Clinical application of the paraspinal erector approach for spinal canal decompression in upper lumber burst fractures

Journal of Orthopaedic Surgery and Research

Zhong-Liang Deng²  Lei Chu²  Yun Chen²  Fu Chen²  Zhen-Yong Ke²  Liang Chen²  Qing Ma¹  Zheng-Jian Yan²  Xi-Yan Xu² 

[1]Department of Pharmacy Practice, University at Buffalo, Buffalo, NY, USA

[2]Department of Orthopaedic Surgery, The Second Affiliated Hospital, Chongqing Medical University, 76 Linjiang Road, Chongqing 400010, China

关键词: Upper lumber burst fractures;    Surgical approach;    Minimally invasive spine surgery;    Direct spinal canal decompression;    Erector spinae;   

Others  :  1151655
DOI  :  10.1186/s13018-014-0105-4

 received in 2014-05-07, accepted in 2014-10-21,  发布年份 2014

【 摘 要 】

Objective

Percutaneous pedicle screw fixation is commonly used for upper lumber burst fractures. The direct decompression remains challenging with this minimally invasive surgery. The objective was to evaluate a novel paraspinal erector approach for effective and direct decompression in patients with canal compromise and neurologic deficit.

Method

Patients (n?=?21) with neurological deficiency and Denis B type upper lumbar burst fracture were enrolled in the study, including 14 cases in the L1 and 7 cases in the L2. The patients underwent removal of bone fragments from the spinal canal through intervertebral foramen followed by short-segment fixation. Evaluations included surgery-related, such as duration of surgery and blood loss, and 12-month follow-up, such as the kyphotic angle, the height ratio of the anterior edge of the vertebra, the ratio of sagittal canal compromise, visual analog scale (VAS), Oswestry Disability Index (ODI), and Frankel scores.

Results

All patients achieved direct spinal canal decompression using the paraspinal erector approach followed by percutaneous pedicle screw fixation. The mean operation time (SD) was 173 (23) min, and the mean (SD) blood loss was 301 (104) ml. Significant improvement was noted in the kyphotic angle, 26.2?±?8.7 prior to operation versus 9.1?±?4.7 at 12 months after operation (p <0.05); the height ratio of the anterior edge of the injured vertebra, 60?±?16% versus 84?±?9% (p <0.05); and the ratio of sagittal canal compromise, 46.5?±?11.4% versus 4.3?±?3.6% (p <0.05). Significant improvements in VAS (7.3?±?1.2 vs. 1.9?±?0.7, p <0.05), ODI (86.7?±?5.8 vs. 16.7?±?5.1, p <0.05), and Frankel scores were also noted.

Conclusions

The paraspinal erector approach was effective for direct spinal canal decompression with minimal injury in the paraspinal muscles or spine. Significant improvements in spinal function and prognostics were achieved after the percutaneous pedicle screw fixation.

【 授权许可】

   
2014 Xu et al.; licensee BioMed Central Ltd.

【 图 表 】

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