Comparison of the effect of small open window between laminates and vertebral pedicle bone graft in the treatment of thoracolumbar burst fracture / 临床外科杂志

Objective To investigate the lamina windowing small gap and the vertebrae pedicle bone graft in the treatment of thoracolumbar burst fractures of the curative effect.Methods 132 patients with thoracolumbar burst fracture of were selecteds, the average random divided into open the window and pedicle group, open a window line set of lamina windowing small gap vertebral body bone graft and pedicle group through pedicle vertebral body bone graft, through intraoperative records, hospital records and postoperative follow-up of collecting morphological index, operation index, JOA score and Frankel classification of spinal cord injury in order to evaluate the clinical curative effect of two kinds of operative methods.Results The operation time in the pedicle group was (103.58±14.37) min, which was more than that of the fenestration group [ (85.72±12.96) min], the incision drainage rate in the pedicle group [ (100.96±5.29) ml] was less than that in the fenestration group [ (178.52±12.41) ml], and the postoperative pain score in the pedicle group [ (15.37±2.86) ] was higher than that in the fenestration group [ (8.26±4.52) ], the healing time of fractures in the pedicle group [ (20.85±0.60) weeks ]was less than that of the fenestration group [ (24.29±1.06) weeks].The difference was all statistically significant (P＜0.05).After treatment, the intervertebral space height of the pedicle group [ (11.55±1.94) mm] was significantly higher than that of the fenestration group [ (9.53±1.92) mm], and the difference was statistically significant (P＜0.05).After treatment, the JOA scores of patients in the pedicle group[7.78±1.39, 4.93±0.92, 13.84±2.74] were significantly higher than those in the open window group[6.24±1.20, 4.50±0.83, 12.43±2.52] (P＜0.05).The difference between the composition of Frankel spinal cord injury in the pedicle group and the fenestration group was statistically significant (P＜0.05).Conclusion Compared with small fenestration through the intervertebral space, this surgical method can promote the fracture healing and improve the symptoms of patients more rapidly, and is more suitable for the surgical treatment of thoracolumbar burst fracture patients.

Tratamiento quirúrgico de las fracturas por estallamiento de columna toracolumbar / Traitement chirurgical des fractures-éclatement du rachis thoracolombaire

Introducción: las fracturas vertebrales constituyen un grave problema de salud, la zona toracolumbar constituye la localización más frecuente. El tratamiento quirúrgico, en fracturas por estallamiento, parece el de mejores resultados pero presenta la disyuntiva de si a todos los pacientes se les debe realizar fusión. Objetivo: mostrar los resultados obtenidos a los dos años con el tratamiento quirúrgico de las fracturas por estallamiento de columna toracolumbar, en los servicios de Ortopedia y Neurocirugía del Hospital Calixto García entre enero de 2011 y julio de 2013. Método: estudio descriptivo prospectivo en pacientes con diagnóstico de fracturas toracolumbares por estallamiento tratados quirúrgicamente, asociando en algunos a la fijación, la fusión. Las variables estudiadas: edad, sexo, mecanismo causal, localización, tipo de fractura, deformidad cifótica y altura del cuerpo vertebral. El índice de Oswestry y la Escala Visual Analógica del dolor, medidos antes y dos años después de la intervención, fueron los instrumentos evaluadores empleados. Resultados: serie constituida por 28 pacientes, predominaron el sexo masculino, y el accidente automovilístico como mecanismo causal; la localización más frecuente fue en el segmento T11-L2 para las fracturas tipo A3 y A4 según AO; las variaciones de deformidad cifótica y altura del cuerpo vertebral fueron muy semejantes a los dos años entre pacientes con fusión y sin ella. El índice de Oswestry y la Escala Visual Analógica del dolor mostraron significativa mejoría. Conclusiones: los resultados radiográficos y funcionales fueron similares en pacientes con fusión y sin ella. La fusión posterior no necesita ser un procedimiento de rutina en fracturas por estallamiento de columna toracolumbar(AU)

