Limitations of dorsal transpedicular stabilization in unstable fractures of the lower thoracic and lumbar spine: an analysis of 133 patients (original) (raw)
Related papers
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%
International Journal of Clinical Trials, 2014
Background: Minimally invasive spinal surgery will be a highlight of operative approaches in the twenty-first century and already has been popularized worldwide. This procedure will provide surgical options that address several pathological conditions in the spinal column without producing the types of morbidity commonly seen in open surgical procedures. The objective was to assess the outcomes of minimally invasive posterior stabilization of dorsal and lumbar spine fractures. Methods: This was a prospective study of twenty patients with dorsal or lumbar fractures who were admitted at Sri Ramachandra University. All patients having dorsal and lumbar spinal fractures with intact neurology were included in the study. All the patients underwent minimally invasive posterior stabilization by freehand technique. Functional outcomes were measured by VAS scale, ASIA scoring (neurology), and their ability to mobilize. Results: The average duration of surgery was 85.50 minutes. The average blood loss in our study group was 77 ml. The average operation to mobilization time was 2.2 days. The average post-operative Cobb's angle was 0.6 degree of kyphosis. The average post-operative gain was 12 degree. Conclusion: Minimally invasive percutaneous stabilization of the spine helps to minimize approach related morbidity and secondary iatrogenic soft tissue trauma. It enables early mobilization, which contributes to improved outcome.
THE PROFESSIONAL MEDICAL JOURNAL, 2017
In this study we analyze and study the effectiveness of pedicle screw and rod fixation for the management of unstable fractures of the thoracolumbar spine. The type of study is a Study Design: Case series. Period: 1.5 year duration from April 2014 to September 2015. Setting: Tertiary Care Centre in Karachi, Pakistan. Materials and methods: N= 35 patients were operated at our institute and included in the study. The inclusion criteria was all those patients who presented to us with unstable fractures of the thoracolumbar spine via the accident and emergency department of the hospital, and were operated upon and gave full informed consent to partake in the research were included in this study. All the patients were operated under general anesthesia. The short segment fixation with pedicle screw rod fixation using the posterior approach was the technique utilized for treatment. Rehabilitation was started immediately after the surgical procedure. Data was analyzed using SPSS version 23. Results: The study population consisted of n= 35 patients of which n= 25 (71.42%) were males and n= 10 (28.57%) were females, the mean age of the study population was 33.5 years. A history of fall from height was the most common cause of injury in n= 26 (74.28%) of the patients, next was automobile accidents in n= 9 patients (25.71%). Burst fracture was the most common type of injury. The sagittal angle was 23.5 O pre operatively and 10.75 O post operatively, and at follow up the loss of angle was found to be 4.80 respectively. The sagittal index values were as follows, pre-operative 0.53, post-operative 0.75 and 0.72 at follow up (final follow up). N= 30 (85.71%) patients showed improvement in their ASIA status, n= 19 (54.28%) showed single grade improvement, n= 10 (28.57%) showed double grade improvement, n= 1 (2.85%) showed triple grade improvement, while n= 5 (14.28%) cases did not show any improvement. The mean duration between injury and surgical intervention was 5.5 days with a range of 1 to 23 days, the major cause of this delay was delay in reaching the hospital. The most common complication observed was pressure sores in n= 4 (11.42%) and urinary tract infections (UTI) seen in n= 5 (14.28%) of patients, followed by implant failure in n=3 (8.57%) patients. Conclusion: According to the results of our study unstable burst fractures was the most prevalent type of fracture observed, there was a marked improvement in the radiological parameters post operatively, while the neurological improvement was decent. The technique of pedicle screw rod and fixation using the posterior approach provides good surgical outcome and better stabilization, with a fair amount of neurological improvement for these patients.
