Abstract
Based on a retrospective review of 101 injuries of the thoracolumbar spine operated at the Orthopaedic and Traumatological Clinic of the Third Medical Faculty, Charles University in 1991-1995 the authors followed up a group so-called pincer fractures. A typical feature of these fractures is a comminuted zone of the median portion of the vertebral body, dislocation of the anterior fragment of the vertebral body in a forward direction and filling of the gap which thus arises with material from the torn intervertebral disc. "Pincer" fractures tend to develop into pseudoarthroses.
In the investigated group 14 fractures of this type were found (14 %). All injuries were treated from a posterior approach by internal AO fixation or USS fixation resp. in two patients in the second stage an anterior approach was used and the vertebral body was substituted.
Based on analysis of the initial morphology of the fractures and the peroperative reponibility of the dislocated fragment of the anterior part of the vertebral body the injuries were classified into three groups and indication criteria for surgery were established. Groups with a non-dislocated or reponible anterior fragment can be treated from the back only by instrumentation, posterior fusion and transpedicular spongioplasty with transpedicular intercorporal desis, the group with an irreponible anterior fragment must be treated by posterior instrumentation and fusion and subsequently from an anterior approach by substitution of the vertebral body and anterior fusion.