INSTRUMENT-AIDED LIGAMENTOTAXIS AND FUSIONLESS STABILIZATION FOR BURST FRACTURES OF MID-LUMBAR SPINE

Abstract

Study design: A prospective study. Objectives: To assess effectiveness of instrument-aided ligamentotaxis and fusionless stabilization utilizing short contoured rod for mid-lumbar burst fractures, and the delayed mobilization on outcome. Summary of background data: A few reported instrument-aided ligamentotaxis with rod derotation and stabilization without fusion, and influence of delayed mobilization and bracing on fracture consolidation and outcomes. Material and Method: 30 patients (14 cases of L2, 10 cases of L3 and 6 cases of L4 fractures) were subjected to this study. Three vertebrae including fractured one (three point fixation) were stabilized with pedicle screws and rods. Fusion was not done. Patients were restricted to bed post-operatively for 2–4 weeks, and were braced for 10–14 weeks. Vertebral height, retropulsed fragment, sagittal curve, neurological status, unfused motion segments, residual pain, flexibility and fixation failure were assessed with a certain interval. Results: The average height at pre- and post-reduction at 0, 3 and 12 months were 43.2% (37.2–46.5%), 97.4% (87.2–100%), 95.3% (87.2–96.4%) and 95.2% (87.2–96.3%) of the normal height. The average intracanal displacement of retropulsed fragment at the same observation times were 43.2% (38.3–65.2%), 37.6% (34.7–40.5%), 36.3% (35.1–39.6%) and 17.7% (15.3–19.7%) of normal A-P diameter, and the average canal area occupancy at the same observation times were 53.7% (47.2–55.8%), 46.4% (43.8–49.3%), 46.0% (43.4–48.5%) and 31.2% (28.2–33.1%) of normal dimension. Consolidation began at 10 weeks and completed at 6 months on average. Kyphosis at pre- and post-reduction at zero and final stages were of 33°, 2° and 3°. Two paraparetics recovered fully. No screw and rod failures were reported. None developed residuals. Conclusion: Instrument-aided ligamentotaxis and stabilization are effective surgical procedures in reduction, maintenance of reduction and fracture consolidation. Delayed mobilization and bracing is thought additionally to be the contributing factors in maintaining reduction and consolidation.