Treatment of unstable thoracolumbar and lumbar spine injuries using Cotrel-Dubousset instrumentation

In this prospective study, the results of treating unstable thoracolumbar and lumbar injuries with Cotrel-Dubousset instrumentation were investigated. To determine the pain and work status of the patients, to evaluate neurologic status, and to assess the efficacy of instrumentation in the short term. Short-segment pedicle screw construct is the method of choice for reduction and stabilization of unstable thoracolumbar spinal injuries. Many investigators have recently reported a high rate of instrument failure. In this study, the use of segmental transpedicular fixation two levels above the kyphosis decreased instrument failure and sagittal collapse. Thirty patients, who had unstable thoracolumbar and lumbar spinal injuries, underwent application from a posterior approach of Cotrel-Dubousset instrumentation two levels above and one below at the thoracolumbar junction and short segment fixation in the lumbar area. Radiologic parameters were evaluated before and after surgery. The mean follow up was 31 months (range, 25-49) months. There were statistically significant differences between the pre- and postoperative values in all radiologic parameters. Neurologic status improved in 70% of the patients, with a mean Frankel grade of 1.3 grades. Cotrel-Dubousset instrumentation provided spinal stability in unstable injuries, forming a rigid construct and restoring physiologic thoracolumbar and lumbar postural contours because of its highly corrective effect in the sagittal profile with no loss of correction.