Treatment of unstable thoracolumbar and lumbar spine injuries using Cotrel-Dubousset instrumentation

Study Design. In this prospective study, the results of treating unstable t horacolumbar and lumbar injuries with Cotrel-Dubousset instrumentation were investigated. Objective. To determine the pain and work status of the patients, to evalua te neurologic status, and to assess the efficacy of instrumentation in the short term. Summary of Background Data. Short-segment pedicle screw construct is the me thod of choice for reduction and stabilization of unstable thoracolumbar sp inal injuries. Many investigators have recently reported a high rate of ins trument failure. In this study, the use of segmental transpedicular fixatio n two levels above the kyphosis decreased instrument failure and sagittal c ollapse. Methods. Thirty patients, who had unstable thoracolumbar and lumbar spinal injuries, underwent application from a posterior approach of Cotrel-Dubouss et instrumentation two levels above and one below at the thoracolumbar junc tion and short segment fixation in the lumbar area. Radiologic parameters w ere evaluated before and after surgery. Results. The mean follow up was 31 months (range, 25-49) months. There were statistically significant differences between the pre- and postoperative v alues in all radiologic parameters. Neurologic status improved in 70% of th e patients, with a mean Frankel grade of 1.3 grades. Conclusions. Cotrel-Dubousset instrumentation provided spinal stability in unstable injuries, forming a rigid construct and restoring physiologic thor acolumbar and lumbar postural contours because of its highly corrective eff ect in the sagittal profile with no loss of correction.