【Abstract】 Objective: to explore the choice of treatment methods for thoracolumbar spine fractures without spinal cord injury. Methods: 98 patients with thoracolumbar spine fracture admitted from January 2005 to December 2009 were analyzed, of which 31 cases were without spinal cord injury. According to Denis’ three-column theory, 23 cases with spinal injuries accumulating the anterior, middle and posterior columns as unstable were treated with posterior transforaminal pedicle nail internal fixation. Stable 8 cases were treated conservatively. RESULTS: Through the follow-up of 3-24 months, all 31 cases were bony healing by X-ray review, none of them had broken nails or rods, loose internal fixation, and no posterior convex deformity. CONCLUSION: For unstable spinal fracture with internal fixation of pedicle nail, implant fusion to stabilize the spine, early discharging from bed and rehabilitation are beneficial. For stable spinal fractures with vertebral body compression <1/3, padded pillow hyperextension and conservative treatment is also an appropriate treatment option. 【Keywords】 Thoracolumbar spine;fracture;pedicle;fixation Thoracolumbar spine fracture dislocation with spinal cord injury is more common in clinic, and the severe cases are life-long disabled, but there is a controversy in clinical treatment of thoracolumbar spine fracture without spinal cord injury. The authors admitted 31 patients with thoracolumbar spine fracture without spinal cord injury from January 2005 to December 2009, and the follow-up results were satisfactory, reported as follows: I. Clinical data The 31 cases in this group were 26 men and 5 women, aged 25-65 years old, with an average age of 42.5 years old. Time from injury to consultation: 18 cases in 2-24h, 13 cases in 2 days-1 week. Causes of injury: 20 cases of traffic accident injury, 8 cases of fall from height injury, 3 cases of fall injury. Injured segments: T10 4 cases, T11 8 cases, T12-L1 11 cases, L2 5 cases, L3 3 cases. Fractures of other parts of the body (1 rib, 1 pubic bone, 2 tibiofibular fractures) were treated after admission to the hospital. According to the Denis classification[2] , there were 23 cases of vertebral compression fracture and 8 cases of burst[1] fracture. 25 cases were nailed in the injured vertebrae, and 6 cases were nailed in the upper and lower vertebrae across the injured vertebrae. After admission, all of them underwent X-ray, CT or MRI examination, and the vertebral canal was patent, with no bone mass occupying the vertebral body and no posterior protrusion of the intervertebral disk. There were 3 cases with imaging manifestations of osteoporosis. At 3-24 months follow-up, all 31 cases had no loosening of internal fixation, fracture healing, and no loss of vertebral body height by X-ray examination. Non-operative treatment For stable fracture, compression <1/3, no synovial strangulation, no nerve injury, osteoporosis, the lumbar and dorsal cushion over-extension reset method was adopted, 3-5 days later, five-point lumbar and dorsal muscle function exercise, Chinese medicine, analgesia, physiotherapy and other symptomatic treatment, absolute bed rest for 2-3 months, with a brace (or lumbar girdle) to get out of bed. Surgery: For vertebral compression >1/3 combined with mild dislocation of the posterior margin of the vertebral body or the posterior margin of the vertebral body with bone encroachment on the vertebral canal, older people should not be bedridden for a long time, I have a request for surgery, and vertebral instability should be the posterior transpedicular endoprosthetic fixation. Surgical method: After the patient is satisfied with tracheal intubation and general anesthesia, he/she lies prone on the spinal stent, and the skin of the surgical field is routinely sterilized and covered with a sterile towel. The length of the injured vertebra was the length of the upper and lower two vertebrae, incision of the skin, subcutaneous, lumbar dorsal deep fascia, stripping of the spinous processes of the paraspinal sacrospinal muscle and the multifidus muscle, and hemostasis was achieved by filling.C-arm X-ray machine confirmed the injured vertebrae, and then chose to enter the nails in the apex of the crest of the plate and the crest of the attached synchondrosis of the herringbone ridge. A localization needle was placed in the herringbone ridge on one side of the vertebra to be fixed, and the direction and depth of the needle in the pedicle were visualized by X-ray machine. The depth and direction were adjusted according to the positioning needle. According to Prof. Ye Bin’s formula for selecting the length of the nail: measure the data from the intervertebral articular process to the anterior edge of the vertebral body X0.83+3mm for the length of the nail for each vertebral segment, and the length of the nail in the vertebral body reaches more than 80%. Adjust the angle according to the sagittal position of the arch root, and detect the built-in nails in the peripheral bone channel, (mostly 6-8 nails). Requirements for the injured vertebrae: Where the injured vertebrae have intact pedicles and the lower endplates of the vertebrae are not ruptured, non-explosive vertebrae are feasible for injured vertebrae to be nailed, and 60 X 35 shorter nails are selected. After nail placement, fluoroscopy again, nail