Introduction: vertebral fractures are serious health problem; the thoracolumbar zone is the most frequent location. Surgical treatment in explant fractures seems to be the one with the best results but presents the dilemma of whether all patients should be fusion. Objective: show the results obtained at two years with the surgical treatment of thoracolumbar spine fractures in Orthopedics and Neurosurgery services at Calixto García Hospital from January 2011 to July 2013. Method: prospective descriptive study was carried out in patients with diagnosis of surgically treated thoracolumbar fractures, associated to fixation, fusion. The variables studied were age, sex, causal mechanism, location, type of fracture, kyphotic deformity and vertebral body height. The Oswestry Index and Visual Analog Pain Scale, measured before and two years after the intervention, were the evaluation instruments used. Results: twenty-eight patients formed this series, the male sex predominated, and automobile accident was a causal mechanism. The most frequent location was segment T 11- L 2 for fractures type A 3 and A 4 according to AO. The variations of kyphotic deformity and height of the vertebral body were very similar after two years in patients with and without fusion. Oswestry Index and Visual Analog Pain Scale showed significant improvement. Conclusions: radiographic and functional results were similar in patients with and without fusion. Post fusion does not need to be a routine procedure in thoracolumbar collapse fractures (AU)

Introduction: les fractures vertébrales, étant plus fréquemment localisées dans la région thoracolombaire, constituent un sérieux problème de santé. Le traitement chirurgical des fractures-éclatement semble être le meilleur étant donnés ses résultats, mais il pose un question -est-ce que tous les patients doivent subir une fusion? Objectif: l'objectif de cette étude est de montrer les résultats obtenus deux ans après le traitement chirurgical des fractures-éclatement thoracolombaires aux services d'orthopédie et de neurochirurgie, à l'hôpital "Calixto García" entre janvier 2011 et juillet 2013. Méthode: une étude descriptive et prospective des patients diagnostiqués et traités chirurgicalement pour des fractures-éclatement thoracolombaires, associant la fixation et la fusion dans certains cas, a été effectuée. Des variables telles que l'âge, le sexe, les causes, la localisation, le type de fracture, la déformation cyphotique, et la taille du corps vertébral ont été aussi étudiées. L'indice d'Oswestry et l'échelle visuelle analogique de la douleur ont été les outils d'évaluation utilisés auparavant et deux ans après l'opération. Résultats: dans une série de 28 patients, ce sont les hommes le plus souvent touchés, tandis que l'accident de voiture a été la cause la plus fréquemment trouvée ; les fractures type A3 et A4, selon AO, se sont souvent localisées au niveau du segment T11-L2 ; les variations de la déformation cyphotique et la taille du corps vertébral ont été très similaires au bout de deux ans chez les patients ayant subi ou pas une fusion. L'indice d'Oswestry et l'échelle visuelle analogique de la douleur ont montré une amélioration significative. Conclusions: les résultats radiologiques et fonctionnels ont été similaires chez les patients ayant subi ou pas une fusion. La fusion postérieure n'est pas nécessairement un procédé habituel dans les fractures-éclatement du rachis thoracolombaire (AU)

Repeated Vertebral Body Fracture at Different Levels due to Sagittal Imbalance

The authors report a case of repeated vertebral body fracture at different levels due to sagittal imbalance resulting from long level spinal fusion after thoracic discectomy. A 69-year-old woman with severe cord compression at T9-T10-T11 due to calcified herniated discs underwent an anterior thoracotomy via the left transpleural approach followed by discectomy of T9-T10-T11. Six weeks later, she complained of severe thoracic and right flank pain after falling over. A newly developed burst fracture resulting in sagittal imbalance was detected, so the authors performed posterior fusion from T8 to L2 and pedicle screw fixation. Unfortunately, 4 months after the second ope- ration the patient revisited our hospital complaining of severe back and right leg pain. The whole spine lateral view revealed a newly developed bursting fracture of L3 and more aggravated sagittal imbalance accompanied with junctional kyphosis at the L2-L3 level. The authors performed a third operation composed of anterior lumbar inter- body fusion at the L5-S1 level and L3 closing wedge osteotomy with fixation for better sagittal balance and nerve decompression. The patient showed no evidence of postoperative neurological compromise. Her back and leg pain improved over time, and she was completely pain-free at 4 months after the surgery

Treatment of Thoraco-Lumbar Bursting Fractures According to Load-Sharing Classification

