A Clinical Study of Single Stage Postero-Lateral Transpedicular Decompression with Screw Rod Fixation in Traumatic ThoracoLumbar Spinal Injuries (original) (raw)
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Egyptian Spine Journal, 2013
Background Data: Treatment of spinal injury aims for restoration of spinal anatomy, relieving the pain and achieving stability without neurological damage. One of the recent surgical approaches to spinal cord compression is transpedicular re-impaction of retro-pulsed vertebral body fragments and/ or partial or complete corpectomy with verebroplasty and posterior fixation. Purpose: to assess the effectiveness of the transpedicular approach in spinal decompression, reconstruction, realignment and fixation. Study design: prospective clinical case study. Patient and Methods: we report on 25 patients with traumatic dorso-lumbar fracture causing anterior neural compression. Ten patients were males and 15 were females. The mean age was 39.4±16.8 (range 17-60). Outcome measures: clinical outcome was assessed by visual analogue scale for pain and ASIA-Imsop scale for motor. Radiological outcome assessed canal compression, vertebral height and kyphotic angel. All patients had been operated posteriorly, with transpedicular decompression with and without vertebroplasty. Long segment pedicle screw fixation was done in all cases. Follow up period was 12 months. Results: Significant improvement in pain and motor state was recorded in early postoperative scales that maintained in late postoperative scale. Canal compromise, vertebral height and kyphotic angel were significantly reduced. Conclusion: Transpedicular approach is an effective technique done in familiar position. It is a safe, taking relatively short time, with minimal blood loss and with few operative complications. The procedure achieved significant ventral decompression, improved and maintained vertebral alignment. (2013ESJ048)
Management of unstable thoracolumbar spinal injuries by posterior short segment spinal fixation
International Orthopaedics, 2007
Fifty patients with thoracolumbar fractures were treated operatively between July 2000 and December 2001. The average age of the patients was 33.6 years (range: 20-50 years), 36 were males and 14 were females and the follow-up averaged 59 months (range: 49-68 months). A fall from a height, usually a tree, was the most common cause of injury. Twenty six patients had unstable burst fractures and 13 had translational injury. There were 15 patients with complete neurological deficit, 17 had partial neurological lesions, while 18 had no neurological deficit. All patients were treated by posterior short segment fixation (Steffee VSP). The average pre-operative kyphotic angle was 21.48°, which improved to 12.86°in the immediate post-operative period. The loss of kyphosis averaged 3.46°(0-26°) at the final follow-up. The average pre-operative anterior vertebral body height was 44.7% (range: 36-90%), which improved to 72.0% (range: 55-97%) in the immediate post-operative period. The loss of body height averaged 3.0% (range: 1-15%) at the final follow-up. No neurological deterioration was seen, and in 24 cases a one grade or better improvement was observed. The mean pain score was 1.6, and the mean functional score was 2.8. We found that the application of posterior instrumentation resulted in a reasonable correction of the deformity with a significant reduction in recumbency-associated complications; there were, however, significant other complications. Résumé Cinquante patients présentant une fracture thoracolombaire ont été traités entre juillet 2000 et décembre 2001. L'âge moyen était de 33.6 ans (20 à 50). Il s'agissait de 36 hommes et 14 femmes. Le suivi moyen était de 59 mois (49 à 68). La chute d'une hauteur habituellement d'un arbre était la cause la plus connue. Vingt-six patients avaient une fracture instable et 13 un traumatisme avec translation. Quinze patients avaient un déficit neurologique complet, 17 un déficit neurologique partiel et 18 aucun déficit neurologique. Tous les patients ont été traités par une fixation postérieure (Steffee VSP). L'angulation sans cyphose préopératoire a été de 21.48°en moyenne, celle-ci s'est améliorée de 12.86°en postopératoire immédiat. La perte de cyphose a été de 3.46°(0-26) au suivi final. La hauteur vertébrale de 44.7% (36-90) s'est améliorée à 72% (55 à 97) en postopératoire immédiat. La perte de hauteur du corps vertébral a été de 3%
Bangladesh Journal of Neuroscience, 2013
Background & Objectives: Thoraco-lumbar fracture is one of the common problems in spinal injury patients. Its early management can prevent complication after injury and can improve neurological function. The treatment plan of unstable fracture is controversial. Methods: The study was carried out at the department of neurosurgery, Bangabandhu Sheikh Mujib Medical University from June 2010 to July 2011 among the patients admitted with thoraco-lumbar spine fracture. Results: A total number of 15 patients with thoracolumbar spine fracture were included in the study. Among the 15 patients, 13(86.66%) were male. The highest number of patients were in age group of 1-20(40%) and 21-40(40%) years. The commonest cause of Thoraco-lumbar spine injuries were fall from height which was 8(53.33%) in number. The commonest site of injury was L1 fracture in 4(60%) patients. It was documented that bladder dysfunction and lower limb weakness were the commonest sign. It was evident that, 10(66.70%) and...
