DECISION-MAKING AND TECHNICAL CHOICE IN INSTRUMENTAL FIXATION FOR NEUROLOGICALLY UNCOMPLICATED ISOLATED BURST FRACTURES OF THE THORACIC AND LUMBAR VERTEBRAE
Objective. To substantiate the principles of context-based optimal decision-making and technical choice in instrumental fixation of the spine in trauma patients with neurologically uncomplicated isolated burst fractures of the thoracic and lumbar vertebrae. Material and Methods. A comparative retrospective analysis of treatment outcomes of 206 trauma patients was performed. Patients of Group 1 (n = 17) underwent anterior spinal fusion with anterior instrumental fixation through isolated open anterior approach, those of Group 2 (n = 80) - open pedicle screw fixation, of Group 3 (n = 70) - posterior mini-invasive percutaneous pedicle screw fixation, of Group 4 (n = 20) - open pedicle screw fixation with the extended laminectomy and reconstruction of the anterior column, and of Group 5 (n = 19) - open pedicle screw fixation and anterior fusion through an open approach. Non-parametric statistical methods were used. Results. Open or minimally invasive posterior instrumental fixation of the spine with instrumentation systems including 6 screws for incomplete burst fractures and 8-10 screws for complete burst fractures should be considered the best operative option in the immediate post-traumatic period (up to 7 days) both from the point of view of convenience and safety of the patient and from the standpoint of maximally effective use of any hospital resources. The use of open anterior approaches for the reconstruction of the anterior spinal column can be justified only when the time from injury exceeds 7 days, as a part of combined procedure, primarily in combination with minimally invasive posterior pedicle screw fixation. Conclusion. To date, decision-making and technical choice in instrumental fixation for neurologically uncomplicated isolated burst fractures of the thoracic and lumbar vertebrae should be context-based. The decision-making algorithm should be built on the basis of the experience of the operating surgeon, the time from injury, the trauma patient’s state of health, as well as the administrative and logistical context of provision of the specialized medical care.