Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 54, Num. 3, 2006, pp. 317-317

Neurology India, Vol. 54, No. 3, July-September, 2006, pp. 317

Letter To Editor

Combined anterior and posterior decompression and short segment fixation for unstable burst fractures in the dorsolumbar region

Pandher DS, Oh KJ, Lee SH

Department of Orthopedics, Konkuk University Hospital, Konkuk University School of Medicine, 4-12 Hwayang-dong, Kwangjin-gu, Seoul, South Korea
Correspondence Address:Department of Orthopedics, Konkuk University Hospital, Konkuk University School of Medicine, 4-12 Hwayang-dong, Kwangjin-gu, Seoul, South Korea, Email: dilbans@yahoo.com

Date of Acceptance: 17-Jul-2006

Code Number: ni06106

Sir,

We have read with interest the article "Combined anterior and posterior decompression and short segment fixation for unstable burst fractures in the dorsolumbar region" by Ramani et al.[1]

We have interest in the short segment fixation and it is an eloquently written article highlighting the benefits of short segment fixation and need for combined fixation.

The authors have mentioned about locally manufactured implants and instruments in their country, which, according to them, made combined approach with short segment fixation most appropriate. But the authors have not elaborated the design of their implants and instruments in this article. It would have been much better if they had described how their implants were different from others that are commonly being used, so that the readers could make a note and if appropriate, use those specific instruments and implants to improve their results.

Secondly, the main concern of short segment fixation is that it fails to prevent further collapse of vertebra,[2] thus resulting in significant deformity. The authors have not mentioned anything about the radiological measurements concerning vertebral height and kyphosis angle. This information could be helpful in proving the superiority of the combined approach over posterior approach. Neurological recovery is not a direct measure of successful fusion, as it would occur in any case in partial-loss patients even with conservative treatment. The purpose of surgery is to allow early ambulation along with maintaining vertebral height.

Finally, the benefit of short segment fixation lies in less stiff spine on long-term follow-up. Authors have discussed this in details but have failed to mention any of their own observations in this regard.

References

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