COTREL-DUBOUSSET INSTRUMENTATION AND THORACOLUMBAR SPINE TRAUMA - A REVIEW OF 55 CASES

A series of 55 patients treated with posterior Cotrel-Dubousset instru mentation and osteosynthesis for unstable thoracolumbar spine fracture s were reviewed. Follow-up averaged 48.3 months. The fractures were al l unstable, with 27 classified as fracture-dislocations (FD) and 28 cl assified as flexion compression injuries or unstable burst fractures ( FC/B). The study population was composed of 29 men and 26 women with a n average age of 31 (range 20-45) years. Mechanisms of injuries includ ed 35 motor vehicle accidents, 19 falls, and one blunt trauma. No case worsened as a result of surgery, and 31% of the cases improved an ave rage of 0.5 Frankel grade (range 0-2). Sixty percent of patients were braced with a custom molded thoracolumbosacral orthosis (TLSO) fitted after surgical stabilization. Minor complications occurred in 45% of t he cases (urinary tract infection most common). There was a singular d eep wound infection and another iliac crest donor site infection. Ther e were no instrument failures or pseudarthroses. Radiographic analysis showed the following improvements in fracture angle, vertebral body c ompression, and fracture displacement. The pattern of radiographic imp rovement in the FD and FC/B subgroups showed significant improvement i n each parameter when comparing preoperative to immediate postoperativ e values. Of importance, the radiographic findings comparing 1 month t o the final follow-up showed little to no deterioration. Cotrel-Dubous set instrumentation proved to be a highly effective device for immedia te restabilization of unstable thoracolumbar injuries.