Surgical Management Of Fracture Lumbar Spine

SUMMARY AND CONCLUSION___In the lumbar spine, the body’s center of gravity falls at or posterior to the vertebral axis. Slight flexion decreases the lordosis and places the axial load force-of-injury vector through the vertebral body.From a neurological standpoint, the content and size of the neural canal distinguish the lumbar area from other regions. The cauda equina alone occupies the spinal canal at and caudad to the second lumbar level. Additionally the dimensions of the spinal canal are wider here than in any other regionManagement of fracture lumbar spine starts with proper diagnosis. History, clinical examination standard X-ray, computerized tomography and magnetic resonance imaging.- Denis classification of spinal fractures proved to be practical in evaluation in our patients.- Load sharing classification gives an excellent and simple way to assess the damage done to the anterior column during the fracture.- Patients were managed operatively with unstable fractures with or without neural affection.- Operative treatment with posterior approach by fixation in all cases, by:- Decompression by laminectomy in all cases with neural affection.- Indirect reduction (by distraction).- Direct reduction by impaction of the fragments anteriorly.- In most cases decortication and posterolateral bone graft were made in most cases.- Pedicular fixation by compact catrrel debousset (C.C.D) or Texas Scotch Rite Hospital (TSRH) and by Isola system.- Direct anterior decompression through thoracoabdominal or abdominal approach has the distinct advantage of providing total visualization of the involved fracture for decompression, stabilization and fusion. The quality and extent of anterior decompression are greater, with less neurologic risk than with a posterior procedure.- Anteriorly approached cases were treated by :- Direct decompression by corpectomy.- Fixation by Isola system in 2 cases and Z plate in 2 cases the above and below vertebrae and augmentation by tricortical iliac graft.- Unlike posterior decompression, little manipulation of neural elements is necessary during anterior decompression. Surgical complications of the anterior approach are minimal when done by an experienced team.- C.T scan was made in most cases postoperatively to assess the canal and position of screws.- Follow up for a minimum period 14 months.- Preoperative and postoperative data were analysed statistically.The results of the present prospective study revealed the following:1- The commonest cause of injury was fall from height.2- The neural deficit was the most frequent presentation.3- Associated injuries were frequent and may need specific treatment accordingly.4- Burst fracture in all cases. Seat belt type and fracture dislocation not included in our study.5- Operative treatment has many advantages as:- Better results in achieving reduction and maintaining it thus providing optimal position for healing and neural recovery.- Shorter hospital stay.- Earlier ambulation avoiding complications of recumbancy and making nursing easier.- Better pscychological condition.