Monosegmental vs bisegmental pedicle fixation for the treatment of thoracolumbar spine fractures
Injury, 2016
The anatomy and biomechanics of the thoracolumbar spine place these segments at high risk of trauma injuries. Treatment options are either conservative or surgical, and there is a lack of consensus about the right indications. International scientific publications agree only on basic surgical principles: vertebral stability, deformity correction, protection of neurological structures and fast functional recovery. The most commonly used approach is the posterior approach, which allows the best management of most vertebral fracture patterns. The aim of this study was to compare clinical and radiological outcomes of monosegmental stabilisation with those of bisegmental stabilisation and fusion in the treatment of traumatic thoracolumbar spine fractures. Materials and methods: This retrospective clinical and radiological study evaluated 48 consecutive patients treated with monosegmental (Group M; n = 14) or bisegmental (Group B; n = 34) posterior pedicular instrumentation for thoracolumbar fractures. Fractures were classified by the new AO Spine TLIC system. Average follow-up was 30 months. Clinical outcomes in both groups were statistically compared. Radiological outcomes were evaluated in terms of vertebral anterior body height restoration and correction of the kyphotic deformity. Results: Radiographical results showed no statistically significant difference between the two groups in vertebral body height restoration and correction of the kyphotic deformity. The mean postoperative somatic vertebral anterior body height in Group M was 25.8 AE 4.52 mm and in Group B it was 24.43 AE 4.27 mm. In Group M the mean postoperative kyphotic deformity was 11.10 AE 5.71 , in Group B it was 9.09 AE 4.93. Conclusions: The results of this study confirm the validity of short and very short instrumentation for the treatment of well-selected type A and B vertebral fractures. In C type fractures correct surgical indication must be evaluated on an individual basis.
Spine, 2002
Study Design. The treatment of unstable thoracic spine fractures remains controversial. Theoretical biomechanical advantages of transpedicular screw fixation include three-column control of vertebral segments and fixation of a vertebral segment in the absence of intact posterior elements. Additionally, pedicle screw constructs may obviate the need for neural canal dissection and potential neural element impingement by intracanal instrumentation. A 3-year consecutive series was performed to evaluate the use of transpedicular screw fixation in the treatment of unstable thoracic spine injuries. Objective. This study was performed to evaluate the efficacy of transpedicular screw fixation in the upper, middle, and lower thoracic spine. Summary of Background Data. The use of rod/hook and rod/wiring techniques has been evaluated in the treatment of thoracic spine injuries. To date, a study evaluating the safety and efficacy of pedicle screw instrumentation in the upper, middle, and lower thoracic spine has not been reported. Methods. Thirty-two patients with 79 individual vertebral injury levels (T2-L1) treated with transpedicular spinal stabilization and bone fusion were evaluated during a 3-year consecutive series from 1998 to 2001. Patient charts, operative reports, preoperative and postoperative radiographs, computed tomography scans, and postoperative follow-up examinations and radiographs were reviewed from the time of surgery to final follow-up assessment. Radiographic measurements included: sagittal index, Gardner segmental kyphotic deformity, and compression percentage. Results. A total of 252 pedicle screws were placed, of which 222 were placed in segments T2-L1. Clinical examination and plain radiographs were used to determine the presence of a solid fusion. Fracture healing and radiographic stabilization occurred at an average of 4.8 months after the initial operation. There were no reported cases of hardware failure, loss of reduction, or painful hardware removal. Two hundred fifty-two transpedicular screws This study was performed to evaluate the use of transpedicular screw fixation in the upper, middle, and lower thoracic spine. We present our 3-year consecutive prospective experience of long and short segment transpedicular fixation of 32 unstable thoracic injuries. Methods Design. Over a 3-year consecutive period from 1998 to 2001, all patients with unstable thoracic (T2-L1) spinal injuries and adequately sized pedicles were treated using pedicle screw in-From
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.
European Journal of Orthopaedic Surgery & Traumatology, 2004
Following fracture reduction and initial reconstitution of spinal alignment, loss of correction over time is frequently observed after posterior instrumentation. The degree of stability to provide a favorable environment for protection of initial correction is not known. A total of 36 patients with thoracolumbar burst fractures were divided into three groups. Group 1 included 12 patients treated by two-levels fixation, group 2 included ten patients treated by four-levels fixation, and group 3 included 14 patients treated by four-levels plus offsethook fixation. Preoperative, early postoperative, and 1year follow-up lateral spinal radiographs were evaluated by measuring the local kyphosis angle (LKA), the percentage of anterior body-height compression (%ABC), and the sagittal index (SI). For protecting the initial correction of LKA, group 3 was superior to the other groups (P<0.05). For protecting the initial correction of %ABC, groups 2 and 3 were the same (P>0.05), and these two groups were superior to group 1 (P<0.05). For protecting the initial correction of SI, group 3 was superior to group 1 (P<0.05), and the other groups were the same (P>0.05). Group 1 had a significant failure rate compared to the other groups (P<0.05). Two-levels fixation was the least stable system, and four-levels fixation plus offset hook was the most stable.