arrangement in the arch root nail length appropriate according to the physiological curvature of the thoracolumbar vertebrae, molding connecting rods, placement of connecting rods. According to the clinical need for decompression, the vertebral plate was bitten off to investigate the spinal cord and nerve roots and the reset of the bone mass in the canal. A large amount of Gentamic saline is used to flush the incision and stop bleeding, and the spinal cord is protected by artificial dural coverage. A negative pressure drainage tube was placed, and the incision was closed after counting the number of instrument gauze pairs. After surgery, the patient was awake, both lower limbs moved normally, and was sent back to the ward for observation and treatment. The negative pressure drainage tube was removed 48h after surgery, and the patient was bedridden for 2-3 weeks, and got out of bed with a waist cuff. Results: 31 cases were followed up for 3-24 months, average 16 months, before discharge, 3 months and 1-2 years after the operation, X-ray review, there was no loss of vertebral body height, physiological curvature, no internal fixation loosening.CT review showed that the original protruding into the vertebral canal bone reset, vertebral fracture has been healed, no case of N-root injury due to nailing symptoms occurred, normal urination and defecation. The operation time of this group was 90-180 min, average 120 min; intraoperative bleeding was 200-1500 ml, average 650 ml; the height of the anterior margin of the injured vertebrae was 52.6% before the operation, compared with 98.3% 3 weeks after the operation; the Cobb angle was 23° on average before the operation, and the Cobb angle was 5° on average after the operation. Thoracolumbar spine fracture accounts for 3-5% of systemic fracture, which is relatively common in clinical practice, and how to deal with it correctly is controversial. In the past, it was believed that those who had no neurological symptoms could be treated non-operatively, and only those who had neurological symptoms could be treated with decompression surgery. With the development of modern medicine and imaging, people’s understanding of spinal injury has become more profound, more theoretical and systematic. Some patients with post-injury vertebral segment instability and height loss >5% have chronic traumatic myelopathy such as pain at the original fracture site, posterior convexity deformity, and fatigue as they grow older, so they undergo further surgical orthopedics and immobilization. Dick, RF, AF, etc. were introduced into the clinic in the early 80s in China, mostly for the upper and lower vertebral segments across the injured vertebrae, with 4 nails and 2 rods for fixation. For restoring the height of the recent efficacy is good. With the passage of time, it has been reported in the literature that most scholars analyzed that the stress of 4 nails and 2 rods is mostly concentrated in the junction of the nail and the tail, and the 4 nails of short segments are prone to shear force, and reported that AF and RF have broken nails and rods in the clinic. Some scholars according to the injured vertebrae have one side of the pedicle and the lower end plate if intact, in the injured vertebrae on the nail (60X35mm) 6-8 nails and 2 rods, through the clinical observation, to restore the height of the injured vertebrae, stabilize the spinal column, not easy to produce shear force, better than 4 nails and 2 rods. We have observed for many years that there is no case of broken nails and rods, loss of vertebral height and postoperative Cobb’s angle. Depending on the intraoperative assessment of the injury: ① the recognition of implant fusion, the restoration and fixation is part of the success, the key is the implant fusion of the vertebral segment after fixation. If the injured vertebrae are eggshells after surgery, the height will inevitably be lost, to be intervertebral bone grafting via the pedicle, filling the empty shell of the vertebral body, solving the problem of bone particles do not leak into the spinal canal, to be permanent fusion stabilization. ② Only internal fixation without bone graft fusion is highly undesirable way of fusion fixation is the main weight-bearing part of the motion segment, more in line with the biomechanical principles, good recovery of the weight-bearing function of the spine, the spine has a stronger load-bearing capacity. ③ With the degree of violence in the spine, the small joints between the vertebrae and the ligament muscles next to the vertebrae are broken, biomechanical strength is reduced, postoperative five-point lumbar and dorsal muscle exercise should be used, method: 1-2 weeks after the operation, straight leg raising exercise in bed, to enhance the muscle strength of the two lower limbs and to promote blood reflux; 3-6 weeks, prone position to do the lower back and legs of the small Yanfei exercise, early to prevent the placement of the nail loosening. 6 weeks after the five-point lumbar and back muscle exercise in bed. After 6 weeks, perform five-point lumbar and dorsal muscle functional exercises in bed. This is to prevent atrophy and weakness of the lumbar back muscles in a gradual manner. Postoperative guidance for patients to train correctly is to promote the recovery of thoracolumbar spine fracture after surgery.