COVID-19 associated myelitis:case series

The coronavirus pandemic brought with it a wide range of clinical presentations. Earlier, the respiratory symptoms comprised most of the clinical picture. However, as more and more people got infected, many atypical presentations came into the limelight, especially the neurological manifestations. Spinal cord complications are widely reported, with COVID-19 associated myelitis constituting a big part. Through this report, we bring you a series of cases of COVID-19 associated myelitis to add to the already available data. We report four patients, two of whom developed longitudinally extensive myelitis (three or more vertebral segments). The other two suffered from multisegmented short-segment myelitis (less than three vertebral segments). COVID-19 myelitis can be seen during COVID-19 illness and post COVID. We aim to familiarize the medical community with this entity so that there is a minimum delay between the onset of the symptoms in the patient and the management of this complication, as the treatment is often gratifying.

Correlation between the schanz screw insertion angle and the loss of kyphosis correction in thoracolumbar fractures / Correlação entre o ângulo de inserção do pino de schanz e a perda de correção da cifose em fraturas toracolombares / Correlación entre el ángulo de inserción del tornillo de schanz y la pérdida de corrección de la cifosis en fracturas toracolumbares

ABSTRACT Objective To compare the Schanz screw insertion angle and the loss of the regional kyphosis correction in thoracolumbar burst fractures following posterior short instrumentation surgery. Methods Patients with a thoracolumbar burst fracture between levels T11-L2 were divided into two groups (parallel and divergent) according to the angle formed between the Schanz screw and the vertebral plateau. Regional kyphosis was evaluated in preoperative, immediate postoperative and last follow-up radiographs. Results Of the 58 patients evaluated, 31 had a parallel assembly and 27 had a divergent assembly. When we analyzed the angle of kyphosis, no statistical difference was observed between the pre- and postoperative radiographs. However, a statistical difference in the last follow-up radiographs and in the final loss of the kyphosis correction was confirmed. Conclusion The insertion of Schanz screws with a divergent assembly presents better radiographic results with less loss of kyphosis correction angle when compared with the parallel assembly technique. Level of Evidence III; Retrospective cohort study.

RESUMO Objetivo Comparar o ângulo de inserção do pino de Schanz e os resultados da perda de correção da cifose regional nas fraturas toracolombares do tipo explosão após tratamento cirúrgico com instrumentação curta por via posterior. Métodos Os pacientes com fratura toracolombar do tipo explosão entre os níveis de T11-L2 foram divididos em dois grupos (paralelo e divergente) de acordo com o ângulo formado entre o pino de Schanz e o platô vertebral. Foi avaliada a cifose regional nas radiografias pré-operatória, pós-operatória imediata e do último acompanhamento. Resultados Dos 58 pacientes avaliados, 31 apresentaram uma montagem paralela e 27 uma montagem divergente. Ao analisarmos o ângulo da cifose, não se observou diferença estatística nas radiografias pré- e pós-operatória imediata. Porém, verificou-se uma diferença estatística nas radiografias do último acompanhamento e na perda final de correção da cifose. Conclusões A inserção do pino de Schanz com uma montagem divergente apresenta melhores resultados radiográficos com menor perda do ângulo de correção da cifose quando comparada com a técnica de montagem paralela. Nível de Evidência III; Estudo de coorte retrospectivo.

RESUMEN Objetivo Comparar el ángulo de inserción del tornillo de Schanz y los resultados de la pérdida de corrección de la cifosis regional en las fracturas toracolumbares del tipo explosión después del tratamiento quirúrgico con instrumentación corta por vía posterior. Métodos Los pacientes con fractura toracolumbar del tipo explosión entre los niveles de T11-L2 fueron divididos en dos grupos (paralelo y divergente) de acuerdo con el ángulo formado entre el tornillo de Schanz y la meseta vertebral. Fue evaluada la cifosis regional en las radiografías preoperatoria, posoperatoria inmediata y del último acompañamiento. Resultados De los 58 pacientes evaluados, 31 presentaron un montaje paralelo y 27 un montaje divergente. Al analizar el ángulo de la cifosis, no se observó diferencia estadística en las radiografías pre y postoperatoria inmediata. Sin embargo, se verificó una diferencia estadística en las radiografías del último acompañamiento y en la pérdida final de corrección de la cifosis. Conclusiones La inserción del tornillo de Schanz con un montaje divergente presenta mejores resultados radiográficos con menor pérdida del ángulo de corrección de la cifosis cuando comparada con la técnica de montaje paralelo. Nivel de Evidencia III; Estudio de cohorte retrospectivo.

