Effectiveness of posterior tension band ﬁxation in the thoracolumbar seat-belt type injuries of the young population

Eur Spine J, 2009 · DOI: 10.1007/s00586-009-0991-z · Published: April 24, 2009

Simple Explanation

This study examines the surgical treatment of thoracolumbar flexion-distraction fractures, which can occur from motor vehicle accidents when wearing a seatbelt. The fractures are considered mechanically unstable due to disruption of the posterior elements and can lead to symptomatic kyphotic deformity if not treated properly. The authors report their experience with posterior surgical approaches to address instability and dislocation while minimizing complications.

Study Duration

1999 to 2006

Participants

19 young males (20-33 years)

Evidence Level

Not specified

Key Findings

1
Fusion was achieved in all patients at follow-up, and clinical condition was satisfactory with absence of significant pain, indicating mechanical stability.
2
Neurological status of patients presenting as ASIA A-B or ASIA E was maintained postoperatively.
3
The use of laminar hooks one level above the dislocation seems to reduce the potential risk of neurological and /or vascular damage.

Research Summary

The study presents results of surgical treatment for thoracolumbar flexion-distraction fractures in young patients caused by motor vehicle crashes, focusing on function, pain, and neurological recovery. All patients were operated on via a posterior approach using hybrid instrumentation or short pedicular fixation to reduce dislocation and achieve spinal fusion, with posterior decompression performed in cases of neurological deficit. The results showed solid fusion in all patients, maintained neurological condition in ASIA A-B/E patients, and good outcomes on back pain rating scale in most cases, suggesting the effectiveness of the surgical approach combined with postoperative rehabilitation.

Practical Implications

Surgical Stabilization

Surgical stabilization and fusion are the preferred treatment for B1 fractures, especially those with severe disco-ligamentous disruption, to restore spinal stability.

Neurological Preservation

Posterior decompression should be performed in patients with neurological deficits to prevent further compromise and potentially improve outcomes.

Minimizing Complications

The use of laminar hooks above the dislocation can reduce the risk of iatrogenic neurological or vascular damage during surgery.

Study Limitations

1
The study lacks a control group for comparison.
2
The sample size is relatively small.
3
The follow-up period, while reasonable, could be longer to assess long-term outcomes.

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