails as the main factor over morphologic characteristics in the reduction by ligamentotaxis of thoracolumbar burst fractures

Author:

Cirillo Juan Ignacio1,Farias Ignacio2,Pino Cristóbal del1,Gimbernat Marcos1,Urzúa Alejandro1,Tapia Carlos1,Zamorano Juan José1

Affiliation:

1. Hospital del Trabajador

2. Hospital San José

Abstract

Abstract Background thoracolumbar burst fractures are associated with spinal canal occupation. The indirect decompression of the spinal canal and reduction of the fragment can be achieved with the distraction of the middle column and ligamentotaxis. Nevertheless, the factors that influence the effectiveness of this procedure and its temporality are controversial. Methods The aim of this observational, cross-sectional study was to evaluate the effectiveness of indirect reduction by ligamentotaxis in thoracolumbar burst fractures according to the fracture's radiologic characteristics and the procedure's temporality. Patients diagnosed with a thoracolumbar burst fracture between 2010 and 2021 were submitted to indirect reduction by distraction and ligamentotaxis. A retrospective analysis of radiologic characteristics and temporality of the procedure was performed with an independent sample t-test or Pearson's correlation coefficient, as required. Results A total of 58 patients were included in the analysis. Postoperatively, ligamentotaxis significantly improved all radiologic parameters (canal occupation, endplates distance, and vertebra height). Still, none of the radiological characteristics of the fracture (width, height, position, sagittal angle) were associated with the postoperative change in canal occupation. The endplates distance and the temporality of ligamentotaxis significantly predicted the reduction of the fracture. Conclusion Fragment reduction effectiveness is more significant when performed as early as possible and adequate distraction is achieved using the internal fixator system. The radiologic characteristics of the fractured fragment do not determine its reduction capacity.

Publisher

Research Square Platform LLC

Reference11 articles.

1. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries;Denis F;Spine (Phila Pa 1976),1983

2. Indirect spinal canal decompression in patients with thoracolumbar burst fractures treated by posterior distraction rods;Crutcher JP;J Spinal Disord,1991

3. Biomechanics of indirect reduction of bone retropulsed into the spinal canal in vertebral fracture;Harrington RM;Spine (Phila Pa 1976),1993

4. Ligamentotaxis with an internal spinal fixator for thoracolumbar fractures;Kuner EH;J Bone Joint Surg Br,1994

5. Indirect spinal canal decompression in burst fractures treated with pedicle screw instrumentation;Sjostrom L;Spine (Phila Pa 1976),1996

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