Effectiveness of sagittal top compression reduction technique in treatment of thoracolumbar vertebral fractures / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of sagittal top compression reduction technique in the treatment of thoracolumbar vertebral fractures.@*METHODS@#A retrospective analysis was conducted on the clinical data of 59 patients with thoracolumbar vertebral fractures who met the selection criteria and were admitted between November 2018 and January 2022. Among them, 34 patients were treated with sagittal top compression reduction technique (top pressure group), and 25 patients were treated with traditional reduction technique (traditional group). There was no significant difference in baseline data between the two groups ( P>0.05), including gender, age, fracture segment, cause of injury, AO classification of thoracolumbar vertebral fractures, thoracolumbar injury classification and severity (TLICS) score, American Spinal Injury Association (ASIA) grading, surgical approach, preoperative vertebral body index, height ratio of the anterior margin of injured vertebra, injured vertebra angle, segmental kyphosis angle, visual analogue scale (VAS) score, and Oswestry disability index (ODI). The operation time, intraoperative blood loss, and incidence of complications between the two groups were recorded and compared. After operation, VAS score and ODI were used to evaluate effectiveness, and X-ray and CT examinations were performed to measure imaging indicators such as vertebral body index, height ratio of the anterior margin of injured vertebra, injured vertebra angle, and segmental kyphosis angle.@*RESULTS@#There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). No complication such as dural sac, nerve root, or vascular injury was found during operation, and all incisions healed by first intention. Patients in both groups were followed up 6-48 months, with an average of 20.6 months. No loosening, breakage, or failure of internal fixation occurred during follow-up. The imaging indicators, VAS score, and ODI of the two groups significantly improved at 1 week and last follow-up when compared to preoperative ones ( P<0.05). At last follow-up, the VAS score and ODI further significantly improved when compared to 1 week after operation ( P<0.05). At 1 week after operation and last follow-up, the vertebral body index, segmental kyphosis angle, injured vertebra angle, and ODI in the top pressure group were significantly better than those in the traditional group ( P<0.05). There was no significant difference in VAS score and height ratio of the anterior margin of injured vertebra between the two groups at 1 week after operation ( P>0.05), but the two indicators in the top pressure group were significantly better than those in the traditional group at last follow-up ( P<0.05).@*CONCLUSION@#The treatment of thoracolumbar vertebral fractures with sagittal top compression reduction technique can significantly improve the quality of vertebral reduction, and is superior to traditional reduction techniques in relieving pain and improving spinal function.

Comparison of Percutaneous versus Open Pedicle Screw Fixation for Treating Unstable Thoracolumbar Fractures

PURPOSE: This study compared the clinical and radiological results between two groups of patients with percutaneous fixation or conventional fixation after hardware removal.MATERIALS AND METHODS: The study analyzed 68 patients (43 open fixation and 43 percutaneous screw fixation [PSF] 25) who had undergone fixation for unstable thoracolumbar fractures. The radiologic results were obtained using the lateral radiographs taken before and after the fixation and at the time of hardware removal. The clinical results included the time of operation, blood loss, time to ambulation, duration of the hospital stay and the visual analogue scale.RESULTS: The percutaneous pedicle screw fixation (PPSF) group showed better results than did the conventional posterior fixation (CPF) group (p<0.05) in regard to the perioperative data such as operation time, blood loss, and duration of the hospital stay. There were no significant differences in wedge angle, local kyphotic angle, and the ΔKyphotic angle on the postoperative plane radiographs between the two groups (p>0.05). There were no significant differences in the wedge angle and local kyphotic angle after implant removal (p>0.05) between the two groups as well. However, there were significant differences in the segmental montion angle (p<0.001), and the PPSF group showed a larger segmental motion angle than did the CPF group (CPF 1.7°±1.2° vs PPSF 5.9°±3.2°, respectively).CONCLUSION: For the treatment of unstable thoracolumbar fractures, the PPSF technique could achieve better clinical results and an improved segmental motion angle after implant removal within a year than that of the conventional fixation method.

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 .

