Abstract
Temporary immobilisation of joints can lead to permanent ankylosis or fusion. The aim of this study is to demonstrate that treatment of vertebral fractures by single level fusion and 2 level fixation preserves movement in the unfused lower motion segment after removal of metalwork.
12 consecutive thoracolumbar fractures were treated by posterior fixation over two motion segments with fusion of the upper injured segment. Average age 39 years (27–50yrs.) and 6 were male. L2 was most frequently affected (6) then T12 (3), L1(2) and L3(1). Using the Denis classification 9 were Burst type B, 1 was Burst type A and 2 were Compression type B. No patients had abnormal neurology or any other vertebral injury. All operations were performed by one surgeon (RC) within 7 days of injury. Metalwork bridging the injured vertebra was removed at mean 11 months (8–13 * one patient 27 months) and average follow up in this study was 12 months (2–40) after removal of metalwork. A simple pain questionnaire and flexion-extension radiographs were obtained. The average movement in the motion segment previously bridged by metalwork was 5 degrees (0–12). For comparison, the level below moved an average of 7 degrees (2–17). Kyphus angle was 11 degrees (1–18) on presentation corrected to 0 degrees at operation (−6 - +12) returning 1 year after removal of metalwork to 5 degrees (1–16). Pain scores (0–10) were measured retrospectively, prior to the accident mean 0(0–1) and at review 2.6 (0–6).
Only one patient failed to return to previous employment. She had the highest pain score at 6, showed no movement at the bridged motion segment where removal of metalwork was delayed to 27 months.
The abstracts were prepared by Mr Simon Donell. Correspondence should be addressed to him at the Department of Orthopaedics, Norfolk & Norwich Hospital, Level 4, Centre Block, Colney Lane, Norwich NR4 7UY, United Kingdom.
