Radiological and Functional Outcome of Short Segment Posterior Stabilization with Intermediate Pedicle Screw in Single Level Thoracolumbar Burst Fractures: A Prospective Study (original) (raw)
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The spine journal : official journal of the North American Spine Society, 2017
Short-segment posterior spinal instrumentation for thoracolumbar burst fracture provides superior correction of kyphosis by an indirect reduction technique, but it has a high failure rate. The purpose of the study we report here was to compare outcomes for temporary short-segment pedicle screw fixation with vertebroplasty and for such fixation without vertebroplasty. This is a prospective multicenter comparative study. We studied 62 consecutive patients with thoracolumbar burst fracture who underwent short-segment posterior instrumentation using ligamentotaxis with Schanz screws with or without vertebroplasty. Radiological parameters (Cobb angle on standing lateral radiographs) were used. Implants were removed approximately 1 year after surgery. Neurologic function, kyphotic deformity, canal compromise, and fracture severity were evaluated prospectively. After surgery, all patients with neurologic deficit had improvement equivalent to at least one grade on the American Spinal Injury...
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2018
Introduction: Treatment of unstable Thoracolumbar vertebra burst fractures has seen a paradigm shift from conservative to surgical modalities with either a short or long-segment posterior fixation with or without fusion. Aim: To assess the functional and radiological outcome in burst fractures of thoracolumbar vertebrae treated with shortsegment posterior instrumentation with and without fusion. Materials and Methods: The study was conducted on 31 patients, divided into two groups, with thoracolumbar burst fractures. Patients above18 years of age, with or without neurological deficit, Kyphosis>300, anterior vertebral height loss >50%, spinal canal narrowing >40% were included in the study. Group A (n=15) had patients in which posterior shortsegment pedicle screw fixation was done while patients with pedicle screw fixation combined with posterolateral fusion were in Group B (n=16). The final outcome was measured using the Modified Mcnab's questionnaire, low back outcome scale of Greenough and Fraser and Frankel scoring system at an interval of 3,6 and 12 months were calculated using the Mann-Whitney's U-test which was not statistically significant (p=0.770). Results: The most common mode of injury was road traffic accident affecting 23 (74.2%) cases. L1, L2 and T12 were the most commonly involved vertebrae. The time duration between the injury and surgery was 12.44±9.6 days in Group A and 8.6±2.7 days in Group B (p=0.1273). Intraoperative blood loss was 468±94.6 mL in Group A and 693±88.3 mL in Group B (p<0.001). The mean surgical time in Group B cases (149.33±4.72 minutes) was more than those in Group A (110.8±4.65 minutes) (p<0.001). The average duration of hospital stay was 27.8±7.33 days in Group A and 24.3±8 days in Group B (p=0.3056). There was a gradual improvement in Frankel scoring, anterior vertebral height and kyphotic angle at last follow-up. The Greenough low back outcome score was 45.25 in Group A and 46.10 in Group B cases which were not significant. As per the modified Mcnab's questionnaire, 17 (54.83%) had excellent, 10 (32.2%) had good and 4 (12.9%) had the poor functional outcome. Superficial infection and screw loosening were apparent in 3 (9.6%) cases. Conclusion: Posterolateral fusion combined with fixation is not superior to fixation alone in burst thoracolumbar fractures.
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.
Asian Journal of Medical Research
Background: The surgical treatment of unstable burst fracture (TLICS >4) of the thoracolumbar vertebrae remain controversial. This study is aimed to compare the short segment versus long-segment posterior fixation for thoracolumbar burst fracture.The objective of the study is to study comparison of outcome of the Short-Segment Posterior Fixation (SSPF) versus Long-Segment Posterior Fixation (LSPF) for treatment of thoracolumbar burst fracture in term of surgical, radiological, neurological and functional outcome. Subjects & Methods: In this prospective study, we included 32 patients with Burst fracture AO type A3, A4 of Thoracolumbar spine (T10-L2), who underwent posterior pedicle screw fixation for Burst fracture Thoracolumbar spine. A total of 18 of the patients underwent Short-Segment Posterior Fixation (SSPF) (Group A); group A is further divided into three subgroups A1: short-segment only(n=10), A2: short-segment with index screw(n=4) and A3: short-segment with anterior colu...
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.
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.
Acta Scientific Orthopaedics
Introduction: Traumatic thoracolumbar (TL) burst fractures requiring stabilization are widespread among younger people. Surgical intervention can be divided into long and short fixation. Here, we report the results of 60 patients operated for TL burst fractures to determine whether one construct was better than the other. Material and Methods: Sixty patients, between 17 and 70 years old, had surgery for TL burst fractures over a 2 years period (2018-2019). Patients who were neuorlogicaly intact in Group A received short fixation (32 patients), while Group B patients had long fixations (28 patients) performed. Their clinical and radiological outcomes were then assessed postoperatively at 3, 6 and 12 months. Results: The demographic data and clinical progression, anterior and posterior height vertebral, the sagittal index and Cobb Angles were similar for both groups. However, those undergoing long fixation exhibited better long-term outcomes (i.e., local kyphosis (GB: 15.10 vs. GA: 22.3; P = 0.003) and sagittal index of Farcy (GB: 16, 35 vs. 24.8; p = 0.011)). However, there was no significative difference Conclusion: Based on our small sample, we concluded that those patients undergoing long-fixation of TL burst fractures had the highest rates of kyphosis correction, and greatest incidence of maintaining correction over the long-term vs. short fixation patients.
