Posterolateral Corpectomy of Thoracolumbar Fractures: Results of 100 Cases

Material and Method: From May 2003 to May 2005, posterolateral corpectomy, grafting and transpedicular screws fixation were done in 100 cases presented with thoracolumbar fractures in Assiut Trauma Unit- Assiut University Hospital. Average age was 32 years old (range 18-62). Fractures were classified according to Mageral et al., comperhensive classification system. Preoperative, postoperative and follow-up X-ray and CT-scan were done for all cases. Load-sharing and neurological status were the guide for preoperative planning. According to Frankel Scoring system, 92 cases presented with variable neurological deficit and 8 were neurologically-free. The surgical technique entailed posterolateral access through hemilaminectomy-facetectomy after transpedicular screws insertion. After efficient spinal decompression and corpectomy, the anterior spinal column was reconstructed with strut tricortical iliac bone graft. Operative time, operative blood loss, intra-operative complications, hospital stay, and postoperative complications were recorded according to Clavien Grading system.

Results: The average follow-up period was 28 months (range 24-36 months). Posterolateral corpectomy of D9 is done once, D10 (4 cases), D11 (13 cases), D12 (21 cases), L1 (44 cases), L2 (7 cases), L3 (5 cases), L4 (3 cases),and L5 (2 cases). The total operative time was 150 minutes in average (range 100-240 min.) the op. Blood loss was 1300cc in average (range 900- 2100 cc. Injury of the neural elements due to fracture was found in 43 cases, in 12 of them the injury was irreparable. Sudden intraoperative death occurred once. No serious post-operative complications were recorded apart from injury of L1 nerve root in two cases. Solid Fusion occurred in 87cases. Neurological improvement rate was 73%.

Conclusions: This modified method of posterolateral corpectomy is a safe, efficient and less morbid technique for treatment of unstable thoracolumbar fractures.