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OBJECTIVE@#To explore the effects of morphological changes such as vertebral wedge deformation and disc degeneration (collapse) on adult thoracolumbar/lumbar degenerative kyphosis(TL/LDK) deformity.@*METHODS@#A retrospective analysis of 32 patients with spinal TL/LDK deformity admitted from August 2015 to December 2020, including 8 males and 24 females, aged 48 to 75(60.3±12.4) years old. On the long-cassette standing upright lateral radiographs, the coronal Cobb angle, sagittal thoracic lumbar/lumbar kyphosis angle(KA) of spine were measured, and the height and wedge parameters of apex vertebral(AV) and two vertebrae(AV-1, AV-2, AV+1, AV+2) above and below AV and the intervertebrae and the intervertebral disc(AV-1D, AV-2D, AV+1D, AV+2D) were evaluated, involving anterior vertebral body height(AVH), posterior vertebral body height(PVH), vertebral wedge angle(VWA), ratio of vertebral wedging(RVW), anterior disc height(ADH), posterior disc height(PDH), disc wedge angle(DWA), ratio of disc wedging(RDW), and DWA/KA.@*RESULTS@#The average angle of kyphosis was (44.2±19.1)°. A significant decrease in anterior height of vertebral was observed compared to the posterior height of vertebral(P<0.005). There was no significant difference in anterior and posterior height of discs. The vertebral wedging ratio/contribution ratio:AV-2(14.98±10.95)%/(14.21±8.08)%, AV-1(21.08±12.39)%/(18.09±7.38)%, AV(26.94±11.94)%/(25.52±8.64)%, AV+1(24.19±8.42)%/(20.82±8.69)%, AV+2(20.56±7.80)%/(15.60±9.71)%, total contribution(94.23±22.25)%, the disc wedging ratio/contribution ratio:AV-2D(2.88±2.57)%/(5.27±4.11)%, AV-1D(1.98±1.41)%/(2.29±2.16)%, AV+1D(-5.54±3.75)%/(-0.57±0.46)%, AV+2D(-8.27±4.62)%/(-1.22±1.11)%, total contribution (5.77±4.79)%. And the contribution rate of AV was significantly higher than that of adjacent vertebral(P<0.05).@*CONCLUSION@#The vertebral body and intervertebral disc shape both have influence on thoracolumbar kyphosis. However, the contribution of vertebral morphometry to the angle of TL/LDK deformity is relatively more important than the disc. The contribution of the wedge change of the AV to the TL/LDK deformity is particularly significant.
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Male , Adult , Female , Humans , Middle Aged , Aged , Retrospective Studies , Thoracic Vertebrae/diagnostic imaging , Lumbar Vertebrae/diagnostic imaging , Kyphosis , Scoliosis , Intervertebral DiscABSTRACT
Objective To explore the clinical effect of posterior indirect reduction and internal fixation and laminectomy in the treatment of thoracolumbar vertebrae burst fracture complicated with spinal cord injury.Methods Eighty patients with thoracolumbar vertebrae burst fracture and spinal cord injury treated in our hospital from March 2014 to March 2015 were selected as the objects,and they were divided into reset group and laminectomy group with forty cases in each group according to surgical method.All the patients were followed up for 1 year,the lumbar function of two groups at 1 week and 1 year after operation were observed respectively,and the pain degree was observed in 1month,3 months and 6 months after operation.The amount of bleeding,operation time,hospitalization time and fracture healing time were observed.Neurological function was assessed by classification criteria of the American Spinal Cord Injury Association(ASIA),and incidence of complications was figured in the two groups.Results The anterior heights of the injured vertebra were higher than those before the operation,and the Cobb's angles were lower than those before the operation,the differences were significant(P ＜ 0.05);while there was no significant differences in the anterior heights of the injured vertebra between the two groups at 1 week and 1 year after operation(P ＞ 0.05).VAS scores of the two groups after 1 month,3 months and 6 months decreased significantly when compared with the preoperative scores(P ＜ 0.05),and VAS scores of each time in the reset group were significantly lower than those in the laminectomy group(P ＜ 0.05).The amount of bleeding,operation time,hospitalization time and fracture healing time in the reset group were less than those in the laminectomy group (P ＜ 0.05).The neurological function recovery of the two groups were significantly improved when compared with that before the operation(P ＜0.05).There was no significant difference in recovery of neurological function between the two groups(P ＞ 0.05).The complication rate was 7.50％ in the reset group,lower than 12.50％ of the laminectomy group,the difference was significant (P ＜ 0.05).Conclusion Posterior indirect reduction and internal fixation of lamina both have a certain effect in the treatment of thoracolumbar vertebrae burst fracture complicated with spinal cord injury.But posterior indirect reduction has less complications and less amount of bleeding,which is beneficial to postoperative recovery.
