surgical treatment of fractures and dislocations of the thoracic and lumbar spine christopher m....
TRANSCRIPT
![Page 1: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/1.jpg)
Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar
Spine
Christopher M. Bono, MD and Mitchel B. Harris, MD
Original Authors: Jim A. Youssef, MD & Mitch Harris; March 2004New Authors: Christopher M. Bono, MD & Mitch Harris, MD;
Revised August 2005 and May 2011
![Page 2: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/2.jpg)
Spinal Stability
Mechanical stability: maintain alignment under physiologic loads without significant onset of pain
or deformity
Neurologic stability: prevent neural signs or symptoms under anticipated loads
![Page 3: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/3.jpg)
Mechanical Stability
3-column theory (Denis ‘83)– middle middle = posterior ½ VB, posterior disc,
post longitudinal lig
2-column theory (Holdsworth,’53) – anterior= VB, disc, ALL, PLL
– posterior= neural arch, Post lig complexPost lig complex
![Page 4: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/4.jpg)
Denis: MIDDLE COLUMN is key to stability
– No anatomic basis– Stable burst fracture defies definition
Holdsworth : PLC is key to stability !!!
– James, et al ‘94
– Posterior lig complex more important to in vitro resistance versus kyphosis
![Page 5: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/5.jpg)
How Can We Detect Instability?
Dynamic: deformity worsens under physiologic loads
– acute kyphosis with standing– progressive kyphosis over time
Static: Inferred from x-rays– Plain films- widened spinous processes, biplanar
deformity– CT - facet complex disruption
– MRI- disrupted PLC
![Page 6: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/6.jpg)
Deformity
(Kyphosis)
Initial radiographs usually
supine
Alignment can appear
acceptable without load
Upright loading can increase
deformity
If unstable, deformity will progress or neurological signs will occur
![Page 7: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/7.jpg)
Instability(“textbook” definition)
Relies on ‘accepted’ standards>50 % loss of height implies PLC injury
>30 º Cobb kyphosis implies PLC injury
Direct MRI visualization of a disrupted PLC
However, little clinical data to support these values.
![Page 8: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/8.jpg)
Neurologic Stability
Defined by the neurological findings at time of presentation …and
Reflects the (remaining) intrinsic ability of the spinal column to protect the neural elements from (further) damage under
anticipated loadsRelated to mechanical stability
Crucial for intact and incomplete SCI
![Page 9: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/9.jpg)
Goals of Surgical Treatment
•To “stabilize” the unstable spine
•To restore/ improve sagittal balance
•To decompress a progressive neural deficit
•To protect intact or incompletely injured neural elements
![Page 10: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/10.jpg)
How Do We Achieve These Goals?
Decompression
Fixation for acute correction and
stability
Fusion with bone graft for long-
term maintenance of
reduction/ stability
![Page 11: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/11.jpg)
Canal Decompression
Complete SCI – Complete SCI (after spinal shock resolves): regardless of treatment method,
shows little functional improvement
Intact neurological status– Intact neuro status: regardless of x-ray
appearance, neuro status can’t get better !!!
![Page 12: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/12.jpg)
Canal Decompression
Indicated for incomplete neurological deficits with canal compromise….
Does surgical decompression improve neurological recovery?
*Current literature lacks stats to support*
![Page 13: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/13.jpg)
Decision to Decompress
Location of SCI – Little functional benefit seen with 1 or 2 level
improvement in upper thoracic (>T9) cord injuries– Conus (T10-L1) lesions are critical: bowel/bladder– Low lumbar--roots more accommodating to canal
compromise, and more apt to recover
Completeness of SCI
![Page 14: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/14.jpg)
Methods of DecompressionAnterior Decompression = “Gold Standard”“Gold Standard”
– Most common in thoracic and thoracolumbar regions– Direct visualization of cord with removal of fractured body
– Readily combined with reconstruction and fusion– Treatment of choice for burst fractures with incomplete SCI– In presence of posterior ligamentous injuries may require
A/P surgery
![Page 15: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/15.jpg)
Methods of Decompression
• Laminectomy alone is Contraindicated !!!– Further destabilizes an unstable spine, may
lead to post-traumatic kyphosis
– Provides access to allow visualization and repair of dural tears.
– Be aware of the clinical triad of neurological injury and concomitant lamina fracture with burst pattern (Cammisa, 1989)---trapped roots!!
