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Surgical reconstruction and fusion form the treatment of choice for unstable thoracolumbar fractures. It remains difficult, however, to prove that surgical treatment provides an increased potential for neurological recovery. Also, the role of a decompressive laminectomy is still unclear. To address these issues, 93 consecutive cases of thoracolumbar fractures treated with dorsal instrumentation were reviewed. The neurological status at the time of admission and at a mean of 26 months postinjury was graded according to a modified Frankel scale. By using preoperative radiographs and computed tomography scans, we differentiated between fracture-dislocation lesions, dislocation lesions, flexion-distraction lesions, complete and incomplete burst fractures. Spinal stenosis was classified from grade 0 (no stenosis) to grade 3 (> 66% stenosis). All thoracolumbar fractures were treated with posterior instrumentation, using Dick's fixateur interne and Steffee's VSP plates and screws. During this procedure, laminectomy was performed in 33 patients (35%). In 17 cases (52% of the laminectomies), a surgically treatable lesion (dural tear, trapped nerve root, etc.) was found, especially in patients with a combination of a neurological deficit and a dislocation lesion, a fracture-dislocation lesion or a complete burst fracture with spinal stenosis grade 2 or 3. The neurological and functional outcome was excellent: none of the patients deteriorated, 68% made a complete neurological recovery, and 61% regained their previous level of activity.

A consecutive series of 75 patients with fractures of the thoracolumbar spine, stabilized with the Dick internal fixator, was studied retrospectively. Posttraumatic kyphosis was measured on the preoperative lateral radiograph by the Cobb angle and the wedge angle and the results were compared with angles measured on the radiographs after instrumentation and after removal of the implants. The presence and number of broken Schanz screws was noted. In the whole group, an average correction of kyphosis of 15.5° was obtained, but 7.6° was lost again at follow-up. In comparing the kyphotic angle with the wedge angle, we found that this loss was almost exclusively situated in the upper intervertebral disc space. In the group of patients with transpedicular intravertebral bone grafting, the relative loss of correction in the wedge angle was smaller than in the group without bone grafting, while the relative loss of correction of the kyphotic angle was similar. Schanz screw breakage was present in 13.3% of patients, occurring in 4.6% of inserted screws. In the group of patients with broken Schanz screws, the loss of correction in the wedge angle was somewhat higher, but not markedly different from that of the patient group without breakage of screws. Risk of screw breakage was enhanced by laminectomy and reduced by transpedicular bone grafting. Screw breakage or important loss of correction did not influence the neurological outcome of the patients. The Dick internal fixator is a very reliable implant, even in patients with highly unstable fractures. To minimize the risk of screw breakage, transpedicular bone grafting is recommended; laminectomy, however, should only be done under certain strictly defined conditions.

We report a case of bilateral synovial cysts at L4–L5 level, examined by myelography, computed tomography (CT) and magnetic resonance imaging (MRI). On myelography, the lesions appeared as extradural masses. On CT, the lesions were cystic, with calcifiedd walls and were in close proximity to the facet joints. On MRI, the cystic nature of the lesions was confirmed. The wall appeared hypo-intense both on T1- and T2-weighted images (WI), and enhanced after intravenous administration of Gadolinium-DTPA (Gd-DTPA). This enhancement is thought to represent the peripheral fibrous capsule of the lesion and might be of importance both in the detection and the differential diagnosis of these lesions.