Postprandial proximal gastric acid pocket and its association with gastroesophageal acid reflux in patients with short-segment Barrett's esophagus / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

OBJECTIVE@#To determine the characteristics of postprandial proximal gastric acid pockets (PPGAPs) and their association with gastroesophageal acid reflux in patients with Barrett's esophagus (BE).@*METHODS@#Fifteen patients with BE (defined by columnar lined esophagus of ≥1 cm) and 15 healthy individuals that were matched for age, gender, and body mass index, were recruited. The fasting intragastric pH and the appearance time, length, lowest pH, and mean pH of the PPGAP were determined using a single pH electrode pull-through experiment. For BE patients, a gastroesophageal reflux disease questionnaire (GerdQ) was completed and esophageal 24-h pH monitoring was carried out.@*RESULTS@#The PPGAP was significantly longer (5 (3, 5) cm vs. 2 (1, 2) cm) and the lowest pH (1.1 (0.8, 1.5) vs. 1.6 (1.4, 1.9)) was significantly lower in patients with short-segment BE than in healthy individuals. The PPGAP started to appear proximally from the gastroesophageal pH step-up point to the esophageal lumen. The acidity of the PPGAP was higher in the distal segment than in the proximal segment. In short-segment BE patients, there were significant correlations between the acidity and the appearance time and length of the PPGAP. The length and acidity of the PPGAP were positively associated with gastroesophageal acid reflux episodes. The acidity of the PPGAP was associated with the DeMeester scores, the GerdQ scores, and the fasting intragastric pH.@*CONCLUSIONS@#In patients with short-segment BE, a PPGAP is commonly seen. Its length and acidity of PPGAP are associated with gastroesophageal acid reflux, the DeMeester score, and the GerdQ score in patients with short-segment BE.

Clinical efficacy and complications of short versus long segments of internal fixation for the treatment of degenerative scoliosis: A meta-analysis / 中国组织工程研究

BACKGROUND: Currently, surgical methods for the treatment of degenerative scoliosis include simple decompression and decompression combined with internal fixation. However, there is still controversy over the choice of fixation and fusion segment in surgery, which requires more reliable evidence-based medical evidence for reference. OBJECTIVE: To evaluate the clinical efficacy and complication of short versus long segments of internal fixation for the treatment of degenerative scoliosis using meta-analysis. METHODS: CNKI, Wanfang Database, VIP, CBM, EMBase, PubMed, Web of Science, and Cochrane Library were searched to collect the randomized and non-randomized controlled studies which compared long fusion with short fusion in the treatment of degenerative scoliosis from inception to February 2019. Relevant conference papers and authoritative journals in the field were retrieved manually. The quality of the included studies was assessed by two evaluation members according to the Cochrane collaboration network standard or the Newcastle-Ottawa Scale. The included studies were analyzed by using RevMan 5.3 software. RESULTS AND CONCLUSION: (1) A total of 20 articles were included, involving a sample of 1 329 individuals. Long segment group consisted of 601 cases, and short segment group consisted of 728 cases. (2) The meta-analysis results showed that long-segment internal fixation surgery had better improvement of coronal Cobb angle (P=0.000 4), coronal balance (P=0.000 2), Oswestry disability index (P=0.003) and visual analogue scale score (P 0.05). (4) These findings verify that long-segment internal fixation is superior to short-segment internal fixation in the correction of scoliosis, but the recovery is slow and the incidence of some complications after operation is high. It should be considered comprehensively when selecting specific surgical procedures.

Comparison of the short-segment and long-segment cement-augmented pedicle screw fixation for osteoporotic thoracolumbar fracture: A finite element study / 中国组织工程研究

