DORSAL SPONDYLODESIS OF UNSTABLE THORACOLUMBAR FRACTURES BY A FAR-LATERAL APPROACH TO THE DISC

This paper describes a modified and less traumatic approach to the tho racolumbar spine and compares it with standard techniques for instrume nted spinal fusion. Ten patients with unstable fractures of the thorac olumbar spine were included in the open prospective investigation, and were treated by a surgical technique consisting of a dorsolateral app roach to the injured segment, filling the disk space and the fractured vertebra with autologous bone, and transpedicular fixation with an AO internal fixator. All patients were followed for 6 to 12 months after surgery by clinical tests and spinal X-rays. Excellent short-term and long-term results were obtained. A stable bony fusion was achieved in all cases, and a minimal mean decrease of 2 degrees in the kyphosis a ngle was found at late follow-up. No major complications related to th e procedure were encountered, and no worsening of neurological deficit s occurred after surgery. In conclusion, the far-lateral approach to t he thoracolumbar spine yields results which are equivalent or better t han those of standard techniques. Major advantages of our procedure, a s evaluated in this rather small group of patients, are selective immo bilization of the injured segment without involvement of functionally intact spinal levels, no manipulations within the spinal canal boundar ies, and relatively limited exposure of the spine.