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.

Posterior Ligamentous Complex Injuries Are Related to Fracture Severity and Neurological Damage in Patients with Acute Thoracic and Lumbar Burst Fractures

PURPOSE: The proposed the thoracolumbar injury classification system (TLICS) for thoracolumbar injury cites the integrity of the posterior ligamentous complex (PLC). However, no report has elucidated the severity of damage in thoracic and lumbar injury with classification schemes by presence of the PLC injury. The purpose of this study was to accurately assess the severity of damage in thoracic and lumbar burst fractures with the PLC injuries. MATERIALS AND METHODS: One hundred consecutive patients treated surgically for thoracic and lumbar burst fractures were enrolled in this study. There were 71 men and 29 women whose mean age was 36 years. Clinical and radiologic data were investigated, and the thoracolumbar injury classification schemes were also evaluated. All patients were divided into two groups (the P group with PLC injuries and the C group without PLC injuries) for comparative examination. RESULTS: Fourth-one of 100 cases showed PLC injuries in MRI study. The load sharing classification score was significantly higher in the P group [7.8+/-0.2 points for the P group and 6.9+/-1.1 points for the C group (p<0.001)]. The TLICS (excluded PLC score) score was also significantly higher in the P group [6.2+/-1.1 points for the P group and 4.0+/-1.4 points for the C group (p<0.001)]. CONCLUSION: The presence of PLC injury significantly influenced the severity of damage. In management of thoracic lumbar burst fractures, evaluation of PLC injury is important to accurately assess the severity of damage.

Risk Factors of Deep Infection after Thoracic and Lumbar Spinal Arthrodesis / 대한척추외과학회지

STUDY DESIGN: This is a retrospective analysis OBJECTIVES: We wanted to analyze the risk factors related to deep infection and removing an implant after thoracic and lumbar spinal arthrodesis. SUMMARY OF LITERATURE REVIEWS: The relationship between deep infection and implant removal is controversial. MATERIALS AND METHODS: We retrospectively compared the infection group with the non-infection group for the rates of deep infection, the preoperative diagnosis, the number of fused segments, the operative methods, the graft materials, the operating time and the blood loss. Moreover, we classified the deep infection patients into two groups: those who underwent implant removal and those who did not, and we compared the microorganisms that were cultured out of the patients. We also compared the relationship of deep infection with the risk factors, the mean hospital stay and the mean number of operations. RESULTS: There were 18 cases (2.46%) of deep infection. The factors that did not show a significant difference were the preoperative diagnosis, the graft material, the increased number of fused segments, age, gender and BMI. The factors that were significant were the operating time (p=0.001), the amount of blood loss (p<0.000), DM (p=0.021), and PLF (p=0.054). The incidence of implant removal was higher for the cases with deep infection caused by MRSA. We were able to see a significant difference of between the group that had undergone implant removal and the group that had not undergone implant removal. CONCLUSIONS: The incidence of deep infection after thoracic and lumbar spinal athrodesis increased as the operating time and blood loss increased, and it was also higher when either PLF or DM were present. Implant removal causes bad clinical results, so physicians should be very cautious when operating on a case of implant removal.

Radiographic study and clinical significance about sagittal plane curves in the adjacent segments of the thoracic and lumbar spine / 中国矫形外科杂志

[Objective]To study the anatomy about the sagittal plane curves of the adjacent segments of the thoracic and lumbar spine on the radiographs of standing position,in order to provide anatomical evidence for clinical operation. [Methods]Seventy-five standing posture radiographs about normal adult were obtained,the sagittal plane curves of the adjacent segments of the thoracic and lumbar spine were obtained by measuring the angles between perpendicular of adjacent superior end plate.The normal value and rule about sagiital plane curves were determined by statistical method.Fifty patients received operation according to these measures.The Cobb's angle of sagittal plane(T12-S1) at 0,3,12 months postoperatively,Denis scores at 12 months postoperatively and the cases in which breaking or loosening internal fixation occurred at 12 months postoperatively were recorded.[Results]The 95% confidence interval of about sagittal plane curves was obtained.There was no statistical significance for sex and age.It would improve function postoperatively and decrease the broken or loosened internal fixation.[Conclusion]It's important to recover the Cobb's angle in the short segmental internal fixation with pedicle screws through posterior approach.

Comparison of Short and Long-Segment Fusion in Thoracic and Lumbar Fractures / 대한척추외과학회지

STUDY DESIGN: A retrospective study was designed to evaluate the clinical result and difference between short segment and long segment fixation, which was undertaken by posterior approach for thoracic and lumbar spine fractures. OBJECTIVE: To determine and compare the mechanical maintenance and ability of correction, and clinical and neurologic recov-ery between short segment and long segment fusion group. SUMMARY OF BACKGROUND DATA: The long segment instrumentation is a cause of decrease of motion segment in thoracic and lumbar spine. In short segment fusion, screw failures were reported. MATERIALS AND METHODS: From 1989 thorough 1997, 54 patients who had been operated on by the posterior approach with transpedicular screw fixation for spine injuries were divided into two groups. The authors applied the short segment transpedic-ular instrumentation including fractured vertebra. Short segment group included 35 cases, and long segment group, 19 cases. The mean follow-up period was one year and eight months for short segment group, two years and seven months for long segment one. The results were evaluated by comparing the anterior vertebral height, sagittal index in simple roentgenogram and neurologic recovery. RESULTS: The average of anterior vertebral height which was 50.7% at preoperation, became 78.7% after the operation and measured 74.9% at final follow-up in long segment fusion group, while in short segment fusion group it was 59.7%, 79.3% and 77.7%, respectively. The average of sagittal index of 17.5degreeat preoperation became 6.7degreeafter the operation, and measured 8degreeat final follow-up in long segment fusion group, while in short segment fusion group it was 19.9degree, 10.4degree, and 12.1degree, respectively. Overall clinical results had no statistical significant difference between two groups. Of the thirty-six patients with neurologic deficits, twenty-two improved by over the one Frankel grade. CONCLUSIONS: The authors conclude that the short segment transpedicular instrumentation including fractured vertebra is a successful method of thoracolumbar and lumbar burst fractures.