BACKGROUND: Pedicle screw fixation combined with cement-augmented is an effective method for the treatment of severe osteoporotic vertebral fractures, but there is no uniform standard. The range of fixed segments is one of the focus of clinical controversy. OBJECTIVE: To establish a three-dimensional finite element model of the short-segment and long-segment cement-augmented pedicle screw fixation for osteoporotic thoracolumbar fracture, and to analyze the biomechanical characteristics of adjacent segment structures, fractured vertebral bodies and internal fixation devices. METHODS: The T 9 -L 5 segment of a volunteer without obvious degenerative disease was selected for CT scan. The CT images of Dicom format were obtained, and the engineering software was imported to establish a finite element geometric model to simulate the thoracolumbar fracture and the short-segment and long-segment cement-augmented pedicle screw fixation models. The relevant material parameters were set and the biomechanical characteristics of the two groups were compared and analyzed. RESULTS AND CONCLUSION: (1) The stress on the vertebrae was mainly concentrated on the periphery of the vertebral body and the small facet of the attachment. In the four directions flexion, extension, left-sided and right-sided curvature, the maximum stress of the proximal and distal adjacent vertebrae in the long-segment group was greater than that in the short-segment group. The stress of the intervertebral disc was mainly concentrated in the peripheral annulus. The maximum stress of the proximal and distal adjacent intervertebral discs was greater in the short -segment than in the long-segment, but the high stress area of the long-segment was larger than that of the short-segment. Therefore, long-segment fixation might accelerate the degeneration of adjacent segments.(2) The vertebral bodies of the long-segment group and the short-segment group were displaced to different extents, and the displacements in the left and right directions were the most obvious. In the six movement directions, the displacement and maximum stress of the injured segment of the short-segment group were greater than those of the long-segment group. So the long-segment fixation could better maintain the stability of the fractured vertebra. (3) The stress on the internal fixing device was mainly concentrated on the screws at both ends and the part of the rod. The maximum stress of the long-segment group was greater than that of the short-segment group, but the main stress area of the screws at both ends was smaller compared with the short- segment group.and the displacements in the left and right directions were the most obvious. In the six movement directions, the displacement and maximum stress of the injured segment of the short-segment group were greater than those of the long-segment group. So the long- segment fixation could better maintain the stability of the fractured vertebra. (3) The stress on the internal fixing device was mainly concentrated on the screws at both ends and the part of the rod. The maximum stress of the long-segment group was greater than that of the short-segment group, but the main stress area of the screws at both ends was smaller compared with the short-segment group.and the displacements in the left and right directions were the most obvious. In the six movement directions, the displacement and maximum stress of the injured segment of the short-segment group were greater than those of the long-segment group. So the long- segment fixation could better maintain the stability of the fractured vertebra. (3) The stress on the internal fixing device was mainly concentrated on the screws at both ends and the part of the rod. The maximum stress of the long-segment group was greater than that of the short-segment group, but the main stress area of the screws at both ends was smaller compared with the short-segment group.So the long-segment fixation could better maintain the stability of the fractured vertebra. (3) The stress on the internal fixing device was mainly concentrated on the screws at both ends and the part of the rod. The maximum stress of the long-segment group was greater than that of the short-segment group, but the main stress area of the screws at both ends was smaller compared with the short-segment group. So the long-segment fixation could better maintain the stability of the fractured vertebra. (3) The stress on the internal fixing device was mainly concentrated on the screws at both ends and the part of the rod. The maximum stress of the long-segment group was greater than that of the short-segment group, but the main stress area of the screws at both ends was smaller compared with the short-segment group.

Imaging evaluation of short-segment fixation and fusion for degenerative lumbar scoliosis assisted by highly selective nerve root block / 中国组织工程研究

BACKGROUND: Short-or long-segment fixation is still controversial in the treatment of adult degenerative lumbar scoliosis. OBJECTIVE: To investigate the effectiveness and feasibility of accurate treatment of short-segment fixation in adult degenerative lumbar scoliosis patients assisted by highly selective nerve root block. METHODS: Thirty-five patients with adult degenerative lumbar scoliosis treated in Chinese PLA General Hospital and People’s Hospital of Peking University from May 2014 to September 2017 were analyzed retrospectively, including 14 males and 21 females aged (64.2±8.1) years. The fixation segments were determined by a highly selective nerve root block. All patients were subjected to transforaminal lumbar interbody fusion. During the follow-up, visual analogue scale score and Oswestry disability index were evaluated. Parameters including lumbar curvature Cobb angle, lumbar lordosis angle, sacral slope, and pelvic tilt and interbody fusion condition were obtained by imaging; and complications were recorded. This study was approved by the Ethics Committee of Chinese PLA General Hospital and People’s Hospital of Peking University. RESULTS AND CONCLUSION: (1) Of the 35 patients, 27 underwent single-segment minimally invasive transforaminal lumbar fusion, 5 underwent double-segment minimally invasive transforaminal lumbar fusion, and 3 underwent three-segment minimally invasive transforaminal lumbar fusion. (2) The follow-up time of 35 patients was (25.6±1.5) months. All patients achieved the grade I fusion. Within 3 months, there were 3 cases of dural tear and cerebrospinal fluid leakage, 1 case of lower-extremity muscular venous thrombosis, 1 case of pneumonia and 1 case of wound fat liquefaction. Three months later, there was 1 case of adjacent segment degeneration; no nerve injury or nonunion, no screw or titanium rod breakage. (3) Visual analogue scale score, Oswestry disability index, Cobb angle, lumbar lordosis angle, sacral slope, and pelvic tilt at the last follow-up were significantly improved in 35 patients compared with those before surgery (P < 0.01). (4) Short-segment precision treatment of adult degenerative lumbar scoliosis with highly selective nerve root block can achieve good clinical effect.

