Results of Non-fusion Method in Thoracolumbar and Lumbar Spinal Fractures.

Study Design: A retrospective study of surgically managed patients. O b j e c t i v e s: To evaluate the results of posterior stabilization of a thoracolumbar fracture, without fusion, followed by the removal of metal implants within an appropriate period. Changes in the sagittal alignment and the restoration of segmental motion were also investigated. Summary of Literature Review : In managing unstable thoracolumbar and lumbar fractures, posterior fusion, using a transpedicular screw system, has been the treatment of choice, but results in the permanent loss of segmental motion. Materials and Methods: Twelve patients with thoracolumbar and lumbar spine fractures, under 40 years of age (mean 28.4 years), were managed using this non-fusion method. Implants were removed at mean 9.2 months after the initial fixation of the fracture. For metal-fixed segments, the sagittal alignment, such as the angle of kyphosis, height of body, recovered motion range in flexion-extension and right-left bending view, were measured radiologically and compared with a control group. Clinical aspects, such as gross deformity and functional ability, were also investigated. Results: The average sagittal angle at the time of injury was average 17.2°, but became 1.7°post-fixation, which increased after removal of the implants, reaching 9.8°at the final follow up. The height of the fractured body was maintained until the final follow-up. The mean segmental motion measured in the sagittal and coronal planes were 11.7 and 9.5°, respectively. Most patients were satisfied with the final gross appearance and functional outcomes. Only one patient showed considerable development of kyphotic angulation, but the functional outcome was good. Conclusion: The author’s non-fusion method seems to be effective in achieving stability and sagittal alignment, as well as in regaining segmental motion of the fixed segments. The non-fusion method seems to be an effective method for managing thoracolumbar fractures, especially for young active persons.