Tratamiento quirúrgico de las fracturas vertebrales mediante instrumentación segmentaria Cotrel-Dubousset

espanolLos autores presentan su experiencia personal en el tratamiento quirurgico de las fracturas vertebrales toracicas y lumbares. Han sido incluidos en el estudio 27 pacientes operados entre 1988 y 1991, todos ellos estabilizados mediante la instrumentacion Cotrel Dubousset. Excepto tres pacientes, todos fueron intervenidos por via posterior. Se realiza un estudio de los resultados obtenidos desde el punto de vista radiologico (indice sagital, porcentaje de ocupacion de canal), funcional y neurologico. La fractura estallido fue la mas frecuente (52% de los casos). En 17 pacientes (63%) se objetivo lesion neurologica, 3 de los cuales (11%) mostraban paraplejia completa, no obteniendo mejoria tras la intervencion. Todos los restantes mejoraron al menos un grado en la escala de Frankel modificada. No se registro pseudoartrosis. El indice sagital no mostro perdidas superiores a 7o . La perdida de altura del cuerpo vertebral fue inferior al 10%. La correccion del muro posterior no presento perdidas durante el seguimiento. Se concluye, que mediante las instrumentaciones segmentarias por via posterior se puede obtener en la mayoria de las ocasiones una estabilidad mecanica y neurologica suficiente de la columna vertebral, incluyendo un numero minimo de niveles sanos, aunque precisando de ortesis durante el postoperatorio. EnglishThe authors showed their experience on the surgical management of thoracic and lumbar fractures. A total of 27 patients surgically treated from 1988 to 1991 by posterior approach have been included in the study. Cotrel-Dubousset instrumentation was used in all cases. Except for three patients, all were operated on by posterior approach. In the burst fractures, decompression and reduction of the posterior wall was performed by transpedicular approach. The results obtained from the radiological (sagittal index, canal occupation) as well as functional and neurological point of view were reviewed. Burst fracture was the must frequent type (52% of cases). Seventeen patients (63%) showed neurological damage, 3 of them with (11%) had paraplegia and did not show any recovery after surgery. Those with incomplete neurological lesion improved at least one or two degrees on the Frankel's score. Neither pseudoarthrosis; nor loss of more than 7 degrees in the sagittal index were observed. The percentage of height loss of vertebral body was always less than 10%. When the sagittal index augmented, it was related with a collapse of discal space. Posterior wall alignement did not suffer loss of correction during follow-up. The CD segmentary instrumentation seems to be an efficient system for stabilization of vertebral fractures. CD shows a wide versatility adapting to different topographic lesions and saving healty levels. However, CD is less efficient with flexion stress and therefore patients require postoperative bracing in lordosis.