Application of real-time B-mode ultrasound in posterior decompression and reduction for thoracolumbar burst fracture

This study aimed to investigate the role of real-time B-mode ultrasound in posterior decompression and reduction and to observe the signal changes in spinal cord blood flow in a thoracolumbar burst fracture (TBF). Between February 2004 and December 2008, 138 patients with TBF were divided into group A (108 cases) and group B (30 cases). In group A, under the assistance of real-time B-mode ultrasound, posterior decompression and fracture piece reduction were performed, and we observed the signal changes in spinal cord blood flow. In group B, posterior fenestration was combined with pushing the fracture piece into the fractured vertebral body using an L-shaped operative tool. Presurgical and postsurgical recovery of neurological function was evaluated according to American Spinal Injury Association (ASIA) standards, and the range of spinal decompression was determined by measuring the proportion of encroached fracture piece in the spinal canal (spinal stenosis rate) on the computed tomography (CT) image. In group A, 12 patients had a grade A spinal injury according to the Frankel grading system, and there were six cases without neurological recovery. In the other patients, neurological function increased by 1-3 grades. There were no aggravated spinal cord injuries or other serious complications. In group B, three patients were categorized as grade A and there were two cases without neurological recovery. In the other patients, neurological function increased by 1-3 grades. In groups A and B, the postsurgical spinal stenosis rate was significantly lower than the presurgical stenosis rate (P<0.05). The postsurgical spinal stenosis rate in group B was significantly higher compared with group A (P<0.05). There was no significant difference in neurological function recovery between the groups (P>0.05). Real-time B-mode ultrasound is an effective method for posterior decompression and reduction and to observe signal changes in spinal cord blood flow in TBF.