![Page 16: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/16.jpg)
• Indirect Reduction (ligamentotaxis)– Canal cleared by spinal realignment– Relies primarily on posterior annulus
reducing retro-pulsed fragment – Optimal time: within 72 hrs.
Methods of Decompression
Posterolateral decompression– Transpedicular or costo-
transversectomy – Useful when anterior approach
not a viable option– Useful in lumbar spine w/dural
mobilization
![Page 17: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/17.jpg)
Timing of Decompression?
Early
1. Most animal SCI studies support early decompression
2. Intuitively, remove pressure early for improved recovery
Delayed
1. Clinically, early intervention has less support, its less convenient.
2. Fear of complications related to early surgery
![Page 18: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/18.jpg)
Indication for Early/Emergent Decompression
Progressive neurological deficit associated with canal compromise from
retro-pulsed fragments or spinal mal-alignment (fracture-dislocations).
![Page 19: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/19.jpg)
Timing of Surgical Stabilization
Benefits of early surgery :– facilitates aggressive pulmonary toilet
– decreases risk of DVT/PE with mobilization– prevents likelihood of decubitus ulcers
– facilitates earlier rehab
Surgery should be delayed until:
– Hemodynamically/medically stabilized– An experienced surgeon/ team is available
![Page 20: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/20.jpg)
Specific Thoraco-lumbar Injuries
Compression fractures
Burst fractures
Flexion-distraction/Chance injury
Fracture-dislocations
Gunshot wounds to the spine
![Page 21: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/21.jpg)
Compression Fractures
Anterior column injury
Does not extend into posterior vertebral wall on CT
With increasing severity, the likelihood of posterior lig complex injury increases.
If PLC is disrupted -- UNSTABLE (not a compression fracture)
![Page 22: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/22.jpg)
Compression Fractures
Compression fractures rarely require surgery
Surgery is indicated if PLC disrupted
Relative indications for surgery– single level lumbar VB height loss >50 %– single level thoracic VB height loss >30 %
– combined multi-level height loss >50 %– relative segmental or combined kyphosis >30
º
![Page 23: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/23.jpg)
Compression Fractures
Non-operative treatment – TLSO or Jewitt extension bracing– Frequent radiographic follow-up
– Deformities can progress
Advantages: avoid surgical complications and muscle injury 20 to surgery
Disadvantages: post-traumatic kyphosis
![Page 24: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/24.jpg)
Compression FracturesOutcomes and Complications
Most common sequelae is
BACK PAIN– does not correlate with severity of deformity (Young, 1993, Hazel, 1988)
– Lumbar worse than thoracic (Day, 1977)
![Page 25: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/25.jpg)
Specific Thoracolumbar Injuries
Compression fractures
Burst fractures
Flexion-distraction/Chance injury
Fracture-dislocations
Gunshot wounds to the spine
![Page 26: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/26.jpg)
Burst Fractures
Definition: fracture extends into posterior vertebral wall
May be stable or unstable
![Page 27: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/27.jpg)
Unstable Burst Fractures
Related to PLC integrity
>30 º relative kyphosis
Loss of vertebral body height > 50%
Biplanar deformity on AP x-ray
MRI finding of disrupted PLC
![Page 28: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/28.jpg)
Stable Burst Fractures
Criteria (burst with intact PLC)– <20-30 º kyphosis(controversial)– <50% lumbar canal compromise– <30% thoracic canal compromise
TLSO/Jewitt brace for comfort
![Page 29: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/29.jpg)
Stable Burst Fractures
Radiographic follow-up to follow potential deformity
progression
Repeat CT to monitor canal
resorption
Same treatment principles as compression fracture
![Page 30: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/30.jpg)
Surgical Approaches Posterior Approach
– Fractures at T6 or above– Posterior ligament complex injury
– Multi-level injury– Associated chest trauma
Anterior Approach– Ideal for T6 and lower
– Decompression via corpectomy– Reconstruction with strut graft and anterior instrumentation
– May combine with post stabilization
![Page 31: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/31.jpg)
Nerve and Cord Decompression
Anterior corpectomy to visualize neural elements.
– Safest and most predictable form of decompression
Alternative within 48-72 hours: indirect decompression – Lordosis and distraction
– Relies on annulus to reduce retro-pulsed fragment through
ligamentotaxis.
