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Document Type

Original Study

Abstract

Background Data: The thoracolumbar junction TLJ (T11–L2) is one of the most commonly injured spinal zones, representing more than 50% of all thoracic and lumbar spine fractures. Of all fractures in the TLJ, 40% are burst fractures. The ventral cord decompression at the TLJ after significant canal compromise is technically demanding. The midline laminectomy corridor does not allow adequate access to the vertebral body without significant neurological morbidity. Purpose: This study aims to evaluate the safety and efficacy of transpedicular (TP) decompression in the management of complete TLJ burst fracture with significant canal compromise. Study Design: A retrospective clinical case series Patients and Methods: This study was conducted on 20 patients with a TLJ complete burst fracture with significant canal compromise (≥35%) and a Thoracolumbar Injury Classification System (TLICS) >4. All patients underwent the TP approach for decompression after simultaneous transpedicular screw fixation, including fractured vertebra, via a posterior midline skin incision. The patient’s neurological status was assessed pre- and postoperatively according to the American Spinal Injury Association (ASIA) impairment scale, and back pain was documented using the visual analog scale (VAS). An axial CT scan was used to assess the pre- and postoperative extent of canal compromise, while the kyphosis was calculated by Cobb’s angle. Results: 11/15 (73.3%) patients improved neurologically by one grade on the ASIA scale, and five patients remained neurologically intact (grade E) preoperatively, and no patient deteriorated or developed iatrogenic nerve root injury. The average VAS dropped from 6.5 preoperatively to 2.15 postoperatively. A unilateral TP decompression was performed in 17 patients; short-segment fixation with an intermediate screw was preferred in nine patients, while long-segment fixation and an intermediate screw were selected in eight patients according to surgeon discretion. Bilateral pediculectomy, performed in three patients due to severe canal compromise (≥50%), had a statistically significant higher duration and more blood loss compared to other patients with unilateral TP decompression. The mean preoperative kyphotic deformity was 12° which improved to 2.2° postoperatively (mean kyphosis correction 9.8°). The mean Cobb’s angle during follow-up (minimum 1 y) was 3.7°, thus resulting in a loss of 1.5°. The average canal compromise decreased from 43% preoperatively to 15% postoperatively (+28%). There was no perioperative mortality or hardware failure. One patient had a wound infection, and debridement was done. Conclusion: TP decompression is a safe, effective, and less invasive option for treating TLJ burst fractures with significant canal compromise. However, it is technically demanding and requires special instrumentation and preparation.

Keywords

burst fracture, posterolateral approaches, thoracolumbar junction, transpedicular decompression, ventral cord decompression

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