[Anterior decompression and reconstruction for the treatment of burst thoracolumbar fractures with anterior and median column injury].

OBJECTIVE: To explore the treatment of anterior decompression and reconstruction for burst thoracolumbar fractures with anterior and median column injury and to evaluate the therapeutic effect. METHODS: Thirty-four patients suffering from burst thoracolumbar fractures with anterior and median column injury (male 22 and female 12, aged from 20 to 63,with an average of 40.5 years) were treated by anterior decompression and reconstruction from May 2001 to October 2006. Operative duration, bleeding and the neurological function of patients were recorded. RESULTS: All the patients were followed up from 3 to 60 months and the average time was 24.5 months. Operative duration was (178 +/- 65) min. The volume of bleeding was (1 750 +/- 950) ml and the volume of autotransfusion was (950 +/- 750) ml. Cobb angle were corrected from 27.0 degrees +/- 6.5 degrees to 3.0 degrees +/- 1.5 degrees. All fractures obtained fusion. No failure of internal fixation and formation of false joint happened. CONCLUSION: The technique of anterior decompression and reconstruction for burst thoracolumbar fractures with anterior and median column injury is effective, with which the decompression and reconstruction of the spinal stability can be performed under direct vision at one stage, and the sagittal alignment can be corrected at the same time. The procedure will be more smoothly by the application of the intraoperative autotransfusion.

[An imaging study on location of the anterior border of facets and the posterior border of vertebral bodies in lower cervical spine].

OBJECTIVE: To explore the location of the anterior border of facets and the posterior border of vertebral bodies in lower cervical spine,and to provide a quantitative data to evaluate the correct length of transarticual screws in lower cervical spine during procedure. METHODS: One hundred standard lateral X-ray films and fifty CT films on cervical spine were used to measure the distance of the anterior border of facets and the posterior border of vertebral bodies in lower cervical spine. HS, HM and HI were defined as parameters, which means the distance between the anterior border of the superior (HS), median (HM) and inferior (HI) part of facets and the posterior border of corresponding vertebral bodies. The value will be negative if the anterior border of the facet located before the vertebral body. RESULTS: 'HS > HM > HI' was found in all facets in lower cervical spine. The anterior border of the facet in C(3,4) located before the posterior border of the vertebral body of C3. The anterior border of C(4,5) and C(5,6) was inclined to posterior. The anterior border of C(6,7) located after the posterior border of the vertebral body of C6. The pattern of HS increased from C(3,4) to C(6,7), the minimal (0 +/- 0.25) mm and the maximal (2.91 +/- 1.05) mm. The tendency of HM raised from C(3,4) to C(6,7), the minimal (-1.57 +/- 0.53) mm and the maximal (1.54 +/- 0.39) mm. The pattern HI added from C(3,4) to C(6,7), the minimal (-2.03 +/- 0.40) mm and the maximal (1.08 +/- 0.70) mm. CONCLUSION: During the implantation of the transarticular screws, the tip of the screws should be 0-2 mm before the posterior border of the vertebral body of C3 at C(3,4), 0-2 mm after that of C4 at C(4,5), 0.5-2.5 mm at C(5,6) and 1-3 mm at C(6,7). The quantitative location between the anterior border of facets and the posterior border of the corresponding vertebral bodies can offer an indirect method to evaluate the correct length of transarticual screws in lower cervical spine during procedure.