PURPOSE: To determine optimal levels of posterior fixation in thoraco-lumbar bursting fractures according to the Load-sharing classification. MATERIALS AND METHODS: From Aug. 1999 to Aug. 2003, 50 patients who had been operated with the posterior fixation in one-body thoraco-lumbar bursting fracture were selected. They were divided into two groups, group I, 6 points and below in the Load-sharing score and group II, 7 points and above. And also, each groups subdivided into two subgroups, A (short segment fixation including below and above one body) and B (long segment fixation including below and upper two body). So patients subdivided into I-A, I-B, II-A, II-B. Change of the corrected kyphotic angle was measured and compared with each subgroups. RESULTS: The loss of the corrected kyphotic angle was measured average 1.7degrees in group I and 4.1degrees in group II, and there was significant difference between two groups (p>0.05). The loss of the corrected kyphotic angle in the subgroups was average 1.8degrees in I-A, 1.6degrees in I-B, 3.5degrees in II-A and 4.9degrees in II-B. And there was significant difference statistically in I-A and II-A (p>0.05). CONCLUSION: In the thoraco-lumbar bursting fracture with 6 points and below of the Load-sharing score, the fixation of the short segment is a useful method. But in the fracture with 7 points and above, the fixation of the short segment is not enough, and these findings be required the further evaluation for some cause of the loss of corrected angle and treatment modalities including the fixation of the long segment.

Effect of Percutaneous Vertebroplasty with Polymethylmethacrylate to Osteoporotic Spinal Compression Fractures and Bursting Fractures

OBJECTIVE: The purpose of this study is to determine the efficacy and safety of percutaneous vertebroplasty for patients with osteoporotic spinal bursting fracture. METHODS: The authors reviewed retrospectively 77 patients who underwent percutaneous vertebroplasty for osteoporotic spinal fracture from May 1, 2000 to March 31, 2003. They were divided into simple compression, mild bursting and severe bursting fracture groups. Cause of injury, height loss of fractured vertebra, operation time interval after fracture, injected amount of polymethylmethacrylate, cement leakage and clinical outcome were investigated. RESULTS: Out of 77 patients, 29 cases (38%) were bursting fractures consisted of 23 mild (mean neural canal involvement=11%) and 6 severe cases (42.8%). Out of the 30 bursting fracture levels, bone cement leakages occurred in 15 vertebral levels (50%), which were more common compared with compression fracture (25%). But the improvement of back pain of the bursting fracture patients (83%) was not different from that of compression fracture patients (87%). In compression fractures, cement leakages were more common when vertebroplasty was done at the time of less than 10 days after onset of symptoms compared with more than 10 days. CONCLUSION: Bone cement leakages are more common in bursting fractures than compression fractures. Nonetheless, the complication is not significant and the same clinical improvement could be anticipated. For elderly patients especially those having difficulty in open surgery under general anesthesia due to their condition, percutaneous vertebroplasty may be considered as a therapeutic option.

A Management for Osteoporotic Bursting Fractures of the Thoracic and Lumbar Spines in the Aged: Posterior Approach with Intraoperative Vertebroplasty

OBJECTIVE: Treatments of osteoporotic bursting vertebral body fracture(OBF) of thoracic and lumbar spines have been limited to conservative managements especially in the elderly patients. The authors correct kyphosis and stabilize the spine by the posterior approach with intraoperative polymethylmethacrylate(PMMA) vertebroplasty. METHODS: From March 1999 to June 2000, eight patients with OBF underwent posterior approach with intraoperative vertebroplasty. The patients included 7 women and 1 man aged 54-82 year. Average T-score on bone marrow density was -3.02. In the case of old fracture with sclerosis in the posterior wall, after laminectomy, the retropulsed posterior wall of the fractured spine was reduced with L-shaped micro-bone impactor through the lateral epidural spaces, in prone position. About 6cc of PMMA was injected into the fractured vertebral body via transpedicular route, and then, small amount of PMMA was also injected into each entry point of the screws. All patients underwent one above and one below short segment fixation followed by correction of kyphotic deformity. RESULTS: The preoperative clinical symptoms improved gradually in all patients. During postoperative follow-up for more than 7 months, there was no recurrence of the preoperative clinical symptoms, aggravation of kyphosis or instrumentation failure. CONCLUSIONS: It is suggested that posterior approach with short segment fixation and intraoperative PMMA vertebroplasty could be a new surgical modality for osteoporotic bursting fracture of the thoracic and lumbar spines especially in the aged.

Imaging Diagnosis of Burst Fracture of Thoracolumbar Spine / 实用放射学杂志

Objective To evaluate the radiographic and CT findings and its diagnostic value of burst fracture of thoracolumbar spine.Methods The features of the frontal and lateral X-ray films and CT in 45 cases of burst fracture of thoracolumbar spine were reviewed.Results Among 45 cases there were type A in 15 cases,type B in 18 cases,type D in 7 cases and type E in 5 cases,three-column injury in 24 cases,two-column injury in 21 cases,the spinal canal narrowing:0?in 5 cases,Ⅰ?in 18 cases,Ⅱ?in 20 cases,Ⅲ?in 2 cases;the line of the posterior rim of the vertebral body being abnormity in 33 cases.Conclusion In examination of thoracolumbar burst fracture,both X-ray films and CT scan are of their own advantages and disadvantages,and they are only in combinodion with each other to improve the accurate diagnostic rate.