Postprandial proximal gastric acid pocket and its association with gastroesophageal acid reflux in patients with short-segment Barrett’s esophagus / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Objective: To determine the characteristics of postprandial proximal gastric acid pockets (PPGAPs) and their association with gastroesophageal acid reflux in patients with Barrett’s esophagus (BE). Methods: Fifteen patients with BE (defined by columnar lined esophagus of ≥1 cm) and 15 healthy individuals that were matched for age, gender, and body mass index, were recruited. The fasting intragastric pH and the appearance time, length, lowest pH, and mean pH of the PPGAP were determined using a single pH electrode pull-through experiment. For BE patients, a gastroesophageal reflux disease questionnaire (GerdQ) was completed and esophageal 24-h pH monitoring was carried out. Results: The PPGAP was significantly longer (5 (3, 5) cm vs. 2 (1, 2) cm) and the lowest pH (1.1 (0.8, 1.5) vs. 1.6 (1.4, 1.9)) was significantly lower in patients with short-segment BE than in healthy individuals. The PPGAP started to appear proximally from the gastroesophageal pH step-up point to the esophageal lumen. The acidity of the PPGAP was higher in the distal segment than in the proximal segment. In short-segment BE patients, there were significant correlations between the acidity and the appearance time and length of the PPGAP. The length and acidity of the PPGAP were positively associated with gastroesophageal acid reflux episodes. The acidity of the PPGAP was associated with the DeMeester scores, the GerdQ scores, and the fasting intragastric pH. Conclusions: In patients with short-segment BE, a PPGAP is commonly seen. Its length and acidity of PPGAP are associated with gastroesophageal acid reflux, the DeMeester score, and the GerdQ score in patients with short-segment BE.

Comparison of short-segment and long-segment bone cement-augmented fixation combined with vertebroplasty in treatment of stage Ⅲ Kümmell disease / 中国修复重建外科杂志

Objective: To compare the effectiveness of short-segment and long-segment bone cement-augmented fixation combined with vertebroplasty in treatment of stage Ⅲ Kümmell disease. Methods: A clinical data of 44 patients with stage Ⅲ Kümmell disease met the selection criteria between January 2014 and December 2017 was retrospectively analyzed. Eighteen cases were treated with short-segment bone cement-augmented fixation combined with vertebroplasty (short-segment group) and 26 cases were treated with long-segment bone cement-augmented fixation combined with vertebroplasty (long-segment group). There was no significant difference in gender, age, disease duration, fracture segment, bone mineral density (T value), Frankle grading, and preoperative pain visual analogue scale (VAS) score, Oswestry disability index (ODI), anterior edge height of injured vertebrae, kyphosis Cobb angle, and thoracolumbar kyphosis (TLK) between the two groups ( P>0.05). The operation time, intraoperative blood loss, bone cement injection volume, bone cement leakage rate, VAS score, ODI, anterior edge height of injured vertebrae, kyphosis Cobb angle, and TLK were compared between the two groups. Results: The operation time and the intraoperative blood loss in the short- segment group were significant lower than those in the long-segment group ( P0.05). All patients were followed up 12-36 months, with an average of 24.4 months. The VAS score, ODI, anterior edge height of injured vertebrae, kyphosis Cobb angle, and TLK significantly improved at 1 week after operation and last follow-up in the two groups ( P0.05). At last follow-up, the neurological function of the two groups recovered, and there was no significant difference in Frankle grading between the two groups ( P>0.05). There were 3 cases (16.67%) of non-surgical vertebral fractures in the short-segment group and 6 cases (23.08%) in the long-segment group, showing no significant difference between the two groups ( P>0.05). Bone rejection occurred in 1 case in the short-segment group, and neither internal fixation failure nor collapse of the injured vertebrae occurred during follow-up. Conclusion: Both short-segment and long-segment bone cement-augmented fixation combined with vertebroplasty can achieve good effectiveness in treatment of stage Ⅲ Kümmell disease, and can maintain the height of the injured vertebra and prevent the collapse of the injured vertebra. Compared with long-segment fixation, short-segment fixation has the advantages of shorter operation time and less intraoperative bleeding.

​Functional Analysis of Effectiveness of Short Segment with Index Vertebra Fixation as Compared with Long-segment Fixation in the Management of Thoracolumbar Spinal Injuries

Background: Dorsolumbar fractures are unstable mostly which requires surgical spinal stabilization to maintain anatomicalreduction and stability and also to promote early bony fusion and mobilization. Posterior short-segment pedicle screw fixation isusually done for burst fractures. Even though early clinical results of this surgery are usually satisfactory, a high failure rate andprogressive kyphosis remain a concern. To overcome this, in addition to short-segment fixation, the pedicle screw is insertedat the fracture site. Long-segment fixation is usually done for fracture dislocations.Materials and Methods: A total of 25 patients with dorsolumbar spinal injuries admitted in Government Rajaji Hospital andMadurai Medical College were selected for the study and followed for a period of 24 months. Of these, four patients were lostfollow–up, and hence, 21 cases were included in the study and followed for a period of 2 years.Results: A total of 25 patients were selected for the study. Our results showed good to excellent in long segment, 72.7% of thepatients were good (eight cases), and in short segment, 70% of the cases were good (seven cases). In long segment, 27.7%of the patients were fair (three cases), and in short segment, 30% of the cases were fair (three cases). In our study, the meanof Oswestry Disability Index in long segment is 32.31 and mean in short segment is 31.99. In our study, only one patient hadrod breakage, but the patient had no pain and no neurological deficit, and functional outcome is good.Conclusion: We conclude that short-segment fixation with index vertebra fixation provides as good results as long-segmentfixation with reduction in cost and time of surgery in the treatment of thoracolumbar spinal injuries.

