Florence Nightingale Hospital POSTERIOR SUBTOTAL VERTEBRECTOMY OF THORACIC BURST FRACTURES WITH SPINAL CORD AND CHEST TRAUMA Selhan KARADERELER, MD Cagatay OZTURK, MD Mehmet AYDOGAN, MD Ahmet ALANAY, MD Murat SIRIKCI, MD Azmi HAMZAOGLU, MD Istanbul Spine Center Florence Nightingale Hospital Istanbul-TURKEY

INTRODUCTION High energy thoracic spine fractures with neurological compromise are usually associated with disruption of rib cage and pulmonary contusion. Anterior decompression and instrumentation may increase the pulmonary morbidity in those patients.

PURPOSE PATIENT SAMPLE To evaluate results of the surgical treatment of thoracic burst fractures with neurological deficit and multiple rib fractures by a subtotal vertebrectomy via a posterolateral approach without opening the pleura. 10 consecutive patients who had thoracic burst fractures and chest trauma causing lung contusion included in the study. PATIENT SAMPLE

METHODS 7 patients had Frankel B and 3 patients had Frankel C neurological deficit at the time of presentation. All ten patients had associated multiple rib fractures and pulmonary contusion requiring chest tube drainage. In the surgical technique; placement of pedicle screws, hemilaminectomy and costotransversectomy via unilateral approach without opening the dura. posterior decompression and subtotal vertebrectomy titanium mesh cage placed anteriorly through the same incision.

RESULTS Mean age of patients (5 female, 5 male): 24.6 (17-37) y Mean follow-up period: 44 (24-78) months. The preoperative Frankel B neurological status were improved to Frankel D in 5 patients and to Frankel C in 2 patients, preoperative Frankel C improved to Frankel D in 3 patients detected at the last follow-up. Except for one patient who developed superficial wound infection treated by debridement and intravenous antibiotics, there was no infection or implant related complication seen during the follow-up.

RESULTS Complete fusion and well sagittal alignment were achieved in all patients. The average preoperative local kyphosis angle of 15 degrees improved to 7 degrees immediately after operation and changed to 8.2 degrees at the last follow-up. None of the patients had further pulmonary complications.

TE, 25y, M, motor vehicle accident, T5-6 fracture dislocation

FT, 24y, F, motorcycle accident, T8 burst fracture

CONCLUSION Posterior subtotal corpectomy and decompresion and reconstruction is a safe and effective method for management of thoracic burst fractures in patients with chest injury and with neurological compromise. It obviates the need for anterior decompression which may further increase the pulmonary morbidity and it allows immediate intervention after the injury.

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