SAGITTAL CONTOUR RESTORATION AND CANAL CLEARANCE IN BURST FRACTURES OF THE THORACOLUMBAR JUNCTION (T12-L1) - THE EFFICACY OF TIMING OF THE SURGERY

The efficacy of timing of surgery (short segment fixation using transp edicular screws), in burst fractures of thoracolumbar spine was evalua ted between May 1993 and October 1994. The patients were divided into two groups according to time elapsed between injury and operation. Cas es operated on within the first 24 h were taken as the early surgery g roup (n = 10) and cases operated on later than 24 h after the injury w ere considered as the late surgery group (n = 8). The efficacy of trea tment was assessed by evaluation of the sagittal index (SI) restoratio n and reduction of canal compromise. The pre-and postoperative values for SI and canal narrowing (CN) for both groups are as follows: Early preoperative SI - 23.40 degrees, late preoperative SI - 24.50 degrees, p = 0.53; early preoperative CN - 0.47, late preoperative CN 0.52, p = 0.33; early postoperative SI - 4.20 degrees, late postoperative SI - 13.50 degrees, p = 0.0001; early postoperative CN - 0.10, late postop erative CN - 0.39, p = 0.0000. There is still controversy concerning t he relationship between canal narrowing and neurologic deficit, and th e effect, if any, of decompression on neural recovery. Nevertheless, i f the main aim of the surgical procedure is to restore the SI and deco mpress the neural canal, then other alternatives of decompression and realignment should be preferred to indirect reduction using short segm ent transpedicular fixation in cases to be operated on later than 24 h after injury.