The efficiency of ultrasound guided spinal fracture reposition |
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Authors: | L Rudig T Seidel C Düber M Runkel P M Rommens J Degreif |
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Affiliation: | Klinik und Poliklinik für Unfallchirurgie, Universit?tsklinikum, Mainz, XX Klinik und Poliklinik für Radiologie, Universit?tsklinikum, Mainz, XX
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Abstract: | Summary
To calculate canal compromise and decrease of midsagittal diameter caused by retropulsion of fragments into the spinal canal
we analyzed the pre- and postoperative computed tomographies of 32 patients with unstable thoracolumbar burst fractures treated
by USS (universal spine system). Our intention was to examine the efficiency of ultrasound guided repositioning of the dispaced
fragments which was performed in all 32 cases. We found a clear postoperative enlargement of canal area (ASP preoperatively
55 %, postop. 80 %) and midsagittal diameter (MSD preop. 58 %, postop. 78 %). 10 of 13 patients presented a postoperative
improvement of neurological deficit, no neurological deterioration occured. Fractures with neurological deficit showed more
canal compromise (52 %) and less midsagittal diameter (MSD compromise 51 %) than those without (40 % or 39 %). There was no
correlation between the percentage of spinal canal stenosis and the severity of neurological deficit. Below L 1 the spinal
canal is greater than between Th 11 and L 1, so a more important spinal stenosis is tolerated. In case of unstable burst fractures
with neurological deficit the ultrasound guided spinal fracture reposition is an effective procedure concerning the necessary
improvement of spinal stenosis: an additional ventral approach for the revision of the spinal canal is unneeded. In fractures
without neurologic deficit the repositioning of the displaced fragments promises an avoidance of long-term damages such as
myelopathia and claudicatio spinalis.
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Keywords: | Intraoperative spinal ultrasound • Burst fracture • Canal compromise • Spinal fracture reposition |
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