TRANSDIAPHRAGMATIC APPROACH TO THORACOLUMBAR JUNCTION FRACTURES

Thoracolumbar Junction Fractures

Abstract

Objective: The purpose of this study is to share experience with transdiaphragmatic approach to thoracolumbar junctions for adequate exposure, decompression, reconstruction and fixation. 
Design:  Quasi-experimental study.
Place and Duration of Study: Neurosurgery department Peoples Medical College Nawabshah, from January 1999 to December 2004.
Patients and Methods: Patients with thoracolumbar junction fractures were being studied. Plain x-rays, CT scan, myelography or MRI were done for assessment and planning. Anterior approach by thoraco-phrenico-laparotomy was used for adequate decompression and stabilization with Webb Morley system.
Results: Males dominated. Adults and middle age groups suffered mostly. Neurological improvement was seen in 17 (47.2%) cases. Bony fusion was observed in 32 (88.9%) cases.
Conclusion: Phrenotomy for anterior approach to thoracolumbar junction provides adequate exposure to facilitate decompression of the cord and instrumentation. Patients with partial neurological deficit improve well than with complete neurological deficit. Most of the patients improve by 1 grade on American spinal injury association (ASIA) scale.