Comparability of Wiltse’s paraspinal strategy and open e-book laminectomy for thoracolumbar burst fractures with greenstick lamina fractures: a randomized managed trial.
J Orthop Surg Res. 2018 Mar 02;13(1):43
Authors: Chen ZD, Wu J, Yao XT, Cai TY, Zeng WR, Lin B
BACKGROUND: Posterior short-segment pedicle screw fixation is used to deal with thoracolumbar burst fractures. Nonetheless, no randomized managed research have in contrast the efficacy of the 2 approaches–the Wiltse’s paraspinal strategy and open e-book laminectomy within the therapy of thoracolumbar burst fractures with greenstick lamina fractures.
MATERIALS AND METHODS: Sufferers with burst fractures of the thoracolumbar backbone with out neurological deficit have been randomized to obtain both the Wiltse’s paraspinal strategy (group A, 24 sufferers) or open e-book laminectomy (group B, 23 sufferers). Sufferers have been adopted postoperatively for common of 27.four months. Scientific and radiographic information of the 2 approaches have been collected and in contrast.
RESULTS: Our outcomes confirmed the anterior segmental top, kyphotic angle, visible analog scale (VAS) rating, and Smiley-Webster Scale (SWS) rating considerably improved postoperatively in each teams, indicating that each the Wiltse’s paraspinal strategy and open e-book laminectomy can successfully deal with thoracolumbar burst fractures with greenstick lamina fractures. The Wiltse’s paraspinal strategy was discovered to have considerably shorter working time, much less blood loss, and shorter size of hospital keep in comparison with open e-book laminectomy. Nonetheless, there have been two (2/24) sufferers in group A that had neurological deficits postoperatively and required a second exploratory operation. Dural tears and/or cauda equina entrapment have been subsequently present in 4 sufferers in group B and all two sufferers of neurological deficits in group A throughout operation. No screw loosening, plate breakage, or different inner fixation failures have been discovered at closing follow-up.
CONCLUSIONS: The outcomes demonstrated that both of the 2 surgical approaches can obtain passable leads to treating thoracolumbar burst fractures in sufferers with greenstick lamina fractures. Nonetheless, if there’s any scientific or radiographic suspicion of a dural tear and/or cauda equina entrapment pre-operation, sufferers ought to obtain an open e-book laminectomy to keep away from a second exploratory operation. Extra analysis remains to be wanted to optimize scientific decision-making relating to surgical strategy.
PMID: 29499742 [PubMed – indexed for MEDLINE]