I.K. Ratkin, A.A. Lutsik, Yu.I. Dotofeev, G.Yu. Bondarenko, A.V. Evsyukov
Novokuznetskaya Clinic of Neurosurgery,
State Institute of Postgraduate Education,
Municipal Clinical Hospital N 29, Novokuznetsk, Russia
While choosing a method of surgical treatment of casualties with spinal trauma at a thoracic level, a surgeon must keep in mind, that it should provide simultaneous decompression of the spinal cord and reliable stabilization of a damaged area of a vertebral column, which will annul possible subsequent development of complications in an operated segment. Trauma at a thoracic level is accompanied by impairment of a supporting complex of the spine with its gross deformity and compression of the spinal cord by bone structures.
Known methods of surgical treatment of complicated fractures of the spine at lower thoracic and upper lumbar levels are, as a rule, characterized by necessity of performing double-stage interventions.
There were 17 cases with spinal trauma at a lower thoracic and upper lumbar levels and a different degree of segmental-conductive disorders of the spinal cord. They were operated in the Novokuznetskaya Clinic of Neurosurgery in 2000-2003. Distribution of patients according to a level of damage (fracture) was as follows: Th9 - 1, Th10 - 2, Th12 - 6, L1 - 6, Th11-Th12 - 1, Th12-L1 - 1.
Decompression of the spinal cord by means of resection of damaged vertebrae, using a anterolateral transpleural approach, was combined with stabilization of an injured segment by a self-wedging interbody reinforced implant, made of porous titanium-nickel alloy. It was the main peculiarity of surgical tactics in these patients. Reinforcing rods, projecting from butt ends of a porous implant, were inserted into vertebral bodies, adjacent to resected vertebra. It allowed to obtain reliable interbody spondylodesis due to appearance of a highly strong compound (titanium nickel alloy-bone tissue) even in resection of two adjacent vertebrae. Preservation of a cortical layer of supporting areas of vertebral bodies around an introduced rod prevented "crumpling" of spongy substance and, as a result, aggravation of kyphotic deformity, when complete restoration of the vertebral axis was impossible. The patients could tolerate axial loads 3 months after operation. However, it was possible only in case of immobilization of the thoraco-lumbar spine with a rigid corset, which allowed these patients to stand.
Thus, a reinforced implant, made of porous titanium-nickel alloy and used as a supporting stabilizing element in decompression-stabilization, is a device of choice in treatment of patients with spinal trauma at a thoracic level. An anterolateral transpleural approach ensures reliable spondylodesis in combination with simultaneous decompression of the spinal cord. Axial load on the spine becomes possible 3 months after intervention in case of its immobilization with a rigid corset.