Short-segment pedicle screw fixation combined with polymethyl methacrylate vertebroplasty in treating thoracolumbar osteoporotic compression fractures / 中华创伤杂志

Objective To evaluate the clinical efficacy and safety of short-segment pedicle screw fixation combined with vertebroplasty for the treatment of thoracolumbar osteoporotic compression fractures.Methods A retrospective case control study was conducted on 63 patients with fresh thoracic or lumbar osteoporotie compression fractures who were surgically treated from January 2010 to December 2013.There were 26 males and 37 females,with age of 63-87 years [(76.3 ± 5.7) years].According to the surgical method,the patients were assigned to simple vertebroplasty group (Group A),short-segment pedicle screw fixation group (Group B),and short-segment pedicle screw fixation group combined with vertebroplasty group (Group C),with 21 cases in each group.Length of hospital stay,operation time,and blood loss were recorded.The visual analog scale (VAS),anterior vertebral body height,angle of the kyphotic deformity,and complications before operation,immediately after operation,3 months after operation,and at the last follow up were compared among three groups.Complications of each group were recorded.Results The hospital stay,operation time,and blood loss in Group C were significantly higher than those in Group A (P ＜ 0.05),but there were no significant differences between Group B and Group C (P ＞ 0.05),except for a longer operation time in Group C.The pre-operative VAS showed no significant difference among three groups (P ＞ 0.05).However,the mean VAS in Groups A,B and C at the last follow up were 1.0(0.0,2.0)points,1.0(0.0,2.0)points,0.0(0.0,1.0)points,respectively.The VAS in Group C was significantly lower than that in Group B or A (P ＜ 0.05).The mean anterior vertebral body height and angle of the kyphotic deformity in Group C had no significant difference from that in Group A or B before operation and immediately after operation (P ＞ 0.05).At the last follow up,the mean anterior vertebral body height and angle of the kyphotic deformity in Groups A,B and C were (68 ±14.7)％,(72.3 ±9.0)％,(81.5 ±5.6)％ and (10.6 ±3.9)°,(10.7 ±5.0)°,(7.4 ± 5.0) °,respectively.The loss of anterior vertebral body height and angle of the kyphotic deformity correction in Group C were significantly less than that in Group A or B (P ＜ 0.05).Superficial infection was found in Groups B (n =2) and C (n =1),and the infection was cured after antibiotic therapy and dress change.Bone cement leakage was found in Groups A (n =8) and C (n =5),with no nerve compression.Internal fixation failure was seen in Group B (n =3),and the implant was removed directly.Conclusion Short-segment pedicle screw fixation combined with vertebroplasty can effectively reduce the loss of anterior vertebral body height and angle of the kyphotic deformity and hence enhance the clinical efficacy.

Posterior short-segment fixation including the fractured vertebra for severe unstable thoracolumbar fractures / 中国修复重建外科杂志

Objective: To discuss the effectiveness of posterior short-segment fixation including the fractured vertebra for severe unstable thoracolumbar fractures using pedicle screw fixation.

Analyzing Risk Factors that were Associated with Loss of Correction Curvature after Short-segment Restoration and Fixation in Cases Who had Single-segment Thoracolumbar Fracture / 现代生物医学进展

Objective:To analyze risk factors that were associated with loss of correction curvature after short-segment restoration and fixation in cases who had single-segment thoracolumbar fracture.Methods:87 Cases who had experienced single-segment thoracolumbar fracture and had underwent short-segment restoration and fixation in our department from Jan 2008 to Jan 2011,and had complete follow-up imaging were included.Cobb angles were measured on lateral thoracolumbar X-ray preoperatively,postoperatively and before removal of internal fixation.And these included the angle formed by vertebras that located above and below injured vertebrae (α angle),superior endplate of injured vertebrae and its superior vertebrae (β angle),inferior endplate of injured vertebrae and its inferior vertebrae (γ angle),inferior and superior endplate of injured vertebrae (δ angle).T-test was used to analyze these angles and their changes.And correlation analysis was used to analyze relationships between α angle change and other risk factors.Results:When compared with preoperative angles,the mean α angle,β angle,γ angle and δ angle were all significantly increased (p＜0.05) after the operation.The mean α angle and δ angle before the removal of internal fixation were both significantly smaller than those after the operation (p＜0.05),and the mean change ofα angle was-2.85 degrees.After the correlation analysis,we found significant correlations between the change ofα angle and postoperative correction curvature(-0.342,p=0.026),injured region in endplate(0.374,p=0.015),and change of the δ angle(0.231,p=0.041).Conclusion:There was significant loss in the correction curvature before the removal of internal fixation.And the loss was significantly associated with postoperative correction curvature,injured region in endplate,and change of the δ angle.

