Ligamentotaxis with an internal spinal fixator for thoracolumbar fractures

• Published in: Journal of bone and joint surgery. British volume Vol. 76; no. 1; pp. 107 - 112
• Main Authors: KUNER, E. H, KUNER, A, SCHLICKEWEI, W, MULLAJI, A. B
• Format: Journal Article
• Language: English
• Published: London British Editorial Society of Bone and Joint Surgery 1994
• Subjects: Adolescent; Adult; Biological and medical sciences; Female; Fracture Fixation, Internal - methods; Humans; Injuries of the limb. Injuries of the spine; Internal Fixators; Lumbar Vertebrae - diagnostic imaging; Lumbar Vertebrae - injuries; Lumbar Vertebrae - surgery; Male; Medical sciences; Middle Aged; Spinal Fractures - diagnostic imaging; Spinal Fractures - surgery; Thoracic Vertebrae - diagnostic imaging; Thoracic Vertebrae - injuries; Thoracic Vertebrae - surgery; Tomography, X-Ray Computed; Traumas. Diseases due to physical agents; Human; Disease of the spine; Orthopedic surgery; Fixation; Treatment; Lumbar spine; Diseases of the osteoarticular system; Internal; Dorsal spine; Fracture; Technique
• ISSN: 0301-620X; 2044-5377
• DOI: 10.1302/0301-620X.76B1.8300651

We assessed narrowing of the spinal canal in 39 burst fractures and fracture-dislocations of thoracolumbar vertebrae treated by the AO Internal Spinal Fixator, using CT preoperatively and at various stages postoperatively. Computer-aided planimetry was used to measure the narrowing, and its restoration shortly after instrumentation, or at 15 months. The mean initial reduction of canal area was to 63.7% +/- 18.8% of normal; this was restored to a mean of 95.4% +/- 21.2% of normal when measured either soon after surgery or at 15 months (p < 0.001 for both groups). There was more improvement in cases assessed later. For fractures from D12 to L3, the mean canal area was restored to 99.4% of normal; but at L4 or L5 the mean restitution was to only 60.9% (p < 0.05). We found no correlation between preoperative loss of area and amount of restoration, or severity of neurological deficit. Nor was there any correlation between the delay before surgery and the improvement achieved. The mechanism of fracture reduction appears to be a combination of distraction ligamentotaxis and forced hyperextension.