POSTERIOR STABILIZATION OF THORACIC AND LUMBAR SPINE FRACTURES WITH THE INTERNAL FIXATOR - TECHNIQUE AND RESULTS

Posterior stabilization by internal fixator is used as a frequent proc edure for the surgical treatment of thoracolumbar spine fractures. The technique of internal fixator stabilization and its results regarding the correction of spinal posture and spinal canal clearance are descr ibed. By transpedicular spongiosal filling of the reduced vertebral bo dy, a complete consolidation can be achieved. Occurring correction los ses of the spinal alignment are mainly attributed to the collapse of i ntervertebral segments, thereby suggesting insufficient anterior fusio n and support after transpedicular intercorporal cancellous bone graft ing. Spinal canal narrowings can only be cleared partially through pos terior approach and indirect reduction by internal fixator. In abscenc e of neurological deficits, residual spinal canal encroachments can be tolerated after surgery, since remodelling phenomenons occur subseque ntly. However, symptomatic spinal cord compression requires a more eff icient decompression technique by direct posterior approach, risking m anipulation damage of neural structures. The limited possibilities of internal fixator technique demand the discerning consideration of alte rnative anterior or combined anterior-posterior procedures for the pla nning of surgical treatment. For spinal fractures with pronounced dest ruction of the anterior column and associated intervertebral disc rupt ures, an interbody fusion by anterior approach should be performed. In case of additional posterior or transverse instability, a supplementa l stabilization by internal fixator is necessary. For severe spinal ca nal encroachments at thoracic spine level with symptomatic or imminent spinal cord compression, the most efficient decompression by an anter ior approach is preferred.