Indirect Spinal Canal Decompression Using Ligamentotaxis Compared With Direct Posterior Canal Decompression in Thoracolumbar Burst Fractures: A Prospective Randomized Study.

Autor:	Shokouhi G; Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, Iran., Iranmehr A; Neurological Surgery Department, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences, Tehran, Iran., Ghoilpour P; Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, Iran., Fattahi MR; Tehran University of Medical Sciences, Tehran, Iran., Mousavi ST; Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, Iran., Bitaraf MA; Neurological Surgery Department, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences, Tehran, Iran., Sarpoolaki MK; Neurological Surgery Department, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences, Tehran, Iran.
Jazyk:	angličtina
Zdroj:	Medical journal of the Islamic Republic of Iran [Med J Islam Repub Iran] 2023 May 29; Vol. 37, pp. 59. Date of Electronic Publication: 2023 May 29 (Print Publication: 2023).
DOI:	10.47176/mjiri.37.59
Abstrakt:	Background: There is still no standard of care to manage thoracolumbar burst fractures. With all the recent advances, posterior approaches are still one of the mainstays of treatment. On the other hand, while spinal canal decompression in neurological impaired patients is an important goal of treatment, its technique remains controversial.This study compared the effects of direct laminectomy decompression against ligamentotaxis/indirect canal decompression on neurological and radiographic improvements. Methods: A prospective double-blind randomized clinical trial was conducted on 60 thoracolumbar burst-fracture patients meeting our inclusion and exclusion criteria. They were randomized into 2 treatment arms: (1) direct decompression using laminectomy and (2) indirect decompression using ligamentotaxis/distraction. Each patient was observed for 6 months, and their neurological and radiographical data were collected prospectively. Statistical analysis was done by the Student t test, Friedman test, Mann Whitney-U test, Wilcoxon ranked test, and 1-way analysis of variance. Results: Among 60 patients enrolled in our study, each treatment arm had an improvement in Frankel scores but there was no difference between the groups at any given time. After 6 months of surgery, local sagittal kyphosis improved in both groups (from 32.2 to 7.43 and 29.93 to 8.77 for the indirect and direct groups, respectively), as well as anterior vertebral height ratio (from 57.73 to 70.7 and 62.17 to 66.27 for the indirect and direct group, respectively) and posterior vertebral height ratio (from 61.17 to 74.87 and 64 to 67.5 for the indirect and direct group, respectively). For between-group comparisons after 6 months, there was a significant difference only for posterior vertebral height ratio ( P = 0.040). Conclusion: Posterior approaches with ligamentotaxis have shown to be safe and may present the same outcome as direct decompression techniques using wide laminectomy. Competing Interests: The authors declare that they have no competing interests. (© 2023 Iran University of Medical Sciences.)
Databáze:	MEDLINE
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