Curative Effect Of Posterior Limited Operation In The Treatment Of Thoracolumbar Burst Fractures With Severe Spinal Stenosis

Objective: To investigate the clinical efficacy assessments of newly limited procedure of posterior approach to fracture vertebral distraction reduction, unilateral laminectomy, bone graft and percutaneous pedicle screw internal fixation in treatment of thoracolumbar vertebral fracture with severe stenosis.Methods: Retrospective analysis of clinical records. During the 2014 January to 2015 January,23 patients with thoracolumbar fracture with severe stenosis, who were all cured by newly limited procedure of posterior approach to fracture vertebral distraction reduction, unilateral laminectomy, bone graft and percutaneous pedicle screw internal fixation. Operation time, amount of hemorrhage, amount of drainage were observed during the perioperative period. Radiological informations of fracture vertebral respectively in preoperative and one week after operation, one year after operation, and three months after operation of internal fixation removal have been compared. Compression ratio of the front edge of the injured vertebrae, Cobb angle, rate of spinal stenosis were measured and all the data for the statistical analysis. The score of VAS were kept respectively in preoperative and one week after operation, one year after operation, and three weeks after operation of internal fixation removal. Neurologic deficit evaluated by ASIA classification method of neural function assessment, in preoperative and final follow-up. All the indications facilitating to assessment of the procedure. The data were processed by SPSS18.0 software.Results: 23 cases with successfully operation and the 100% of incision healing.The average operative time were(193.60±16.51)min, the amount of intraoperative bleeding were(394.35±98.06)ml, amount of drainage were(111.30±24.18)ml,the Cobb angle from(17.22±1.55)°in preoperative sharply declined to(3.34±0.88)°,(3.78±1.04)°,(4.67±1.06)°, respectively in one week after operation, one year after operation, and three months after postoperative of internal fixation removal. The Cobb angle have a significantly improvement compared to those of preoparative(P<0.05).Compression ratio of the front edge of the injured vertebrae were :(50.60±7.02)%,which greatly ascend to(96.01±1.93)%,(95.78±1.86)%,(95.27± 1.83)%,respectively in one week after operation, one year after operation,and three months after operation of internal fixation removal.The data also have significantly meaning in statistics(P<0.05), rate of spinal stenosis were(67.52±9.48)% for preoperative,which greatly decline to(11.41±3.14)%,(11.25±3.09)% respectively in one week after operation, one year after operation.The score of VAS were(7.04±0.93) for preoperative.Those were(1.96±0.77),(1.48±0.51),(1.4±0.51)during the follow-up. Among the cases with neurologic deficit impaired being:Grade A:2,Grade B:4,Grade C:12,Grade D:4,Grade E:1, the distribution of ASIA grade have changed into Grade A:1,Grade B:1,Grade C :3,Grade D:8,Grade E:10 in one year after operation.The neurological functions have made a progress to some extent.The statistical analysis:1. Compression ratio of the front edge of the injured vertebrae, Cobb angle, rate of spinal stenosis in one week after operation, one year after operation, and three months after operation of internal fixation removal have statistical significance compared to preoperative(P<0.05).There were no significant of these above indications during the follow-up(P>0.05).2.The score of VAS have significance between the preoperative and the following time(P< 0.05).3.The assessment of ASIA for neurological functions have obviously improved with statistical significance(Z=-3.67,P<0.05)Conclusion: The application of newly limited procedure of posterior approach to fracture vertebral distraction reduction, unilateral laminectomy, bone graft and percutaneous pedicle screw internal fixation can achieve decompressing completely, reconstruction of the height of injured vertebrae,instantly stability,alleviating the pain by less interference to paravertebral muscle.Which is a mini-invasive surgery in curing the thoracolumbar vertebral fracture with severe stenosis.