Intraoperative spinal sonography in thoracic and lumbar fractures: evaluation of Harrington rod instrumentation

Thirty-seven patients with thoracic and lumbar spine fractures were treated with Harrington rod instrumentation (HRI), and the progress and results of that surgery were monitored with intraoperative spinal sonography (IOSS). Adequate neural tissue decompression and spinal column alignment was achieved in less than one-half (14/31, 45%) of the patients in whom HRI was performed as the first step of the surgical procedure. As a result of these findings, further surgical maneuvers were performed which, in most cases, resulted in adequate spinal realignment and neural tissue decompression. In six patients, direct surgical reduction of displaced bone fragments was performed before HRI. Since total decompression of neural tissue may be important in patients with spinal cord or cauda equina injuries, it is recommended that IOSS be used in all cases of HRI for thoracic and lumbar spine fractures. The need to perform additional surgical maneuvers to accomplish neural tissue decompression may be obviated if intraoperative sonography shows adequate decompression with HRI alone.