Techniques in Orthopaedics, 2014
Posterior distraction and stabilization using pedicle screws instrumentation for unstable thoracolumbar burst fracture is less extensive approach and offers comparable neurological outcome to anterior direct decompression. However, this method requires spinal column distraction which may result in late kyphotic deformity. Pedicle screws insert at the level of fracture (index screws) confers mechanical advantage for deformity correction and maintain spinal alignment. We suppose that the index screws manipulation with gradual reduction technique could facilitate reduction and restore vertebral height which promotes reduction of retropulsed bone fragments. Therefore, the aim of this study was to present our gradual reduction technique with index pedicle screws applied for treatment of thoracolumbar burst fracture and evaluate the results. There were 14 male and 17 female patients with thoracolumbar burst fracture recruited in this retrospective study. The mean age was 41 years (range, 16 to 79 y). The mean preoperative Cobb angle was 17.5 ± 11.82 degrees. The kyphotic deformity was corrected to À 0.23 ± 7.04 degrees (P < 0.0001) after operation. At the final followup, 1 year after the surgery, mean kyphotic angle was changed to 0.32 ± 8.77 degrees. No statistically significant difference was demonstrated when compared with the immediately postoperative results (P = 0.974). No neurological deterioration was found after the operation. The overall motor recovery was 70% with additional simple laminectomy. In conclusion, short-segment pedicle screws instrumentation with gradual reduction technique could achieve the strong implant construction for reduction and maintain kyphosis deformity correction. The neurological recovery could be expected with additional simple laminectomy.
Journal of Orthopaedic Surgery and Research, 2009
Background: Treatment of unstable thoracolumbar fractures is controversial regarding short or long segment pedicle screw fixation. Although long level fixation is better, it can decrease one motion segment distally, thus increasing load to lower discs. Methods: We retrospectively analyzed 31 unstable thoracolumbar fractures with partial or intact neurology. All patients were operated with posterior approach using pedicle screws fixed two levels above and one level below the fracture vertebra. No laminectomy, discectomy or decompression procedure was done. Posterior fusion was achieved in all. Post operative and at final follow-up radiological evaluation was done by measuring the correction and maintenance of kyphotic angle at thoracolumbar junction. Complications were also reported including implant failure. Results: Average follow-up was 34 months. All patients had full recovery at final follow-up. Average kyphosis was improved from 26.7° to 4.1° postoperatively and to 6.3° at final follow-up. And mean pain scale was improved from 7.5 to 3.9 postoperatively and to 1.6 at final follow-up, All patients resumed their activity within six months. Only 4 (12%) complications were noted including only one hardware failure. Conclusion: Two levels above and one level below pedicle screw fixation in unstable thoracolumbar burst fracture is useful to prevent progressive kyphosis and preserves one motion segment distally.
