[Reposition of dislocated dorsal vertebral wall fragments in fractures of the thoracolumbar transition and the lumbar spine. Experience with 35 cases].
Pre- and postoperative CT scans of 35 patients with fractures of the thoracolumbar and lumbar spine (20 men and 15 women, with a mean age of 35 years), were evaluated with reference to the extent and shape of spinal stenosis. There were 24 patients with wedge-shaped fragments compressing the canal, the wedge being intact in 14 and broken in 10; 3 had fragmented wedges; and in 5, pedicular or arch fragmentation was combined with the dorsal vertebral fractures mentioned. Spinal stenosis was due to flexion-distraction injuries with angulation 3 patients, 1 of whom showed signs of dislocation and compaction. Fixation was done with the fixateur interne (F.I.) in 28 patients (combined with remodeling in 2), while 7 patients underwent plating with Teinturier plates and screws from the USI program. Burst fractures were most commonly encountered (25 patients) followed by flexion-distraction injuries of different types (10 patients). Instrumented reduction of the vertebral fragments was done in 24 patients. The effects of ligamentotaxis alone were relied upon in only 2 patients. Mean spinal canal narrowing amounted to slightly more than 50% (0.56) preoperatively. Residual narrowing postoperatively was just over 25% (0.26). In the patients followed up there was no evidence of secondary dislocation since the postoperative findings had been recorded. (ABSTRACT TRUNCATED AT 250 WORDS)