Efficiency of transpedicular reduction of intracanal bone fragments in comminuted fractures of L1 vertebra

Abstract

The objective was to retrospectively review the relationship between the parameters and the position of intracanal bone fragments in comminuted fractures of LI vertebra and the effect on neurological status and restoration of the anterior wall of the spinal canal using a transpedicular reduction device. Material and methods Spiral computed tomography (CT) scans and case histories of 45 patients with spinal cord injury at the level of L1 vertebra were reviewed. The study included patients with comminuted fractures including intracanal bone fragments from the posterior portion part of L1 vertebra. Bone fragments were relocated from the spinal canal to varying degrees in patients who underwent procedure using the posterior access and transpedicular reduction system. Two groups of patients were identified with regard to displacement: the bone could be shifted by 50 % and over in the first group (n = 25) and less than 50 % in the second group (n = 20). Results Preoperative time was shorter in the first group: 6.7 ± 3 versus 15.5 ± 5.6 days in the second group. The bone width was statistically smaller in the first group with 18.2 ± 2.3 mm versus 22.3 ± 2.6 mm in the second group. Deficient lumen and deficient area of the spinal canal were significantly greater in the first group. Discussion Prediction of the effective ligamentotaxis is essential for optimal surgical strategy. Bone parameters and position, performance of distraction and correction of angulation of injured vertebral segment play a role in the effectiveness of indirect reduction of bone fragments protruding into the spinal canal. Conclusion Deficient lumen and deficient area of the spinal canal, the length and width of the intracanal bone fragment were not associated with neurological disorders ASIA C, D and E types in case of comminuted fractures of LI vertebra. The effectiveness of closed decompression of the spinal cord in spinal cord injury at L1 level was dependent on the width of intracanal bone fragments and the preoperative time.