The Comparison of the Results Between AO Internal Fixator (Long lever-arm) and Screw-Rod System (Short lever-arm) Through Posterior Approach in Unstable Thoracolumbar Fractures / 대한척추외과학회지

STUDY DESIGN: Prospective study. OBJECTIVES: To analyze the outcome of posterior reduction and fixation with the AO internal fixator and with the screw-rod system in unstable thoracolumbar fractures and to investigate differences in effectiveness between the two methods. SUMMARY OF LITERATURE REVIEW: In unstable thoracolumbar fractures, fixation with the AO internal fixator is an effective method for posterior reduction. However, the results of correction are quite variable. MATERIALS AND METHODS: We analyzed 51 patients with unstable thoracolumbar fractures who underwent correction through posterior approach between 1997 and 2003. We divided the patients into two groups: Patients in Group A (25 cases) were treated with the AO internal fixator, and patients in Group B (26 cases) were treated with the screw-rod system. We added transpedicular bone grafts for 17 patients in Group A. We evaluated correction of deformity (anterior and posterior height of vertebral body, sagittal index, disc height), loss of correction, spinal canal clearance, and neurological recovery. RESULTS: Comparing correction of deformity, we saw better results in Group A than in Group B in regards to sagittal index and anterior height of vertebral body. However, we saw a higher degree of correction loss in the anterior height of the vertebral body in Group A. We grafted autogenous bone into the fracture site by transpedicular approach for 17 patients in Group A. We saw less correction loss in the anterior vertebral body height and sagittal index. In regard to spinal canal clearance, we saw better results in Group A (18%) than in Group B (10%). As for neurological recovery, we could not find any statistically significant difference between the two groups. CONCLUSIONS: Through an operative procedure, we could achieve better results in restoration of anterior vertebral height and canal clearance with the AO internal fixator system. Further study is necessary to keep the reduced state of vertebral height.

Operative Treatment of Delayed Collapse of Osteoporotic Vertebral Fracture with Claudication: Transpedicular Bone Graft and Pedicle Screw Fixation / 대한척추외과학회지

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the efficacy of transpedicular bone graft and pedicle screw fixation in delayed collapse of osteoporotic vertebral fracture with claudication. SUMMARY OF LITERTURE REVIEW: Delayed collapse of osteoporotic vertebral fracture may result in seemingly unrelenting back pain and neurologic deficits. Though there are many surgical options for such cases, comprehensive improvement of symptoms is uncertain. MATERIALS AND METHODS: Nineteen patients who underwent operation and were followed-up for more than 2 years were studied. The regional sagittal angle, restoration ratio of the vertebral body, standing sagittal balance, and additional fracture were assessed. Improvement of back and leg pain was assessed using 10 point Visual Analog Scales (VAS). The causes of sustained clinical symptoms were analyzed. RESULTS: The regional sagittal angle was corrected from 25.2+/-13.9degrees to 12.4+/-10.4degrees (p=0.000). The vertebral body ratio was restored from 36+/-14.1% to 72+/-16.7% (p=0.000). Six cases were found to be neutral and 13 cases showed a positive sagittal balance. Additional fractures were found in 11 cases. The VAS value for leg pain was improved from 6.6+/-1.0 to 1.0+/-1.1 (p=0.000), while that for back pain was not improved (6.4+/-1.7 to 7.1+/-2.3, p=0.474). Positive sagittal balance was a significant risk factor (p=0.037, odds ratio=58.084) for sustained back pain. CONCLUSION: For the treatment of delayed collapse of osteoporotic vertebral fracture with claudication, transpedicular bone graft and pedicle screw fixation was effective in improving claudication and restoring the vertebral body and regional sagittal angle. However, it was not capable of alleviating back pain. Positive sagittal balance was considered to be a cause of sustained back pain.

Scofix system combined with transpedicular bone graft to treat 62 patients with thoracolumbar fracture / 中华创伤骨科杂志

Objective To sum up the clinical experience of treating thoracolumbar fractures with Scofix system and transpedicular bone graft. Methods 62 consecutive patients with thoracolumbar fracture were treated operatively with reduction and stabilization by Scofix system combined with vertebral fusion via transpedicular bone grafting. Results 62 patients were followed up. Their postoperative radiographs and CT scans showed that more than 90%of the cases gained reduction, the effective diameters of vertebral canal became normal and the mean time of vertebral fusion was about 3 months. Conclusions Scofix system is effective in reduction and fixation for thoracolumbar fractures, and transpedicular bone graft is helpful in restoring the height of vertebral body and increasing vertebral fusion. The procedure also has advantages of preventing vertebral collapse, reducing nerve injury and facilitating functional recovery.

The Effectiveness of Transpedicular Bone Graft in Burst Fracture / 대한척추외과학회지

PURPOSE: To assess the effectiveness of transpedicular bone graft after short segmental fixation in the treatment of thora-columbar burst fracture. MATERIALS AND METHODS: Patients who were admitted to our hospital from January 1994 to December 1998 for thoracolumbar burst fracture and treated with open reduction and internal fixation were reviewed. Seventy-five cases who were followed up for more than 1 year were selected. Among of these, 45 cases were treated with internal fixation and posterior fusion only, and in 30 cases transpedicular bone graft was done additionally. Denis classification was used and preop., postop., final follow up wedge angle, Cobb's angle, the height of disc space, and anterior body height were compared and analized respectively. RESULTS: The preop, postop and final follow-up of wedge angle, cobb's angle, disc height and anterior body height were mea-sured. The preop, postop. and final follow up wedge angle of patients who underwent transpedicular bone graft and patients who were treated with posterior fusion only were 20.4 +/-8.4 degrees, 9.8+/-4.6 degrees, 11.5+/-5.3 degrees and 21.4+/-5.9 degrees, 6.7+/-3.1 degrees , 6.8+/-3.1 degrees respec-tively. The Cobb's angle were 19.2+/-7.3 degrees, 8.9 +/-4.4 degrees, 9.2+/-4.6 degrees and 20.2+/-9.9 degrees, 11+/-5.9 degrees, 15+/-6.9 degrees respectively. Anterior body height were 51+/-15.3%, 93 +/-8.8%, 91+/-8.9% and 53+/-11.3%, 88+/-12.8% and 84+/-15.3%. These values were statistically signifi-cant(p<0.05). CONCLUSION: Transpedicular bone graft reduced the loss of the Cobb's angle, wedge angle and anterior body height at postop. and last follow-up. The transpedicular bone graft was a valuable method to prevent reduction loss in the treatment of thoracolumbar burst fracture