[Clinical diagnosis and treatment of multiple level thoracolumbar spinal fractures].

Objective: To investigate the clinical characteristics and methods of diagnosis and treatment multiple level thoracolumbar spinal fractures.

Methods: From March 2002 to March 2006, 17 patients with 35 thoracolumbar spinal fractures were treated, 13 males and 4 females, aged 21-52 years old (36.4 on average), among whom there were 10 cases of traffic accident injury and 7 of high falling injury. One fracture was located at T2, 1 at T3, 1 at T10, 4 at T11, 6 at T12, 5 at L1, at L2, 7 at L3, 5 at L4, and 2 at L15, with a total of 35 segments including 26 segments with unstable fractures and 9 segments with stable compression fractures. According to the Frankel grade, there was 1 case of grade A, 1 of grade B, 2 of grade C, 5 of grade and 8 of grade E. The preoperative height of the anterior border of the vertebral body was (20.8 +/- 3.8) mm and the preoperative kyphosis angle was (16.2 +/- 3.4) degrees. All the unstable fractures were performed operation. Sixteen injured vertebras were treated with long-segment pedicle screw internal fixation; 8 were treated with short-segment pedicle screw internal fixation, and 2 were treated with anterior fusion and fixation. Five injured vertebras with stable compression fractures were not treated and 4 were treated with pedicle screw implantation.

Results: The operation time was 1.8-4.2 hours and the amount of blood loss was 300-900 mL. The incisions obtained healing by first intention after the operation. All 17 patients were followed up for 13-41 months (18 months on average), and radiological evaluation showed no failure of the internal fixation. After the operation, Frankel scale assessment showed that 1 patient of grade A improved to grade B, 1 of grade B improved to grade C, 1 of grade improved to grade D, 1 of grade C improved to grade E, 5 of grade D improved to grade E, and 8 of grade E had no improvement. At the final postoperative follow-up, the height of the anterior border of the vertebral body was (31.9 -/+ 3.2) mm and kyphosis angle was (6.8 +/- 3.7) degrees, which were significantly different from those of preoperation (P < 0.01).

Conclusion: The treatment of multiple level thoracolumbar spinal fractures should be individualized according to the patients' actual conditions in order to obtain decompression and stability of spines.