Evaluation by MRI of Disc Injury in Fractures of the Thoracic and Lumbar Spine

Injury to a lumbar disc is rare, and is seldom mentioned in the literature describing spinal fracture; even in patients with such fractures, disc herniation is infrequent and is often considered to be a sequella of trauma. Using magnetic resonance imaging(MRI) we investigated the incidence and pattern of disc injuries by an in 37 patients with fractures of the lumbar and thoracic spines. Discs adjacent to the fracture site were found to be normal in 19 patients(51.4%), but in ten(27.0%), the end plate was disrupted. The disc was ruptured in six patients(16.2%), and had degenerated in two patients(5.4%). Injured discs were found in the three patients with fracture-dislocation and three of the seven(42.9%) with burst fracture, but in none of the 27 with compression fracture. The three lower lumbar discs(L3-4, L4-5, and L5-S1) were found to be normal in 26 patients(70.3%), but had degenerated in seven(18.9%). Incidental asymptomatic disc herniation was found in four patients(10.8%), including one with degenerative spondylolisthesis. There was no traumatic disc herniation in the lower lumbar region. These results suggest that traumatic lumbar disc herniation is quite uncommon, even in the unstable thoracolumbar spinal injuries.

Surgical Experience of transpediculr Screw Fixation of the Spine

Vertebral transpedicular screws provide secure attachment for posterior spinal fixation device, the authors had experienced 29 cases of transpedicular screw fixation to obtain fixations of the thorcolumbar and lumbar spine instability, the patients were operated between February, 1992, and May, 1995. Spinal Fusion was attempted at one to four levels of thoracic and lumbar spine. Follow-up period was from 6 to 33 months, averaging 16 months. The result was summerized as follows: 1) Of the 29 cases, 20 were spondylolisthesis and 9 were fracture and dislocation. 10 patients(34.5%) were 30 years old, and 20 cases(69%) were female. Mean age was 42 years. 2) The symptom included low back pain, sciatica and intemittant claudificaton in the order of incidence. 3) The sites of spondylolisthesis were L4-5 in 12 cases(60%) and L5-S1 in 8 cases(40%). The average degree of slippage in spondylolisthesis was Meyerding's grade I(85%). The sites of fracture were T12 in 5 cases(55.6%), L1 in 2 cases(22.2%), L2 with L3 in 1case(11.1%) and L1 in 1 case(11.1%). 4) There was no patient with significant neurologic injury or functional root loss. A screw malposition was observed in one case. 5) The results of operations were considered exellent in 16 cases(55%), good in 10 cases(35%) and fair in 3 cases(10%), and satisfactory bony fusion was obtained.

Differentiation Between Acute and Old Fractures in The Thoracic and Lumbar Spine: Observer Agreement

Differentiation between acute and old fractures in the thoracic and lumbar spine is often difficult. We have evaluated the intraobserver agreement and interobserver variability of interpretations. We have prepared 50 cases from 40 patients with thoracic or lumbar spine fracture for evaluation. At first, two radiologist interpreted each of the 50 cases, Only by using plain roentgenograms. Then, they interpreted the cases again using also spine CT, MRI, bone scintigrams and follow-up roentgenograms. Intraobserver agreement was found to be 78% in Doctor A, and 76% in Doctor B. Interobserver agreement was only 62% at first. It was 88%, when they used CT, MRI, bone scintigrams and follow-up roentgenograms. It was not easy to differentiate the old fractures from acute one only by plain roentgenograms. Differentiation was more difficult, when the patient was female or over 55 years old. Plain roentgenography in hyperextension posture seems to be a simple but useful method for the diagnosis of the acute fracture. MRI was more valuable than CT or bone scintigraphy to differentiate the old fractures from the acute ones.

Treatment of Unstable thoracic and Lumbar Spine Fracture with Harrington Segmental Spinal Instrumentation (SSI) / 대한정형외과학회잡지

This is a retrospective clinical and roentgenographic study to measure the correction of deformity and rigidity of Harrington SSI in the stabilization of unstable thoracic and lumbar spine fractures. 35 patients with unstable thoracic and lumbar spine fracture were treated with Harrington SSI from Feb. 1985 to Mar. 1987 in SNUH and 29 patients were followed up for more than 1 year, average 15.6 months. At final follow up of these 29 patients, 73.1% of patients gained neurologic improvement. Measurement of correction of anterior, middle and posterior column height, local kyphosis and anteroposterior offset were 29.7%, 5.2%, 31.2%, 12.8°and 5.3mm and loss of correction of these were 6.5%, 0.1%, 5.8%, 3.1°and 1.1 mm.