ANTERIOR DECOMPRESSION AND STABILIZATION WITH THE KANEDA DEVICE FOR THORACOLUMBAR BURST FRACTURES ASSOCIATED WITH NEUROLOGICAL DEFICITS

One hundred and fifty consecutive patients who had a burst fracture of the thoracolumbar spine and associated neurological deficits were man aged with a single-stage anterior spinal decompression, strut-grafting , and Kaneda spinal instrumentation. At a mean of eight years (range, five years to twelve years and eleven months) after the operation, rad iographs showed successful fusion of the injured spinal segment in 140 patients (93 per cent), Ten patients had a pseudarthrosis, and all we re managed successfully with posterior spinal instrumentation and a po sterolateral arthrodesis. The percentage of the canal that was obstruc ted, as measured on computed tomography, improved from a preoperative mean of 47 per cent (range, 24 to 92 per cent) to a postoperative mean of 2 per cent (range, 0 to 8 per cent), Despite breakage of the Kaned a device in nine patients, removal of the implant was not necessary in any patient. None of the patients had iatrogenic neurological deficit s, After the anterior decompression, the neurological function of 142 (95 per cent) of the 150 patients improved by at least one grade, as m easured with a modification of the grading scale of Frankel et al. Fif ty-six (72 per cent) of the seventy-eight patients who had preoperativ e paralysis or dysfunction of the bladder recovered completely, One hu ndred and twenty-five (96 per cent) of the 130 patients who were emplo yed before the injury returned to work after the operation, and 112 (8 6 per cent) of them returned to their previous job without restriction s. We concluded that anterior decompression, strut-grafting, and fixat ion with the Kaneda device in patients who had a burst fracture of the thoracolumbar spine and associated neurological deficits yielded good radiographic and functional results.