The Relationship between Superior Disc-Endplate Complex Injury and Correction Loss in Young Adult Patients with Thoracolumbar Stable Burst Fracture

BACKGROUND: To determine the relationship between superior disc-endplate complex injury and correction loss after surgery in a group of young adult patients with a stable thoracolumbar burst fracture. METHODS: The study group was comprised of young adult patients who had undergone short-segment posterior fixation and bone grafting under the diagnosis of a stable thoracolumbar burst fracture from March 2008 to February 2014. Follow-up was available for more than 1 year. Before surgery, magnetic resonance imaging was performed to determine injury to the anterior longitudinal ligament, posterior longitudinal ligament, and superior and inferior intervertebral discs and endplates. Correction loss was evaluated by the Cobb angle, intervertebral disc height, upper intervertebral disc angle, vertebral wedge angle, and vertebral body height. RESULTS: No significant relation was noted between correction loss and an injury to the anterior longitudinal ligament, posterior longitudinal ligament, inferior intervertebral disc/endplate, and fracture site, whereas an injury to the superior endplate alone and superior disc-endplate complex showed a significant association. Specifically, a superior intervertebral disc-endplate complex injury showed statistically significant relation to postoperative changes in Cobb angle (p = 0.026) and vertebral wedge angle (p = 0.047). CONCLUSIONS: A superior intervertebral disc-endplate complex injury may have an influence on the prognosis after short-segment fixation in young adult patients with a stable thoracolumbar burst fracture.

Short Segment versus Long Segment Pedicle Screws Fixation in Management of Thoracolumbar Burst Fractures: Meta-Analysis

Posterior pedicle screw fixation has become a popular method for treating thoracolumbar burst fractures. However, it remains unclear whether additional fixation of more segments could improve clinical and radiological outcomes. This meta-analysis was performed to evaluate the effectiveness of fixation levels with pedicle screw fixation for thoracolumbar burst fractures. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Springer, and Google Scholar were searched for relevant randomized and quasirandomized controlled trials that compared the clinical and radiological efficacy of short versus long segment for thoracolumbar burst fractures managed by posterior pedicle screw fixation. Risk of bias in included studies was assessed using the Cochrane Risk of Bias tool. Based on predefined inclusion criteria, Nine eligible trials with a total of 365 patients were included in this meta-analysis. Results were expressed as risk difference for dichotomous outcomes and standard mean difference for continuous outcomes with 95% confidence interval. Baseline characteristics were similar between the short and long segment fixation groups. No significant difference was identified between the two groups regarding radiological outcome, functional outcome, neurologic improvement, and implant failure rate. The results of this meta-analysis suggested that extension of fixation was not necessary when thoracolumbar burst fracture was treated by posterior pedicle screw fixation. More randomized controlled trials with high quality are still needed in the future.

Efficacy and safety of minimally invasive percutaneous surgery for treatment of thoracolumbar fracture combined with posterior ligament injury / 局解手术学杂志

Objective To investigate the efficacy and safety of the minimally invasive percutaneous surgery in the treatment of thoracolumbar fracture combined with posterior ligament injury.Methods The 94 cases of thoracolumbar fracture combined with posterior ligament injury who were admitted into our hospital from Septenber 2012 to January 2016 were selected and equally divided into the observation group and the control group(47 cases in each group) according to different methods.Patients of the observation group were treated with short segment of minimally invasive percutaneous surgery,while patients of the control group were underwent single segment of minimally invasive percutaneous surgery.Recorded the outcomes and prognosis of the two groups.Results There was no significant difference in the operation time and blood loss between the two groups(P ＞ 0.05).The postoperative volume of drainage and the length of stay in the observation group were significantly shorter than those in the control group(P ＜ 0.05).The JOA score of the observation group 1 month after operation was significantly better than that of the control group(P ＜ 0.05).The incidence of complications including pedicle screw breakage,pedicle screw loosening,incision infection,and pulmonary infection in the observation group was 4.3％,which was significantly less than 21.3％ in control group (P ＜ 0.05).The Cobb's angle of the obervation group and control group 1 month after operation were (8.55 ± 1.34) ° and (16.30 ± 2.33) ° respectively,which were significantly lower than (32.19 ± 1.98) ° and (32.08 ± 2.08) ° before operation (P ＜ 0.05).And the Cobb's angle 1 month after operation in the observation group were significantly lower than that of the control group(P ＜ 0.05).Conclusion The short segment of minimally invasive percutaneous surgery for the treatment of thoracolumbar fracture combined with posterior ligament injury can reduce the incidence of postoperative complications,promote the patient's rehabilitation,correct the kyphosis and promote the recovery of neural function,which was safer and more efficient.