Spine Journal, 2004
BACKGROUND CONTEXT: Conventional transpedicular decompression of the neural canal requires a considerable amount of lamina, facet joint and pedicle resection. The authors assumed that it would be possible to remove the retropulsed bone fragment by carving the pedicle with a high-speed drill without destroying the vertebral elements contributing to spinal stabilization. In this way, surgical treatment of unstable burst fractures can be performed less invasively. PURPOSE: The purpose of this study is to demonstrate both the possibility of neural canal decompression through a transpedicular approach without removing the posterior vertebral elements, which contribute to spinal stabilization, and the adequacy of posterior stabilization of severe vertebral deformities after burst fractures. STUDY DESIGN: Twenty-eight consecutive patients with complete or incomplete neurological deficits as a result of the thoracolumbar burst fractures were included in this study. All patients had severe spinal canal compromise (mean, 59.53%Ϯ14.92) and loss of vertebral body height (mean, 45.14%Ϯ7.19). Each patient was investigated for neural canal compromise, degree of kyphosis at fracture level and fusion after operation by computed tomography and direct roentgenograms taken preoperatively, early postoperatively and late postoperatively. The neurological condition of the patients was recorded in the early and late postoperative period according to Benzel-Larson grading systems. The outcome of the study was evaluated with regard to the adequate neural canal decompression, fusion and reoperation percents and neurological improvement. METHODS: Modified transpedicular approach includes drilling the pedicle for removal of retropulsed bone fragment under surgical microscope without damaging the anatomic continuity of posterior column. Stabilization with pedicle screw fixation and posterior fusion with otogenous bone chips were done after this decompression procedure at all 28 patients included in this study. RESULTS: Twenty-three of 28 patients showed neurological improvement. The percent of ambulatory patients was 71.4% 6 months after the operation. The major complications included pseudarthrosis in five patients (17.8%), epidural hematoma in one (3.5%) and inadequate decompression in one (3.5%). These patients were reoperated on by means of an anterior approach. Of the five pseudarthrosis cases, two were the result of infection. CONCLUSION: Although anterior vertebrectomy and fusion is generally recommended for burst fractures causing canal compromise, in these patients adequate neural canal decompression can also be achieved by a modified transpedicular approach less invasively. Ć 2004 Elsevier Inc. All rights reserved.
Asian spine journal, 2014
Study Design: Prospective clinical study. Purpose: The present prospective study aims to evaluate the clinical, radiological, and functional and quality of life outcomes in patients with fresh thoracolumbar fractures managed by posterior instrumentation of the spine, using pedicle screw fixation and monosegmental fusion. Overview of Literature: The goals of treatment in thoracolumbar fractures are restoring vertebral column stability and obtaining spinal canal decompression, leading to early mobilization of the patient. Methods: Sixty-six patients (46 males and 20 females) of thoracolumbar fractures with neurological deficit were stabilized with pedicle screw fixation and monosegmental fusion. Clinical, radiological and functional outcomes were evaluated. Results: The mean preoperative values of Sagittal index, and compression percentage of the height of the fractured vertebra were 22.75° and 46.73, respectively, improved (statistically significant) to 12.39°, and 24.91, postoperatively. The loss of correction of these values at one year follow-up was not statistically significant. The mean preoperative canal compromise (%) improved from 65.22±17.61 to 10.06±5.31 at one year follow-up. There was a mean improvement in the grade of 1.03 in neurological status from the preoperative to final follow-up at one year. Average Denis work scale index was 4.1. Average Denis pain scale index was 2.5. Average WHOQOL-BREF showed reduced quality of life in these patients. Patients of early surgery group (operated within 7 days of injury) had a greater mean improvement of neurological grade, radiological and functional outcomes than those in the late surgery group, but it was not statistically significant. Conclusions: Posterior surgical instrumentation using pedicle screws with posterolateral fusion is safe, reliable and effective method in the management of fresh thoracolumbar fractures. Fusion helps to decrease the postoperative correction loss of radiological parameters. There is no correlation between radiographic corrections achieved for deformities and functional outcome and quality of life post spinal cord injury.
Bangladesh Medical Research Council Bulletin, 2011
This study is to evaluate the clinical and radiological success of posterior decompression, posterolateral fusion and stabilization by pedicle screw and rod in the management of traumatic thoracolumbar fractures. It is a prospective interventional study which is carried out in Bangabandhu Sheikh Mujib Medical University and different private hospitals in Dhaka city from January 2008 to December 2010. Total 16 patients were selected according to the inclusion and exclusion criteria. There were 10 male patients and 06 female within a age range of 21-40 years. Mean age was 33.32 years. Total 08 cases involved L1, 03 cases involved at D12, 02 cases involved at D11 and at L2 each whereas 01 case at L3. Total 10 cases were of compression fracture and remainder 06 burst fractures. Ten (10) patients presented with paraparesis, 05 patients with incomplete paraplegia and 01 patient with complete paraplegia. All the patients were followed up for minimum 1 year. Patients with paraparesis fully ...