Treatment of unstable thotacic spine traumatic injuries using Hartshill rectangle

Abstracts

Foram avaliados 14 pacientes com lesão instável da coluna torácica e lombar, tratados com instrumentação de Hartshill. De uma forma geral, obtivemos bons resultados com a técnica proposta.

Lesões traumáticas instáveis da coluna; lesões traumáticas da coluna torácica e lombar; retângulo de Hartshill

ARTIGO ORIGINAL

Treatment of unstable thotacic spine traumatic injuries using Hartshill rectangle

Júlio César Pereira da Cunha^I; Jorge Mauad Filho^II; Nelson Hely Mikael Barsam^III; José Wagner de Barros^IV

^IEx-Resident

^IIMaster in Orthopaedics and Traumatology from FMRP-USP, Head of Spine Surgery Sector

^IIIOrtopaedist Surgeon

^IVChairman

^{Correspondence}

SUMMARY

Fourteen patients with unstable thoracolumbar spine injuries treated with Hartshill's instrumentation have been evaluated. Good results were generally achieved using this technique.

Key words: unstable spine trauma, trauma thoracolumbar spine, Hartshill's instrumentation

INTRODUCTION

Open reduction and internal fixation is routine procedure when treating unstable injuries of thoracic and lumbar spine^{(3, 19)}. New advances in fixation devices brought significant advances to spine stabilization^{(4, 5,13,15,17)}. The rectangle⁽⁶⁾, used in the last decades has demonstrated relevant clinical results^(6,19).

The objective of this study is to evaluate 14 patients with unstable injury of thoracic and lumbar spine, who were treated with Hartshill's instrumentation plus arthrodesis.

CASES AND METHODS

Between July, 1990 and April, 2000, 14 patients with unstable injury of thoracic and lumbar spine underwent surgical treatment with Hartshill's instrumentation plus arthrodesis. From these patients, 11 (78.6%) were male and three (21.4%) female. Age ranged between 16 and 42 years, average approximately 29 years.

Patients underwent AP and lateral radiograph (Figures 1 A-B). Thoracic spine was involved in six patients (42.9%), lumbar in six (42.9%) and thoracolumbar in 2 (14.2%).

The injuries were evaluated according to American Spinal Injury Association (ASIA)⁽¹⁶⁾ (Table 1). Ten (71.4%) were rated as C and four (28.6%) as B. In preoperative evaluation, patients were clinically evaluated, with a careful screening for neurologic damage, according to the scale⁽⁸⁾Table 2. General characteristics of these patients is in Table 3. Internal fixation device was a Hartshill's rectangle with 26.3 mm wide and ranging from 40 to 400 mm long, using Luque wires with diameters of 1 and 1.2 mm.

Patients underwent general anesthesia, and placed in ventral decubitus. Approach as median longitudinal. After exposure of spinal processes of involved vertebras, and two vertebras above and two below the injury, a reduction was performed and when necessary, decompressive laminectomy was performed. Lesions were stabilized with the previously molded Hartshill's rectangle and Luque wires fixed to the laminas above and below the lesion (Figures 2 A-B). Arthrodesis was performed by cancellous bone graft from iliac or spinal processes.

Postoperatively patients underwent a new clinical evaluation according to the scale of neurologic damage⁽⁸⁾ (Table 2) and radiographic evaluation performed at 30, 60 and 90 days.

Patients presenting walking conditions Fran-kel D and E were allowed early walking using a Jewet vest for 3 months, and not walking patients, Fankel A, B and C were referred to Physiotherapy for rehabilitation.

RESULTS

From the 14 evaluated patients, postoperatively 5 (35.8%) were Frankel A, 7 (50%) Fran-kel B, 1 (7.1%) Frankel C and 1 (7.1%) Frankel E.

From the 5 Frankel A patients, 2 kept the result, one became B, one O and the other one became E. From the 7 Frankel B, two became C, three O and two E. The Frankel C patient, became E. The Frankel E remained as E. Postoperative clinical evolution of the patients, is in Table 4.

No secondary complication was observed, such as infection, loss of reduction or failure of the implant. Only one patient presented with persistent pain, remitting four weeks after treatment with NSAID.

DISCUSSION

Unstable injuries of thoracic and lumbar spine have been widely discussed regarding surgical treatment^{(4,5,13,15,17)}.

Some authors recommend reconstruction and stabilization of the posterior part of the spine with the implant working as a tensor⁽²⁰⁾. Others prefer anterior approach and fixation⁽¹⁾, not considering the axial load to anterior spine. And others recommend a fixation both anterior and posterior, as the best stabilizing method^(10,9). Generally, all methods recommend instrumentation with arthrodesis that allow stabilizing the lesions^(11,12,18), being indicated to reduce morbidity and shorten in hospital stay^(2,14).

Reduction and fixation of fractures, with anatomical restoration of unstable injuries of thoracic and lumbar spine allow an stability that allows a better evolution in patients with a neurologic deficit⁽⁷⁾.

The results of this series were similar to those in the literature, when compared to other instrumentation techniques^(13,15), monosegmental fixation with transpedicular screws⁽⁵⁾ and Harms method⁽⁴⁾.

The Hartshill's rectangle used by us, allowed a best postoperative stabilization and demonstrated to be a good option for posterior fixation of unstable injuries of thoracic and lumbar spine in this group of patients.

CONCLUSIONS

Internal fixation and anatomical restoration of unstable lesions of thoracic and lumbar spine with Hartshill's rectangle allowed stability to the fractures and proved to be adequate in treatment of patients with severe traumatic spinal injury.

REFERÊNCIAS BIBLIOGRÁFICAS

*Work performed at Department of Orthopaedics and Traumatology from Hospital Escola da Faculdade de Medicina do Triângulo Mineiro - Uberaba - MG

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Correspondence to

José Wagner de Barros

Disciplina de Ortopedia e Traumatologia

Departamento de Cirurgia do HE/FMTM

R. Getúlio Guaritá S/Nº

Bairro Abadia - CEP 38025-440 - Uberaba - MG

Publication Dates

• Publication in this collection
  21 Sept 2005
• Date of issue
  Mar 2002

History

• Accepted
  27 Nov 2001
• Received
  03 Jan 2001