Surgical timing prevails as the main factor over morphologic characteristics in the reduction by ligamentotaxis of thoracolumbar burst fractures

BMC Surgery, 2023 · DOI: https://doi.org/10.1186/s12893-023-02061-z · Published: June 8, 2023

Surgery Orthopedics Musculoskeletal Medicine

Simple Explanation

Thoracolumbar burst fractures involve the middle part of the spine and often cause spinal canal narrowing. This study investigates how well a surgical technique called ligamentotaxis can restore the canal's width. Ligamentotaxis aims to reduce the fracture by using the posterior longitudinal ligament to pull back displaced bone fragments. The study explores whether the shape of the fracture or the timing of the surgery affects how well this technique works. The study found that the timing of surgery and the amount of distraction achieved during the procedure are more important for successful fracture reduction than the specific characteristics of the fractured bone fragments.

Study Duration

2010-2021

Participants

58 patients diagnosed with a thoracolumbar burst fracture

Evidence Level

Cross-sectional study

Key Findings

1
Ligamentotaxis significantly improved canal occupation, endplates distance, and vertebra height postoperatively.
2
The temporality of the procedure was associated with the procedure’s capacity for reduction.
3
Endplates distance was also statistically significantly associated with the outcome.

Research Summary

This study evaluated the effectiveness of indirect reduction by ligamentotaxis in thoracolumbar burst fractures based on radiologic characteristics and procedure timing. The study found that postoperative ligamentotaxis significantly improved all radiologic parameters, including canal occupation, endplates distance, and vertebra height. Fragment reduction effectiveness is more significant when performed early and with adequate distraction, and the radiologic characteristics of the fragment do not determine its reduction capacity.

Practical Implications

Surgical Timing

Performing ligamentotaxis as early as possible after the fracture can lead to better reduction of the fracture and decompression of the spinal canal.

Adequate Distraction

Achieving adequate distraction using an internal fixator system is crucial for maximizing the effectiveness of ligamentotaxis.

Focus on Technique

Surgeons should focus on optimizing the surgical technique and timing rather than being overly concerned with the initial characteristics of the fractured bone fragments.

Study Limitations

1
The study focused solely on the percentage of occupation of the medullary canal as the reduction parameter.
2
Only 24% of the variability in the change in channel occupancy is explained by the multiple regression formula.
3
Further evidence is required to determine the optimal timing for surgery when performing reduction by ligamentotaxis.

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