Burst Fracture with Distraction Injury in the Posterior Column of the Thoracolumbar Spine / 대한정형외과학회잡지

PURPOSE: To evaluate the characteristics of burst fracture with distraction injury of the posterior column and provide diagnostic information categorizing thoracolumbar fractures causing instability. MATERIALS AND METHODS: Twenty-one patients with a thoracolumbar burst fracture and posterior column injury, as confirmed by radiogram or MRI were included in this study. To evaluate clinical features, the characteristics of the injury mechanism and the physical findings were reviewed. The degree of kyphotic deformity, compression ratio and canal encroachment were measured. RESULTS: The group consisted of ten men and eleven women with a mean age of 39.3 years. The most common cause of injury was a fall from height in 14 cases. A superficial tenderness was noted in all cases. Of twenty-one patients, eleven had an associated spinal fracture. Kyphotic deformity, compression ratio and canal encroachment were 19.9o, 23% and 14% in an average, respectively. CONCLUSION: Our data demonstrated that burst fracture with distraction injury of the posterior column has no remarkable radiographic parameter despite the associated significant instability. This finding suggests that the index of suspicion for this type of injury is important, and physicians should be aware of the integrity of the posterior column.

Clinical Results of Internal Fixation Using Several Instruments in Unstable Thoracolumbar Bursting Fracture

Fifty six patients with unstable thoracolumbar bursting fractures were treated using variable internal fixation devices such as the Kaneda Anterior Fixation System(Kaneda device), the Z-Plate-ATL(TM) Anterior Fixation System(Z-Plate ATL(TM) device), the Harrington device, Cotrel-Ducousset(CD) or Compact Contrel Dubousset(CCD) device or Steffee Transpedicular System with or without decompression. Such internal fixation devices were grouped into anterior and posterior internal fixation devices and compared with each other in the aspect of the degree of neurological improvement, the changes of the vertebral height and the kyphotic angle, the duration of admission, and postoperative complications. In conclusion, the anterior internal fixation device appears to be of more benefit in the management of patients with unstable thoracolumbar bursting fracture.

Surgical Approach of Thoracolumbar or Lumbar Bursting Fracture with Associated Laminar Fracture

In case of thoracolumbar or lumbar bursting fractures with associated laminar fracture, there are the possibilities of posterior dural lacerations or neural entrapment caused by impaction of the dural sac into the gap of the fractured lamina. We treated thirty six patients of these fractures with anterior or posterior approach during last 10 years. The posterior approach had less delayed kyphosis and postoperative cerebrospinal fluid leakage than the anterior approach. Posterior dural laceration was noted during operation in sixteen cases out of a total of thirty six patients. The statistical analysis revealed significant associations of the dural laceration with preoperative neurological deficits, high grade spinal canal compromise, and comminuted laminar fracture. These patients should undergo posterior exploration of the spinal canal, extraction of neural elements, and repair of the lacerated dura before any spinal reconstruction maneuver.

The Imaging Analysis of the Spinal Bursting Fracture / 实用放射学杂志

Objective To study the value of common X-ray and CT scanning in the spinal bursting fracture (abridged English:BF).Methods By the frontal,lateral X-ray film and CT scanning,the imaging manifestations of BF in 43 cases were analysed,contrasted,summarised and classified .Results Among the BF 43 cases,the classifications were type A(10 cases),type B(15 cases),type C(2 cases),type D(9 cases) and type E(7 cases).The three-post injure had 34 cases,the two-post injure had 9 cases,the spinal canal narrowing:0?was 8 cases,1?was 12 cases,2? was 23 cases;the rear spinal edges discontinuation was 35 cases.Conclusion The diagnostic value of X-ray film to BF is reflecting the bones injured change of spinal fracture type,flexion and damaged rear edge.The CT scanning advantage is showing the fracture lines trend,relative scope,degree of spinal canal deformation and narrow,infering the pressed situation and injured spinal cord.The two methods combine and confirm each other in order to help clinical diagnosis the right treating.