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10.3969/j.issn.2095-4344.2013.26.022
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To enhance the fusion of graft bone in thoracolumbar vertebrae and minimize the postoperative loss of correction, short-segment pedicle screw fixation was reinforced with posterior moselizee bone grafting in vertebrae for spinal fusion in patients with thoracrolumbar vertebrate fractures. Seventy patients with thoracrolumbar vertebrate fractures were treated by short-segment pedicle screw fixation and were randomly divided into two groups. Fractures in group A (n=20) were reinforced with posterior morselized bone grafting in vertebrae for spinal fusion, while patients group B (n=50) did not receive the morselized bone grafting for bone fusion. The two groups were compared in terms of kyphotic deformity, anterior vertebral height, instrument failure and neurological functions after the treatment. Frankel grading system was used for the evaluation of neurological evaluation and Denis scoring scale was employed for pain assessment. The results showed that the kyphosis correction was achieved in both group A and group B (group A: 6.4 degree; group B: 5.4 degree)/At the end of follow-up, kyphosis correction was maintained in group A but lost in group B (P=0.0001). Postoperatively, greater anterior height was achieved in group A than in group B (P<0.01). During follow-up study, anterior vertebral height was maintained only in Group A (P<0.001). Both group A and group B showed good Denis pain scores (P1 and P2) but group A outdid group B in terms of control of severe and constant pain (P4 and P5). By Frankel criteria, the changes in neurological functions in group A was better than those of group B (P<0.001). It is concluded that reinforcement of short-segment pedicle fixation with morselized bone grafting for the treatment of patients with thoracolumbar vertebrae fracture could achieve and maintain kyphosis correction, and it may also increase and maintain anterior vertebral height. Morselized bone grafting in vertebrae offers immediate spinal stability in patients with thoracolumbar vertebrate fractures, decreases the instrument failure and provides better postoperative pain control than without the morselized bone grafting.
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[Objective]To discus clinic value of fixation by vertebral pedicle screw system and vertebroplasty using injectable graft for thoracolumbar vertebrae fractures.[Method]Fifteen cases of thoracolumbar vertebrae fractures(7 cases with compress fractures,8 cases with burst fractures) were treated with fixation by vertebral pedicle screw system and vertebroplasty using injectable graft.[Result]The group was followed up for average 9.6 months,no case showed internal fixation device loosening or breaking,nor were chronic lumbar pain seen in this group.No case had lost the anterior height of body of spine.All injected grafts were Abs orbed within 3 months postoperatively.According to Frankels grading,there were 4 cases in Grades B,6 cases in Grade C and 2 cases of Grade D preoperatively,but 3 cases of Grade C,5 cases of Grade D and 4 cases of Grade E postoperatively in 12 cases with incomplete paraplegia,with a statistically significant difference(x~2 =21.000,P=0.000
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[Objective] To evaluate the efficacy of reinforcing short-segment pedicle screw fixation with posterior morselized bone grafting in vertebrae for spinal fusion in patients with thoracolumbar vertebrae fractures.[Method]Seventy patients with thoracolumbar vertebrae fractures were treated with short-segment pedicle screw fixation.Fractures in Group A(n =20) were reinforced with posterior morselized bone grafting in vertebrae for spinal fusion.Group B patients(n =50) were not treated with morselized bone grafting.Kyphotic deformity,anterior vertebral height,instrument failure rates,and neurological function outcomes were compared between the two groups.[Result]Kyphosis correction was achieved in Group A(morselized bone grafting) and Group B(Group A,6.4 degrees,Group B,5.4 degrees).At the end of the follow-up period,kyphosis correction was maintained in Group A but lost in Group B(Group A,0.33-degree loss,Group B,6.20-degree loss)(P=0.0001).After surgery,greater anterior vertebral height was achieved in Group A than in Group B(Group A,12.9%,Group B,2.3%)(P
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Thoracolumbar burst fractures account for more than half of all thoracolumbar fractures,which often result in neurologic deficit,kyphosis deformity and significant disability.The management of thoracolumbar burst fractures differ with the types.Nowadays,the accepted methods of treatment of thoracolumbar burst fractures include conservative therapy,posterior reduction and instrumentation,anterior decompression and instrumentation,combined anterior-posterior approach and minimally invasive approach.Howerer,the optimal technique is not always evident.There is no precise classification system to determine which surgical procedure is the best.The following review summarizes the recent advances in treatment of thoracolumbar burst fractures.Recent clinical evidence shows that there is no significant difference between conservative therapy and surgical treatment for thoracolumbar burst fractures without neurologic deficit,and that surgical treatment should be considered for unstable fractures with neurological injuries.Some other clinical evidence shows that short segment combined fractured vertebra plasty with various manners has gained popularity,because it can reconstruct anterior column and decrease the failure of internal fixation and the occurrence of long-term spinal kyphosis deformity.In accordance with the principles of biomechanics and taking into account the occurrence of degeneration of adjacent segment,surgeons gradually applied non-fusion technology in clinical practice,and yet its long-term results need to be confirmed by further studies.
