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Diagnosis and treatment of the spine traumas of the thoracolombar junction


Author: Marcel Şincari
Degree:doctor of medicine
Speciality: 14.00.28 - Neurosurgery
Year:2005
Scientific adviser: Grigore Zapuhlih
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific consultant: Stanislav Groppa
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 20 April, 2005
Approved by NCAA on the 23 June, 2005

Abstract

Adobe PDF document0.48 Mb / in romanian

Thesis

CZU 616.711.5/.6-001-07-089

Adobe PDF document 2.11 Mb / in romanian
121 pages


Keywords

burst fracture; retroperitoneal approach; compromise of the spinal canal

Summary

The spine traumas of the thoracolombar junction are considered to be the major issues of the contemporary medicine, caused by the acute clinical signs, high disability and frequency of the developing complications, as well as problems of diagnosis and treatment.

A number of 70 pateints were observed who had spine tramas of the thoracolumbar junction, confirmed by the compeuted tomography (CT) and Magnetic Resonans Imaging (MRI). The most frequent causes of the spine traumas of the thoracolumbar junction were falling from the height. In the most cases the patients had burst fratctures with compromise of the spinal canal of the II and III degree. This series of patients were dominated by the incomplete neurological deficit. Often average middle-aged population about 32,4 years old got sick, proportion of men men and women being 1,1 / 1. Three major surgical approaches were used: anterior decompression through retroperitoneal approach, lateral approach and posterior approach (laminectomia).

The main indications for operative treatment were the presence of incomplete neurological deficit associated with the compromise of the spinal canal of the II and III degree. Anterior decompression provided an optimum enviroment of the recovery of incomplete neural deficits by achieving better reduction and decompression of the spinal canal. Decompression of the entire anterior aspect of the thecal sac can be accomplished under direct vision, and successful anatomical decompression was demonstrated radiographically in the group of patients operated on through the retroperitoneal approach. The lateral approach allows the surgeon to decompress simultaneously the ventral spinal card and to place instrumention devices dorsally through the same incision, under the same anesthesia.

Persistent bony retropulsion may or may not impair neurological recovery, depending on the sizes of the fragment and the dimensions of the individual patient’s spinal canal. In the cases with burst fractures and kyphosis combined approaches are recommended: anterior decompression of the dural tube through retroperitoneal approach and posterior approach, making use of endocorrector-contractor with purpose of kyphosis correction. The use of the combined approach made possible fast mobilization of the patients.