The role of surgical treatment in the rehabilitation protocols of thoraco-lumbar spine injuries

F. De Iure, J. Bonavita, M. Saccavini, L. Mavilla, G. Bosco, S. Boriani

Department of Oncologic and Degenerative Spine Surgery, Rizzoli Institute, Bologna, Italy. giusbosco@libero.it

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• Orthopedics

BACKGROUND: Rehabilitation is a crucial issue in the management of spinal cord injuries (SCI) but, in these patients, the primary treatment can bias the outcome of recovery protocols.

AIM: Purpose of this paper is to review our case load in the treatment of surgical failures and to define the role of surgery in thoraco-lumbar injuries rehabilitation.

PATIENTS AND METHODS: Between 2000 and 2009 seventy patients with post-traumatic paraplegia were referred to Surgical Department as rehabilitation was unfeasible due to inadequate spine injury treatment. Forty-six had had surgery, 24 were treated conservatively Twenty-five patients had a thoracic lesion, 9 a lumbar lesion and 36 a lesion of the thoraco-lumbar junction. A total of 44 surgical procedures were performed (by anterior, posterior or anterior-posterior).

RESULTS: On postoperative imaging sagittal alignment was found good in 93% of cases and acceptable in 7%. All patients regained the sitting position within 5 days after surgery. Wound healing problems requiring revision were observed in 4 cases. Major complications were a cerebro spinal fluid (CSF) leakage and a massive pulmonary embolism case in the early post-op.

CONCLUSIONS: Wrong primary treatment frequently leads to demanding revision procedures with increased risks for the patient and more than double costs for the health care system. Whatever the technique a stable spine is the target in surgery of SCI allowing a quick and effective rehabilitation without external orthosis.

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