Posterior short segment and long segment pedicle screws internal fixation in treatment of thoracolumbar burst fracture:Meta analysis / 中国综合临床

Objective To systematically evaluate the efficacy and safety of posterior short segment and long segment pedicle screw internal fixation in the treatment of thoracolumbar burst fracture. Methods By searching the database, including PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, a comprehensive study was carried out to make a comparison between the posterior short segment and the long segment pedicle screws internal fixation in treatment of thoracolumbar burst fracture, and Meta analysis was performed. Results A total of 14 related studies and 658 patients were enrolled in the study, including 320 patients in short segment group and 338 cases in long segment group, and Meta analysis was performed. The results suggested that there was no significant difference between the short segment group and the long segment group in terms of the deformity angle of the injured vertebra measured after operation and at the last follow?up, and sagittal index at the last follow?up ( MD=-0. 22,95%CI -2. 73,2. 28,P=0. 86;MD=-0. 28,95%CI -2. 23,1. 67, P=0. 78;MD=0. 47, 95%CI -3. 45, 4. 39, P=0. 81 ) . Besides, both groups had no statistical difference in post?operative COBB angle,anterior vertebral height and compression rate of injured vertebrae ( MD=0. 21,95%CI -0. 65,1. 06,P=0. 64; MD=-0. 46,95%CI -1. 40,0. 49,P=0. 34; MD=0. 47,95%CI -2. 28, 3. 21, P= 0. 74 ) , while the differences in COBB angle, anterior vertebral height, compression rate, correction loss were statistically significant at the last follow?up (MD=5. 11,95%CI 2. 81,7. 40,P<0. 0001;MD=-11. 89,95%CI-15. 28,-8. 50,P<0. 00001;MD=6. 46,95%CI 3. 85,9. 07,P<0. 00001) . There was no significant difference in VAS scores and the ODI scores between the two groups at the last follow?up ( MD =0. 01,95%CI -0. 15,0. 17,P=0. 9; MD=-0. 47,95%CI -2. 68,1. 74,P=0. 86),while the two groups showed statistically significant difference in fixation failure ( RR = 0. 08, 95%CI 0. 01, 0. 15, P = 0. 02 ) . Conclusion Posterior long segment pedicle screw internal fixation is more effective in treating thoracolumbar burst fracture than short segment surgery. It can reduce the COBB angle,restore the anterior height of the injured vertebra,and decrease the anterior vertebral pressure.

COMPARISON OF SHORT SEGMENTAL FIXATION WITH AND WITHOUT FUSION IN TREATMENT OF THORACOLUMBAR BURST FRACTURE BY POSTERIOR APPROACH / 中国修复重建外科杂志

OBJECTIVE: To compare the effectiveness of short segmental pedicle screw fixation with and without fusion in the treatment of thoracolumbar burst fracture. METHODS: A retrospective analysis was made on the clinical data of 57 patients with single segment thoracolumbar burst fractures, who accorded with the inclusion criteria between February 2012 and February 2014. The patients underwent posterior short segmental pedicle screw fixation with fusion in 27 cases (fusion group) and without fusion in 30 cases (non-fusion group). There was no significant difference in gender, age, cause of injury, time between injury and admission, fracture segment and classification, and neurologic function America Spinal Injury Association (ASIA) classification between 2 groups, which had the comparability (P>0.05). The operative time, blood loss, and hospitalization days were compared between 2 groups. The height of the injured vertebra, the kyphotic angle, and the range of motion (ROM) were measured on the X-ray film. The functional outcomes were evaluated by using the Greenough low-back outcome score and the visual analogue scale (VAS) for back pain. The neurologic functional recovery was assessed by ASIA grade. RESULTS: The operative time was significantly shortened and the blood loss was significantly reduced in the non-fusion group when compared with the fusion group (P0.05). The patients were followed up for 2.0-3.5 years (mean, 3.17 years) in the fusion group and for 2-4 years (mean, 3.23 years) in the non-fusion group. X-ray films showed that 2 cases failed bone graft fusion, the fusion time was 12-17 weeks (mean, 15.6 weeks) in the other 25 cases. Complication occurred in 2 cases of the fusion group (1 case of incision deep infection and 1 case of hematoma at iliac bone donor site) and in 1 case of the non-fusion group (fat liquefaction); primary healing of incision was obtained in the others. The Cobb angle, the height of injured vertebrae showed no significant difference between 2 groups at pre-operation, immediate after operation, and last follow-up (P>0.05). The ROM of injured vertebrae showed no significant difference between 2 groups at 1 year after operation (before implants were removed) (P>0.05). The implants were removed at 1 year after operation in all cases of the non-fusion group, and in 11 cases of the fusion group. At last follow-up, the ROM of injured vertebrae in the non-fusion group was significantly higher than that in the fusion group (P0.05). CONCLUSIONS: Fusion is not necessary when thoracolumbar burst fracture is treated by posterior short segmental pedicle screw fixation, which can preserve regional segmental motion, shorten the operative time, decrease blood loss, and eliminate bone graft donor site complications.

