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.

Treatment of Osteoporotic Stable Burst Fracture with Percutaneous Vetebroplasty

PURPOSE: To evaluate the result of percutaneous vertebroplasty in the treatment of osteorporotic stable burst fracture that has not neurologic symptom. MATERIALS AND METHODS: A retrospective review was conducted in 37 vertebrae of 33 patinets with osteoporotic stable burst fracrure treated by percutaneous vertebroplasty from February 2000 to May 2003. Stable burst fracture was classified by McAfee. The operation was performed in the patient without neurologic symptom, BMD T-score was below -2.5 and hot uptake was seen in (99m)Tc bone scan. The operation was held from post-traumatic 7 to 32 days, average 17 days. Follow up period was from 5 months to 38 months, average 11 months. The result of the treatment was assesed by clinical finding (pain scale and work status by Denis) and radiologic findings (percentage height restored and change of kyphotic angle). RESULTS: In clinical assessment, 27 had a satisfactory pain scale below the P3, 25 had a satisfactory work status below the W3. In the radiologic findings, percentage height restore was increased from 0% to 62%, average 23.3%. The preop. kyphotic angle was from -20 degree to 42 degree, average 8.9 degree. The postop. kyphotic angle was from -20 to 42 degree, average 6.5 degree. The kyphotic angle was decreased average 2.4 degree after operation. CONCLUSION: Treatment of osteoporotic stable burst fracture with percutaneous vertebroplasty is the minimal invasive treatment that has satisfactory pain relief and reduction of fracture.

Conservative Treatment of Compression and Stable Burst Fractures in the Thoracolumbar Junction: Early Ambulation Vs. Late Ambulation / 대한정형외과학회잡지

PURPOSE: To analyze the efficacy of early ambulation in a selected group of patients with compression and stable burst fractures in the thoracolumbar junction. MATERIALS AND METHODS: We reviewed retrospectively 65 cases of compression and stable burst fractures in the thoracolumbar junction. Group I was composed of 36 cases treated with bed-rest for 2 weeks or less followed by ambulation with bracing, Group II 29 cases treated with bed-rest for 4 weeks or more followed by ambulation with bracing. Radiologic results were compared for the two groups using lateral radiographs, and functional results were analyzed using Denis pain and work scores. RESULTS: Change in wedge angle at last follow up was 6.39+/-3.67degrees in group I and 5.28+/-2.72degrees in group II. Change in anterior body height was 14.46+/-8.25% in group I and 12.25+/-4.58% in group II (p>0.05). Satisfactory pain scores of less than or equal to P3 were noted in 11 cases (69%) of group I and in 12 cases (80%) of group II. Satisfactory work scores of less than or equal to W3 were noted in 12 cases (75%) of group I and in 12 cases (80%) of group II (p>0.05). CONCLUSION: Conservative management of compression and stable burst fractures in the thoracolumbar junction with 2 weeks or less of bed-rest followed by ambulation with bracing can predictably lead to satisfactory functional results.

Radiographic Comparison of Stable Burst Fractures with Compression Fractures in Thoracolumbar Spine / 대한척추외과학회지

STUDY DESIGN: A retrospective study was designed to evaluate the radiographic diagnostic method to detect any abnormal findings and differentiate stable burst fractures with compression fractures at thoracolumbar spine. OBJECTIVES: To evaluate diagnostic sensitivity of radiographic analysis and confirm the effectiveness of the radiographic diagnostic methods to differentiate stable burst fractures with pure compression fractures. SUMMARY OF BACKGROUND DATA: A data showed that the diagnostic sensitivity using radiographic analysis was 83%. The greater sensitivity was obtained at high posterior superior vertebral angle and PSVA/PIVA > 1.3. MATERIALS AND METHODS: Thirty-one patients with thoracolumbar spine fractures were evaluate to differentiate stable burst fractures with pure compression fractures. All patients were taken X-ray and CT. The PSVA(Posterior superior vertebral angle), PIVA(Posterior inferior vertebral angle), PSVA/PIVA were checked using lateral plain radiographs during follow-up period, and the final data was analysed using radiological & statistical methods. RESULTS: Middle column failure of stable burst fractures was greatly observed at high PSVA(especially >100degree) and high PSVA/PIVA ratio(> 1.3). CONCLUSION: The radiographic analysis using PSVA(Posterior superior vertebral angle), PIVA(Posterior inferior vertebral angle), PSVA/PIVA might be the one of useful methods to differentiate stable burst fractures with pure compression fractures at thoracolumbar spine during follow-up period.