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[Objective]To evaluate the clinical value of surgical treatment of multiple thoracolumbar spinal fractures by pedicle screw/rod Instrumentation system.[Method]Ninteen cases of male 14 and femal 5 of multiple injuries involving thoracic and lumbar spine were surgically treated through anterior approach by open reduction,selective vertebral canal decompression,internal fixation with pedicle screw/Rod spine instrumentation,and followed by anterior lateral bone graft fusion according to complex classification system 19 cases,Ba.m1T_(11) 1 cases,Ba.m.p2T_(11) 2 cases,Ba.m1T_(12) 1 cases,Ba.m.p2T_(12) 1cases,Ba.m.p3T_(12) 1cases,Ba.m1_L 4 cases,Ba.m.p2L_1 3cases,Fa.m.p3(T_(12),L_1) 2cases,Sa.m.p3L_2 1cases,Ba.m.p1L_2 1 cases.[Result]All cases were followed up form 6 to 15 months averageing 10.5 months.No implant failure and late kyphosis deformity was observed.The average vertebra height was improved from preoperative 48.14% to postoperative 92.14%.The postoperative neurological function in two cases of complete spina lcord injuries and 11 incomplete spina lcord injuries were improved according to JOA criterion.Astable bone fusion according to radiological criteria was achieved in call cases postoperatively,and progressive compression did not occur.[Conclusion]Pedicle screw/rod instrumentation system can achieve effective reduction for the fractured vertebrae and simultaneously restore spine stability on the basis of adequate vertebral canal decompression.Posterior spine instrumentation is an ideal choice for surgical treatment of thoracolumbar unstable fractures with or without spinal cord dysfunction.
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Objective To evaluate the clinical efficacy of vertebroplasty using vertebral pedicle screw technique combined with calcium sulfate cement injection in the treatment of thoracolumbar vertebrae fractures.Methods Twenty-eight patients with thoracolumbar vertebrae fractures admitted in our department in recent 2 years were enrolled in this study,including 21 cases of type A,3 cases of type B,and 4 cases of type C.All patients were fixed with vertebral pedicle screw,and then verteplasty was performed using calcium sulfate cement injection.Results All patients were followed up for an average time of 16 months.Within the follow-up,there was no complication noted,such as loosening or breakage of internal fixation,chronical lumbar back pain,and loss of effected vertebral height.Artificial bones injected into vertebrae were absorbed in about 3 months.Conclusion Vertebroplasty using vertebral pedicle screw technique combined with calcium sulfate cement injection is an effective and safe procedure for thoracolumbar vertebrae fractures,which renders it possible to bear weight early and to maintain corrected vertebral height postoperatively.
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@#ObjectiveTo study the clinical outcome and efficacy of closed management of theoracolumbar burst fractures without neurologic deficits.Methods 20 patients with a burst fracture of thoracolumbar vertebrae but without neurologic deficit were reviewed clinically and radiographically following nonoperative management.ResultsAfter treatment, the averaged Cobb angle (8°)was better than that (18.5°) before treatment (P<0.01), and the averaged anterior body height (87.18%) was also better than that (50.68%) before treatment (P<0.01). In 12 patients, averaged occupying area of vertebra in vertebral canal was 27% before treatment and lowered 16% after treatment (P<0.01). During treatment period, one patient developed neurologic deterioration that prompted surgery. All other patients remained neurologically intact. After follow-up (average 2.5 years), an overall outcome evaluation indicated that 70% of patients had excellent outcomes relative to pain and function, 25% had good and 5% had poor outcomes.Conclusions These findings suggest that nonoperative management as the preferred treatment can use in above circumstances.
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Objective To evaluate the effectiveness of Moss Miami pedicle sc re w system in the treatment of thoracolumbar burst fractures. Methods A total of 2 7 cases of thoracolumbar burst fractures were operated on with Moss Miami pedicl e screw system through posterior approach to provide spreading, reduction and fi xation. The bilateral posterolateral bone-graft spinal fusion was also done at the same time. Results The 27 patie nts were followed up for 6 to 30 months. The heights of compressed vertebral bod y and the cross spinal canal were significantly increased after treatment (P