Burst fractures of the thoracolumbar spine: changes of the spinal canal during operative treatment and follow-up

Although multiple studies have concluded operative decompression of a traumatically narrowed spinal canal is not indicated because of spontaneous remodeling, instrumental decompression is frequently used as part of the operative treatment of spinal fractures. To investigate the process of remodeling, we studied the diameter of the spinal canal in 95 patients with burst fractures at the thoracolumbar junction (T9-L2). To measure and compare the spinal canal's diameter we used either computed tomography (CT) scans or radiographs, made preoperatively, postoperatively, after 9 months and after 24 months. In lateral plain radiographs we found that the initial percentage of cases with bony canal narrowing preoperatively of 76.5 was reduced to 18.4% postoperatively, to 8.2% at 9 months, and to 2.4% at 24 months. In CT scans in a selection of patients, the mean residual diameter of the spinal canal was 53% preoperatively and 78% at 24 months. The posterior segmental height increases during operation and decreases in the respective periods after operation. So ligamentotaxis can only play a role in the perioperative period. We conclude that a significant spontaneous remodeling of the spinal canal follows the initial surgical reduction. Two years after operation, bony narrowing of the spinal canal is only recognizable in 2.4% of the patients on plain lateral radiographs. The remodeling of the spinal canal can be seen on plain radiographs, although not as accurately as on CT scans.