THE EFFICIENCY OF ULTRASOUND-GUIDED SPINA L FRACTURE REPOSITION

To calculate canal compromise and decrease of midsagittal diameter cau sed by retropulsion of fragments into the spinal canal we analyzed the pre-and postoperative computed tomographies of 32 patients with unsta ble thoracolumbar burst fractures treated by USS (universal spine syst em). Our intention was to examine the efficiency of ultrasound guided repositioning of the displaced fragments which was performed in all 32 cases. We found a clear postoperative enlargement of canal area (ASP preoperatively 55%, postop. 80%) and midsagittal diameter (MSD preop. 58%, postop. 78%). 10 of 13 patients presented a postoperative improve ment of neurological deficit, no neurological deterioration occured. F ractures with neurological deficit showed more canal compromise (52%) and less midsagittal diameter (MSD compromise 51%) than those without (40% or 39%). There was no correlation between the percentage of spina l canal stenosis and the severity of neurological deficit. Below L 1 t he spinal canal is greater than between Th 11 and L 1, so a more impor tant spinal stenosis is tolerated. In case of unstable burst fractures with neurological deficit the ultrasound guided spinal fracture repos ition is an effective procedure concerning the necessary improvement o f spinal stenosis: an additional ventral approach for the revision of the spinal canal is unneeded. In fractures without neurologic deficit the repositioning of the displaced fragments promises an avoidance of long-term damages such as myelopathia and claudicatio spinalis.