Anterior Approach for Surgical Management of Dorsolumbar Fractures
Ibrahim Mahmoud Hegazy;
Abstract
The anatomy of the spine and the paraspinous tissues must be understood prior to attempting any spinal operation. In this essay we discuss the anatomy of the dorsal and lumbar spine including the bony, muscular anatomy and the related nervous elements and blood supply. Also, the important anatomical structures related to anterior spinal approaches are discussed.
Understanding the biomechanics allows one to understand the mechanism of fractures and plan optimal management. So the spinal mechanics are discussed including the mechanics of each individual component of the spinal column, spinal moion and stability, and the mechanics of instrumentation devices.
There are many classification systems for fractures and dislocation of the spine . The most frequently used is the Denis classification. The basis of this classification scheme is integration of the morphological characteristics of the fracture with the biomechanical three-column system spine model. Classification strategies for thoracolumbar fractures helps identification of patients with unstable injuries that will benefit from surgical intervention from those with unstable or stable injuries that can be managed conservatively.
Careful history taking, knowledge of the natural history of the condition and proper examination are important in early diagnosis and in determining the subsequent management and suspecting the expected surgical outcomes.
Routine X rays, CT and MRI are the usual methods used to diagnose spinal fractures, supplemented at times by bone scanning. MRI permits visualization of the soft tissue. Bone scans are often ordered to determine if the bone infection or bone tumor is present. Various additional tests including electrophysiological, and diagnostic laboratory testing, may be performed to identify or confirm the underlying disease process.
The general lines of treatment of thoracolumbar pathology are discussed including the first aid treatment, choice of further line of treatment, indications of stabilization , the time of surgery and the indications of anterior thoracic and lumbar surgery. The prime indication for an anterior approach in spinal traumatology is incomplete neurological deficit related to medullary compression induced by canal stenosis which cannot be managed using any other approach.
There are different ventral surgical approaches according to the level of the lesions. The thoracic spine is exposed easily by temporarily deflating one lung using a double-lumen endotracheal tube. The collapsed lung creates a large empty working space in the pleural space in which to access the thoracic and upper lumbar spine. Transabdominal and retroperitoneal approaches provides excellent access to the lumbar spine and lumbosacral junction. All these approaches for anterior decompression and fixation are discussed in addition to the devices that used for anterior spinal fixation.
Postoperative care and management of postoperative problems are pointed to with mentioning the most important operative complications and possible management of the most important.
Understanding the biomechanics allows one to understand the mechanism of fractures and plan optimal management. So the spinal mechanics are discussed including the mechanics of each individual component of the spinal column, spinal moion and stability, and the mechanics of instrumentation devices.
There are many classification systems for fractures and dislocation of the spine . The most frequently used is the Denis classification. The basis of this classification scheme is integration of the morphological characteristics of the fracture with the biomechanical three-column system spine model. Classification strategies for thoracolumbar fractures helps identification of patients with unstable injuries that will benefit from surgical intervention from those with unstable or stable injuries that can be managed conservatively.
Careful history taking, knowledge of the natural history of the condition and proper examination are important in early diagnosis and in determining the subsequent management and suspecting the expected surgical outcomes.
Routine X rays, CT and MRI are the usual methods used to diagnose spinal fractures, supplemented at times by bone scanning. MRI permits visualization of the soft tissue. Bone scans are often ordered to determine if the bone infection or bone tumor is present. Various additional tests including electrophysiological, and diagnostic laboratory testing, may be performed to identify or confirm the underlying disease process.
The general lines of treatment of thoracolumbar pathology are discussed including the first aid treatment, choice of further line of treatment, indications of stabilization , the time of surgery and the indications of anterior thoracic and lumbar surgery. The prime indication for an anterior approach in spinal traumatology is incomplete neurological deficit related to medullary compression induced by canal stenosis which cannot be managed using any other approach.
There are different ventral surgical approaches according to the level of the lesions. The thoracic spine is exposed easily by temporarily deflating one lung using a double-lumen endotracheal tube. The collapsed lung creates a large empty working space in the pleural space in which to access the thoracic and upper lumbar spine. Transabdominal and retroperitoneal approaches provides excellent access to the lumbar spine and lumbosacral junction. All these approaches for anterior decompression and fixation are discussed in addition to the devices that used for anterior spinal fixation.
Postoperative care and management of postoperative problems are pointed to with mentioning the most important operative complications and possible management of the most important.
Other data
| Title | Anterior Approach for Surgical Management of Dorsolumbar Fractures | Other Titles | التدخل الجراحي الامامى لعلاج كسور الفقرات الصدريه والقطنيه | Authors | Ibrahim Mahmoud Hegazy | Issue Date | 2014 |
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