Combined Approach Operation for the Lumbar Spine Fractures according to 'The Load-sharing Classification'.

Bak, Koang Hum; Choe, Il Seung; Kim, Jae Min; Kim, Choong Hyun; Oh, Seong Hoon; Kim, Nam Kyu; Baik, Hong Kyu

Original Article

Journal of Korean Neurosurgical Society 1999;28(7): 949-955.

Koang Hum Bak, Il Seung Choe, Jae Min Kim, Choong Hyun Kim, Seong Hoon Oh, Nam Kyu Kim, Hong Kyu Baik

¹Department of Neurosurgery, School of Medicine, Hanyang University, Seoul, Korea.
²Department of General Surgery, School of Medicine, Hanyang University, Seoul, Korea.

ABSTRACT

BACKGROUND
Lumbar spine fractures treated conservatively or operatively may result in severe kyphotic deformity. Reliable operation plan should be made to prevent the development of delayed kyphosis in unstable lumbar spine fracture. STUDY DESIGN: Between September 1995 and March 1997, twelve cases with highly unstable lumbar spine fractures (7 according to'Load-sharing classification score') or fracture-dislocations were operated with combined retroperitoneal and posterior approach. The patients underwent anterior corpectomy, interbody fusion and short segment fixation with posterior transpedicular screws(1 level above and 1 level below). All patients were operated on the same day except one case. The patients were followed-up at least 12 months and mean follow-up period was 17.2 months after operation. The kyphotic angle was measured by Salter's method preoperative, immediate postoperative and at 12 months.
RESULTS
There were 9 cases of burst fractures and 3 cases of fracture-dislocations. The mean kyphotic angle was 24degrees preoperatively, -5degrees postoperatively and -2degrees at 12 months follow-up. This means the patients regained normal lumbar lordosis after the operation and maintained on long term follow-up. There was no case of pseudoarthrosis or delayed kyphosis development during follow-up period.
CONCLUSIONS
Highly unstable lumbar spine fracture with high load-sharing classification score could be treated to achieve normal lumbar lordosis immediate postoperatively and prevent kyphotic deformity on long-term follow-up evaluation with combined approach.

Key Words: Spine fracture; Load-sharing; Lumbar spine; Kyphosis; Combined approach