Ventral Plus Dorsal Techniques for Thoracolumbar Arthrodesis

摘要

An unstable thoracolumbar fracture with incomplete neurologic deficit requires decompression and stabilization. The choice of surgical approach and the extent of fusion are dependent upon numerous factors, including the pattern and level of the fracture, the comorbidities of the patient, and the experience of the surgeon. In a patient with an unstable fracture of L1with dorsal retropulsion of fragments into the spinal canal, we would consider a two-stage surgical procedure. In the first stage, T12 to L2 is exposed via a thoracoabdominal approach. A corpectomy of L1 allows access for ventral decompression of the thecal sac. A titanium cage filled with autograft can be used for replacement of L1 with supplementation by a ventral rod construct from T12 to L2. Some patients may require supplemental dorsal tension band reconstruction. In the second stage, a dorsal pedicle screw and rod construct from T11 to L3 can enhance stability and spread the stresses of the reconstruction over subsequent levels. Adequate decompression of the spinal canal with subsequent reconstruction and stabilization of L1 optimizes the environment for functional rehabilitation and recovery.