![Page 32: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/32.jpg)
Burst FracturesOutcomes and Complications
Anterior Approach– Ileus (GI) after anterior approach
– Retrograde ejaculation– Risk of large vessel damage
Improved chances of bladder recovery with anterior decompression (SRS,’92)
Without decompression: fragment resorption decreases canal compromise by 30%
Non-operative results are similar to results of operative treatment.
![Page 33: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/33.jpg)
Specific Thoracolumbar Injuries
Compression fractures
Burst fractures
Flexion-distraction/Chance injury
Fracture-dislocations
Gunshot wounds to the spine
![Page 34: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/34.jpg)
Chance (Flexion-Distraction) Injury
“Seatbelt” injury
Trans-abdominal ecchymosis
Common in children (seatbelt higher up)
0-30% neurologic injury
Most common associated non-spinal injury: perforated viscus (pressure)
![Page 35: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/35.jpg)
Chance Injury
Injury involves 3-columns
Usually little comminution
Center of rotation: ALL
PLC disrupted or posterior neural arch fractured
transversely
![Page 36: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/36.jpg)
“Chance” Fracture Variants
Purely ligamentous/ trans-discal
• Part bony/part ligamentous
• Purely bone
Best healing No healing
Some healing
![Page 37: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/37.jpg)
Flexion-Distraction Injuries
Boney Chance: stable in extension (TLSO) brace
– the fracture will heal
Ligamentous injuries do not heal, require stabilization and fusion
– need to restore the disrupted posterior tension band
![Page 38: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/38.jpg)
Surgical Approach
Posterior approach
Relies on intact ALL
If burst component present, optimal treatment with pedicle
screws (maintain anterior column length, don’t over
compress as that may increase retro-pulsion )
![Page 39: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/39.jpg)
Chance FracturesOutcomes and Complications
10-20% residual pain
65% functional recovery
35% diminished function
![Page 40: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/40.jpg)
Specific Thoracolumbar Injuries
Compression fractures
Burst fractures
Flexion-distraction/Chance injury
Fracture-dislocations
Gunshot wounds to the spine
![Page 41: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/41.jpg)
Fracture-Dislocations
High-energy injuries
Highest rate of SCI of all spinal fractures
Thoracic--worst prognosis
Rare non-operative management
Unstable with multi-planar deformity---little residual stability
![Page 42: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/42.jpg)
Decompression
Spinal realignment often decompresses the cord.– prone positioning on OR
table– “O.R.I.F.”
– “locked” facets requires open reduction by
resection of articular processes.
![Page 43: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/43.jpg)
Posterior constructs provide stability after
re-alignment – little chance for neuro
recovery
Rarely require anterior decompression/ reconstruction
Fracture-Dislocations
![Page 44: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/44.jpg)
Fracture-dislocationsOutcome and Complications
Severity of SCI --main predictor of outcome
![Page 45: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/45.jpg)
Specific Thoracolumbar Injuries
Compression fractures
Burst fractures
Flexion-distraction/Chance injury
Fracture-dislocations
Gunshot wounds to the spine
![Page 46: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/46.jpg)
Gunshot Wounds
Non-operative treatment the standard
Steroids not useful (Heary, 1997)
10-14 days IV antibiotics for colonic perforations (colon before spine) ONLY
No role for debridement
![Page 47: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/47.jpg)
Treatment
Decompression rarely of benefit except for
INTRA-CANAL BULLET AT THE T12 TO L5 LEVELS
(better motor recovery than non-operative)
Fractures usually stable, despite “3-column” injury
![Page 48: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/48.jpg)
GSW to the SpineOutcome and Complications
Most dependent on SCI and associated injuries
High incidence of CSF leaks with unnecessary decompression
Lead toxicity rare, even with bullet in canal
Bullet migration rare: late neurological sequelae
![Page 49: Surgical Treatment of Fractures and Dislocations of the Thoracic and Lumbar Spine Christopher M. Bono, MD and Mitchel B. Harris, MD Original Authors: Jim](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d095503460f949db636/html5/thumbnails/49.jpg)
Thank you
Return to SpineIndex
E-mail OTA about
Questions/Comments
If you would like to volunteer as an author for the Resident Slide Project or recommend updates to any of the following slides, please send an e-mail to [email protected]