OUTCOME OF FIXATEUR INTERNE IN THORACOLUMBAR TRAUMA

Authors

  • Lal Rehman
  • Azmatullah Khattak
  • Ismail Akbar
  • Mohammad Ilias
  • Amir Nasir
  • Mohammad Siddique
  • Mushtaq Mushtaq

Abstract

Background: Spinal cord injury (SCI) is a devastating condition often affecting young and healthyindividuals around the world. This debilitating condition not only creates enormous physical andemotional cost to individuals but also is a significant financial burden to society at large. The Objectivewas to study the outcome of spinal fixation with fixateur interne in cases of thoracolumbar spinalinjuries in terms of neurological recovery and complications. Methods: This Descriptive study wasconducted at Department of Neurosurgery, Hayatabad Medical Complex and Postgraduate MedicalInstitute, Peshawar, from March, 2006 to December, 2007 Study included patients admitted inNeurosurgery Ward HMC, with acute traumatic spinal injuries during the above mentioned period whounderwent thoracolumbar spinal fixation with fixateur interne. Name, age, sex, other relevant data,history, examination findings and investigation results were recorded. Postoperative outcome wasevaluated taking neurological status, and complications like infection, implant failure and othercomplications into consideration. Follow-up of 6 months was carried out. Results: There were 31patients, (18 male and 13 female). Fall from height (48%), road traffic accidents (26%) and crushinjuries (26%) caused the trauma. Most common age group was from 21–30 years age. Fracturedvertebrae included 2 D11 fractures, 12 D12 fractures, 13 L1 fractures, 3 L2 fractures and 1 L3 fracture.Mean operative time 80 minutes, mean blood loss 200 ml, mean hospital stay 6 days and mortality ratewas 0%. Number of patients with Frankel grade A reduced from 27 to 19 and in Frankel grade Eincreased from 0 to 4 patients. Only one patient had infection and one patient had implant removal.Conclusion: Fixateur interne is a useful and low-cost implant for fixation of thoracolumbar junctioninjuries with very easy availability and easy operative insertion and little blood loss. It has excellentpost-operative outcome in terms of neurological improvement and a very low complication rate.Mortality rate is minimal.Keywords: Spinal Fixation, Fixateur Interne, Thoracolumbar Injuries

References

Ackery A, Tator C; Krassioukov A. A global perspective on

spinal cord injury epidemiology. J Neurotrauma

;21:1355–70

Benz RJ, Garfin SR: Current techniques of decompression of

the lumbar spine. Clin Orthop Relat Res 2001;(384):75–81.

Collins WF: Surgery in the acute treatment of spinal cord

injury: a review of the past forty years. J Spinal Cord Med

;18(1):3–8.

Kuptniratsaikul V. Epidemiology of spinal cord injuries: a

study in the Spinal Unit, Siriraj Hospital, Thailand, 1997-2000.

J Med Assoc Thai 2003;86:1116–21.

Dryden DM, Saunders LD, Rowe BH, May LA,

Yiannakoulias N, Svenson LW, et al. The epidemiology of

traumatic spinal cord injury in Alberta, Canada. Can J Neurol

Sci 2003;30(2):113–21.

Martins F, Freitas F, Martins L, Dartigues JF, Barat M. Spinal

cord injuries--epidemiology in Portugal's central region. Spinal

Cord. 1998; 36:574–8.

Brandenburg MA, Archer P, Mallonee S. All-terrain vehiclerelated central nervous system injuries in Oklahoma. J Okla

State Med Assoc 2005;98(5):194–9.

Dubuisson AS, Kline DG. Brachial plexus injury: a survey of

consecutive cases from a single service. Neurosurgery

;51:673–82. discussion 682–3.

Butt MF, Farooq M, Mir B, Dhar AS, Hussain A, Mumtaz M.

Management of unstable thoracolumbar spinal injuries by

posterior short segment spinal fixation. Int Orthop.

;31:259–64.

Junge A, Gotzen L, von Garrel T, Ziring E, Giannadakis K.

Monosegmental internal fixator instrumentation and fusion in

treatment of fractures of the thoracolumbar spine. Indications,

technique and results. Unfallchirurg 1997;100:880–7.

Nadeem M, Ghani E, Zaidi GI, Rehman L, Noman MA,

Zaman K. Role of Fixateur Interne in Thoracolumbar Junction

injuries. J Coll Physicians Surg Pak 2003;13:584–7.

Liu CL, Wang ST, Lin HJ, Kao HC, Yu WK, Lo WH. AO

fixateur interne in treating burst fractures of the thoracolumbar

spine. Zhonghua Yi Xue Za Zhi (Taipei) 1999;62:619–25.

Koo DW; Fish WW. Spinal cord injury and snowboarding--

the British Columbia experience. J Spinal Cord Med

;22:246–51.

Benson DR, Burkus JK, Montesano PX, Sutherland TB, McLai

n RF. Unstable thoracolumbar and lumbar burst fractures

treated with the AO fixateur interne. J Spinal

Disord 1992;5:335–43.

Lindsey RW, Dick W. The fixateur interne in the reduction and

stabilization of thoracolumbar spine fractures in patients with

neurologic deficit. Spine 1991;16(3 Suppl):S140–5.

Sim E, Stergar PM. The fixateur interne for stabilising fractures

of the thoracolumbar and lumbar spine. Int Orthop

;16:322–9.

Sandvoss G, Feldmann H. Kluger's "fixateur interne" for spinal

instability. Neurosurg Rev 1991;14(2):119–25.

Noack W, Raetzel G. Treatment of spondylolisthesis in

adults using the dorsal approach with the fixateur interne and

a special repositioning device. Z Orthop Ihre Grenzgeb

;126:205–10.

Briem D, Rueger JM, Linhart W. Osseous integration of

autogenous bone grafts following combined dorso-ventral

instrumentation of unstable thoracolumbar spine fractures.

Unfallchirurg 2003;106:195–203.

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Published

2010-03-01

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