European Journal of Orthopaedic Surgery Traumatologie, 2010
Objectives Although there is an agreement of using longlevel construct than short-level construct to correct the kyphosis, no literature mentioned the success of this treatment based on timing of surgery after the injury. Objective of this paper was to study the eVect of ligamentotaxis on preventing the development of postoperative kyphosis in unstable thoracolumbar burst fractures based on injury surgery interval (ISI). Study design This is a retrospective analysis in 67 patients with unstable thoracolumbar burst fractures operated with posterior-only pedicle screw Wxation. Methods A retrospective analytical study was conducted in 67 patients who had unstable thoracolumbar fracture and operated with posterior-only pedicle screw construct two levels above and one level below the fractured vertebra. Results were analyzed based on ISI: group 1 (34 patients) was operated within 7 days; group 2 (19 patients) operated between 7 and 14 days; and group 3(14 patients) operated after 14 days of injury. Immediate postoperative and Wnal follow-up kyphotic angles were analyzed among all three groups using Kruskal-Wallis test. Complications regarding implant failure were also noted at Wnal follow-up. Results Average follow-up was 37 § 8.1 months. Average preoperative kyphosis at thoracolumbar junction was 26.3° § 3.9°, 26.3° § 2.9° and 26.3° § 2.8° in groups 1, 2 and 3, respectively, which did not show any diVerence (P = 0.98). Immediate postoperatively kyphotic angle was improved to 4.3° § 1.9°, 5.4° § 1.7° and 10.1° § 3.0° in groups 1, 2 and 3, respectively, which exhibited statistically signiWcant diVerence (P < 0.001); and at Wnal follow-up kyphotic angles were 5.4° § 1.9°, 7.2° § 1.7° and 15.0° § 1.6° in groups 1, 2 and 3, respectively showing 1.1°, 1.7° and 4.9° loss in correction at Wnal follow-up. Comparison of kyphotic angles and loss of kyphotic angles amongst the three groups showed statistically signiWcant diVerence (P < 0.001). Two patients from group 3 had implant failure that required implant extraction. Conclusion Posterior-only pedicle screw Wxation in unstable thoracolumbar fractures would correct and maintain the postoperative correction in kyphosis, at least at 3-year follow-up, without increasing implant failure if ISI is less than 2 weeks. While patients operated after 2 weeks of injury would require additional anterior procedure.
Orthopedic Research and Reviews, 2022
The radiological complications including correction loss and hardware failure of short segment posterior pedicle screw fixation in the treatment of unstable thoracolumbar burst fractures remain a main concern. Several procedures aiming to reinforce the anterior column have been introduced to solve these limitations, including transforaminal interbody fusion (TIF). The purposes of this study were to evaluate the radiological complications of short-segment pedicle screw fixation in combination with transforaminal interbody fusion in the treatment of unstable thoracolumbar burst fractures. Methods: This retrospective case series study enrolled patients with isolated unstable thoracolumbar burst fractures, who were treated by posterior short fixation with TIF between January 2013 and January 2017. Patients were followed up for a minimum of one and half years. For evaluation of correction loss, % loss of anterior vertebral body height (%AVB), vertebral kyphotic angle (VA) and regional kyphotic angle (RA) were collected preoperatively, postoperatively and at the final follow-up. Hardware failure was assessed on radiological images at the last follow-up. Results: There were 36 patients who met the inclusion criteria with a mean follow-up duration of 53 months. The mean correction loss of %AVB, VA and RA were 10.2%, 2.9°and 5.6°, respectively. There were 6 patients (16.7%) with hardware failure at the final follow-up. Conclusion: Short-segment posterior pedicle screw fixation with TIF using bone chip grafts does not completely prevent hardware failure and progressive kyphosis in the treatment of unstable thoracolumbar burst fractures.
European Journal of Orthopaedic Surgery & Traumatology, 2018
Purpose To assess and compare the efficacy of two minimally invasive techniques (percutaneous pedicle screw with intermediate screw vs. percutaneous pedicle screw with kyphoplasty) for spinal fracture fixation by comparing the segmental kyphosis and vertebral kyphosis angles after trauma before surgery, after surgery, and at 4-month and 12-month follow-up. Methods Data from 49 patients without neurological deficit treated by either percutaneous pedicle screw with intermediate screw or percutaneous pedicle screw with kyphoplasty were retrospectively analysed. The segmental kyphosis and vertebral kyphosis angles over time were calculated and correlated with the type of procedure, AO classification, lumbar or thoracic site and the age and sex of the patients. Results After surgery, both techniques were found to be efficacious means of bringing about a significant correction of the segmental kyphosis angle (p = 0.002) and a just significant correction of the vertebral kyphosis angle (p = 0.06), although less effectively in thoracic fractures (p = 0.004). At follow-up, the vertebral kyphosis angle was stable in both groups, while there was a significant loss of segmental kyphosis angle stability in the percutaneous pedicle screw with kyphoplasty group at 1 year (p = 0.004); fractured thoracic vertebrae maintained a greater vertebral kyphosis angle (p = 0.06) and segmental kyphosis angle (p < 0.001), than the lumbar. Conclusion At 1 year after surgery, the use of intermediate screws in fractured vertebrae seemed to maintain a more efficacious correction with respect to kyphoplasty, although thoracic fracture sites appear to be associated with greater posttraumatic segmental kyphosis and lesser stability in the long term after both percutaneous surgical techniques.