The Journal of Bone and Joint Surgery, Vol 67, Issue 1 89-104, Copyright © 1985 by Journal of Bone and Joint Surgery, Inc
Anterior decompression of traumatic thoracolumbar fractures with incomplete neurological deficit using a retroperitoneal approach
PC McAfee, HH Bohlman and HA Yuan
Between 1973 and 1981, seventy patients with a spinal cord injury secondary
to a thoracolumbar fracture were treated by anterior spinal-canal
decompression through a retroperitoneal approach. All of these patients had
an incomplete neurological deficit caused by retropulsed vertebral-body
fragments and intervertebral disc material in the spinal canal. Forty-eight
patients have been followed for an average of 3.4 years (range, two to 8.6
years). Either computed tomography or lateral tomography, or both, was
performed after surgery on these forty-eight patients, and confirmed the
successful removal of the cause of compression in all of them. No patient
lost further cord or cauda equina function after the anterior
decompression. Thirty-seven of the forty-two patients who had a motor
deficit improved by at least one class in motor strength. Fourteen of the
thirty patients whose quadriceps and hamstrings were too weak to permit
walking regained full independent walking ability. Twelve of the thirty-two
patients who had a conus medullaris injury demonstrated neurogenic bowel
and bladder recovery. The degree of neurological recovery of spinal cord
injury after anterior spinal decompression of thoracolumbar fractures
appears more favorable than after other, previously reported techniques
that do not decompress the spinal canal.
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