Prediction of Subsequent Vertebral Collapse after Osteoporotic Thoracolumbar Vertebral Fractures / 대한골다공증학회지

OBJECTIVES: To evaluate the clinical significance of vertebral bone bruise (VBB) in terms of subsequent collapse after osteoporotic thoracolumbar vertebral fractures. METHODS: We reviewed 41 consecutive patients with 46 osteoporotic thoracolumbar vertebral fractures treated nonoperatively from March 2007 to February 2010. Anterior wedge angle (AWA) was measured on plain radiographs and the change of AWA between the initial and last measurement was used to represent the subsequent vertebral collapse. The size of VBB was measured and VBB ratio was calculated on T1-weighted sagittal MR image. RESULTS: The average VBB ratio was 49.1% and the average change of AWA was 7.1degrees. Only VBB ratio significantly correlated with the change of AWA (P<0.001, cc=0.660). The other factors such as age, initial AWA, and endplate status showed no significant correlation with the change of AWA (P=0.629, P=0.724, P=0.690, respectively). In DEXA group, no correlation was found between T-score and the change of AWA as well as between T-score and VBB ratio (P=0.548, P=0.370, respectively). Five fractures were diagnosed as delayed post-traumatic vertebral collapse. Their average VBB ratio was 71.2% which was significantly higher than that of the other subjects (P=0.015). The fractures with VBB ratio more than 60% was likely to progress to delayed post-traumatic vertebral collapse. CONCLUSIONS: VBB after osteoporotic thoracolumbar vertebral fracture was significantly correlated with subsequent vertebral collapse (cc=0.660). We recommend the patients with a large vertebral bone bruise, especially more than 60%, should be followed up meticulously for the early detection of delayed post-traumatic vertebral collapse.

Preventive measure of fixation failure of thoracolumbar vertebral fracture with pedicle screw / 中国矫形外科杂志

[Objective]To discuss the fault and its prevention of thoracolumbar vertebral fracture treated with pedicle screw.[Method]A retrospective study of 13 failure patients of thoracolumbar vertebral fracture were treated with pedicle screws from July 1998 to October 2007.The pedicle screw was found entering into the vertebral canal or being outside of the vertebral pedicle in 6 patients.The broken pedicle screw were found in 3 patients.The fixing position were fault in 3 patients and the system were loosen in 3 patients in the first X-ray photogram.One patient was misdiagnosed and 1 pedicle screw was broken within 6 months.[Result]Two patients refused any treatment.Eleven patients were followed-up in this group ( ranged from 6 months to 4 years,mean 15 months).The fixator were removed in 7 patients and 1 broken screw was left in the vertebral body.Another 4 patients were operated with new fixation and fusion in the second time.[Conclusion]The fixed approach of the vertebral pedicle root is narrow and small.Failure of internal fixation could only be avoided by means of careful reading Roentgen images preoperatively,fluoroscopical examination intraoperatively,and avoiding second implantation.

The Comparison of Loss of Reduction at the Thoracolumbar Fracture According to Insertion of Screw Including Fractured Vertebra or not in Short Segment Posterolat Fusion / 대한척추외과학회지

STUDY DESIGNS: Retrospective analysis of the surgical treatment in patients of thoracolumbar spine fractures. OBJECTIVES: To measure by modified Cobb method the correction angle of thoracolumbar vertebral fractures and to comparison the difference between short segment pedicular fixation with fractured vertebra(group A) and without fractured vertebra (group B). SUMMARY OF LITERATURE REVIEW: The major treatment of thoracolumbar spine fractures is surgical correction of kyphotic angle by posterior decompression and posterolat. fusion at one level or more. MATERIALS AND METHODS: The materials are the patients who visited due to trauma beween 1991.1 and 2000.12. and treated by post. decompression and short segment posterolat. fusion with iliac bone graft. The number were A group, 28 persons and B group, 15 persons. The method of radiologic measurement is done by the modified Cobb method. The follow up time is till 2001.7. and the duration are minimal 6 months and maximal 77 months. The age was between 17 old and 60 old. The neurologic abnormalities in patients are 12 persons. The fractures were classified by the Denis classification. There are compressive fracture are 3 persons and bursting fracture type A are 18 persons, type B are 22 persons. The materials were confirmed by radiologic union and excluded if more than one vertebra fusion is needed. RESULTS: The most fractures were due to falldown injury. The most fracture site was T-L level (T12-L3). The one case was complicated by deep infection and treated and the other case was reduction loss due to metallic failure. The results of the loss of correction were A group, 5.3 degree and B group, 6.2 degree. (P>0.05). The relative correction loss were A group, 42%, and B group, 54%. (P<0.05). CONCLUSION: The mean correction angle and loss of correction are more good results in the group of short segment pedicular fixation with fracture vertebra. But to get more good results, our study do more long term follow-up and rule out other statistical errors and consecutive radiologic follow-up.