Results of the AO spinal internal fixator in the surgical treatment of thoracolumbar burst fractures
European Spine Journal, 1994
The potential for clinical instability following thoracolumbar fractures has evoked a progressive increase in interest in the surgical treatment of unstable thoracolumbar fractures. From September 1988 to October 1991,44 thoracolumbar burst fractures were treated surgically by the AO Spinal Internal Fixator at the Orthopaedics and Traumatotogy Clinics of Ankara Social Security Hospital. Mean follow-up period was 28.8 (range 12~48) months. Fourteen (31.8%) of the patients were female, and 30 (68.2%) were male. Postoperatively, the mean anterior vertebral height loss and spinal canal compromise were corrected by 36.5% and 39.9%, respectively. Also, postoperatively 15.9 ° of improvement was obtained in the mean kyphosis angle. The mean compression angle, which was 19.5 ° preoperatively, was corrected by 12.3 ° and came to an average of 7.1 ° posteroperatively. In light of these data, it is suggested that the AO Spinal Internal Fixator effectively restores three-dimensional alignment of the spine and provides a rigid fixation.
Bracing of thoracic and lumbar spine fractures
Paraplegia, 1987
A prospective study of the non-operative management of 33 thoracic and lumbar fractures and dislocations was undertaken examining factors such as duration of bed rest and brace prescription. Outcome was assessed using Frankel's grading system and serial radiological examination. Bed rest for 6 to 8 weeks followed by 16 weeks of immobilisation in a thoraco lumbar orthosis (either a moulded plastazote lined polythene brace or a Taylor brace) resulted in less than 15�' kyphus in 8500 of patients and less than 20° () kyphus in 9400, One patient with a T12/L1 dislocation who had an early decom pressive laminectomy showed persistent instability and required internal fixation. One patient with an L1 fracture who initially wore a Hexalite brace developed late instability (at 12 months after injury) and required spinal osteotomy and fusion. Neurological improvement was observed in 50° () of patients, and no permanent neurological deterioration occurred. A non-operative regimen of treatment of fractured thoracic and lumbar vertebrae as described is an alternative to prolonged immobilisation in bed, or early operative fusion.
Egyptian Journal of Neurosurgery, 2019
Background: The thoracolumbar spine is vulnerable to fracture in falls or motor vehicle accidents. Thoracolumbar spine fracture can be associated with neurological deficits, long-term pain and disability. The optimal management for these injuries remains a considerable subject for research. Objectives: To evaluate short-term surgical and functional outcome of posterior short-segment fixation with implanting pedicle screw in the fractured level (short same-segment fixation) for treatment of recent single-level traumatic thoracolumbar fracture. Methods: This prospective study included 36 patients with radiologically confirmed single-level thoracolumbar fracture. Patients were evaluated preoperatively, at time of discharge, and at follow-up visit after 1 year clinically using the Low-Back Outcome Scale of Greenough and Fraser Score, the American Spinal Injury Association (ASIA) for neurological evaluation, and the AO fracture classification for injury severity evaluation. Radiological evaluation included calculation of the sagittal index (SI) of injured vertebral body, anterior body compression (ABC) according to Mumford's equation, and regional kyphosis using Cobb angle. All patients underwent posterior trans-pedicular screw insertions into a vertebral body one level above and below the fracture site, and an additional pedicle screw was inserted at the level of the fracture. Postoperative clinical and radiological evaluations were compared to the preoperative. Results: All surgeries were conducted uneventfully within 129.7 ± 33.9 min with mean operative blood loss of 351.4 ± 140.5 ml. Wound infection was encountered in two patients and responded to conservative treatment. Mean duration of postoperative hospital stay and follow-up were 17.7 ± 4.4 days and 26.5 ± 5.1 months, respectively. After 1 year, mean low-back pain scores were significantly higher than preoperative and early postoperative scores and frequency of patients with excellent-good postoperative status was significantly higher at early postoperative evaluation and after 1 year compared to the preoperative status. Eight patients had neurological deficit, after 1-year follow-up; six patients were improved by one grade, while the other two cases remained stationary. Mean SI and ABC calculated at discharge and after 1 year were significantly higher compared to the preoperative measures. Mean Cobb angle was significantly decreased compared to the preoperative angle. Mean improvement of kyphosis angle at discharge and after 1 year was 60.9% and 48.1%, respectively; however, there was loss of kyphosis correction by about 4.2°after 1-year follow-up compared to the early postoperative finding.