Question:Our nephew was in a terrible motorcyle and broke the middle of his spine in half. He had a six-hour surgery to put screws in place to hold the spine upright while it heals. He's up walking already and not even using a brace. We're more than a little concerned about this. Shouldn't he have some kind of external support?
Answer:Reduction and fixation of spinal fractures in the thoracic spine can be a very complex procedure. Sometimes the facet (spinal) joints get disrupted overlap one another. They must be distracted, unlocked, and repositioned.
To do this, the surgeon can place screws through the pedicles of the vertebrae. The pedicle is the area of vertebral bone between the upper facet of one spinal segment and the lower facet joints of the adjacent spinal segment.
Usually a long rod that is curved to match the shape of the spine is attached to the screws. The surgeon uses the screws to hold and tighten the rod in place. X-rays taken in the operating room help the surgeon judge the correct facet position. Getting the upper and lower facet joint surfaces to match will ensure proper positioning and prevent deformity.
At the same time, bone chips are harvested from the patient's iliac crest (top of the pelvic bone). The bone graft is placed across the top and bottom of the rod and screws. With the rod and bone graft in place, bracing may not be needed.
The pedicle screws go through 80 per cent of the depth of the vertebrae. The implants are designed to withstand fatigue failure even during the acute healing phase. The patient has some activity restrictions during the first four months until the fusion is strong enough to support more vigorous activities. There are usually some lifelong restrictions as well.Samuel Abraham Joseph, Jr, MD, et al. The Successful Short-Term Treatment of Flexion-Distraction Injuries of the Thoracic Spine Using Posterior-Only Pedicle Screw Instrumentation. In Journal of Spinal Disorders & Techniques. May 2008. Vol. 21. No. 3. Pp. 192-198.
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