Radiological Outcome of Short Segment Posterior Instrumentation and Fusion for Thoracolumbar Burst Fractures

STUDY DESIGN: Retrospective study. PURPOSE: To evaluate the radiological outcome of the surgical treatment of thoracolumbar burst fractures by using short segment posterior instrumentation (SSPI) and fusion. OVERVIEW OF LITERATURE: The optimal surgical treatment of thoracolumbar burst fractures remains a matter of debate. SSPI is one of a number of possible choices, yet some studies have revealed high rates of poor radiological outcome for this SSPI. METHODS: Patients treated using the short segment instrumentation and fusion technique at the Spinal Injuries Center (Iizuka, Fukuoka, Japan) from January 1, 2006 to July 31, 2012 were selected for this study. Radiographic parameters such as local sagittal angle, regional sagittal angle, disc angle, anterior or posterior height of the vertebral body at admission, postoperation and final observation were collected for radiological outcome evaluation. RESULTS: There were 31 patients who met the inclusion criteria with a mean follow-up duration of 22.7 months (range, 12-48 months). The mean age of this group was 47.9 years (range, 15-77 years). The mean local sagittal angles at the time of admission, post-operation and final observation were 13.1degrees, 7.8degrees and 14.8degrees, respectively. There were 71% good cases and 29% poor cases based on our criteria for the radiological outcome evaluation. The correction loss has a strong correlation with the load sharing classification score (Spearman rho=0.64, p<0.001). CONCLUSIONS: The loss of kyphotic correction following the surgical treatment of thoracolumbar burst fracture by short segment instrumentation is common and has a close correlation with the degree of comminution of the vertebral body. Patients with high load sharing scores are more susceptible to correction loss and postoperative kyphotic deformity than those with low scores.

Effect of Short-segment Pedicle Screws System with or without Pedicle Screws on Fractured Level on Type A Thoracic and Lumbar Spine Fracture / 中国康复理论与实践

@#Objective To investigate the effects of short-segment pedicle screws system on type A thoracic and lumbar spine fracture with or without pedicle screws on the fractured level. Methods 23 patients with type A thoracic and lumbar spine fracture were included, in which 11 cases received traditional short-segment pedicle screws system without pedicle screws on the fractured level (group A), and other 12 cases with pedicle screws on the fractured level (group B). The anterior vertebral height, posterior vertebral height and local kyphosis an-gle were measured before and after operation. Results All pedicle screws were successfully implanted with good location and stability. The vertebral height and kyphosis angle significantly improved after operation in both groups (P<0.05), and the improvement of kyphosis angle was more in group B than in group A (P<0.05). Conclusion Short-segment pedicle screws system with pedicle screws on the fractured level may fine correct the kyphosis angle in short term.

Short-segment fixation via versus across the injured vertebrae for thoracolumbar vertebral fractures / 医学研究生学报

Objective Short-segment fixation is one of the most commonly used methods for the management of thoracolumbar vertebral fractures.In this study, we compared the clinical effects of short-segment fixation via and across the injured vertebrae in the treatment of thoracolumbar vertebral fractures . Methods We retrospectively analyzed 75 cases of thoracolumbar vertebral fractures treated by short-segment fixation, 39 via the injured vertebrae (group A) and 36 across the injured vertebrae (group B).We obtained the pre-and post-operative anterior vertebral body height ratio (AVBHr) and sagittal Cobb angle, operation time, and intraoperative blood loss, and compared them between the two groups of patients . Results Compared with the baseline, the AVBHr and the sagittal Cobb angle were significantly restored after surgery in both groups A ([56.32 ±12.53] vs [85.76 ±11.48]%and [20.41 ±5.73] vs [8.72 ±5.34]°, P0.05).The losses of the AVBHr and Cobb angle were (3.78 ±1.24)%and (2.25 ±1.06)°in group A, signifi-cantly lower than (6.69 ±2.52)% and (6.31 ±2.18)°in group B (P<0.05). Conclusion For thoracolumbar fractures, short-segment fixation either via or across the injured vertebrae can effective-ly improve the vertebral height and Cobb angle , but fixation via the injured vertebrae may achieve a better maintenance of correction .