ABSTRACT
Objective To investigate the effect of percutaneous lordorizing screws fixation for correcting kyphosis in thoracolumbar burst fractures and treatment strategies.Methods A retrospective case control study was designed to analyze data of 97 patients with single-level thoracolumbar burst fractures without neurological deficits undergone percutaneous lordorizing screw fixation from April 2010 to March 2015.According to the different surgical procedures,the patients were divided into Group A (percutaneous transpedicle fixation,n =47) and Group B (percutaneous transpedicle fixation combine lordorizing screw fixation,n =50).Each group was subdivided based on the preoperative segmental kyphosis:Group A consisted subgroups A1 (kyphosis angle≤ 10°,n =11),A2 (kyphosis angle between 10° and 20°,n =20) and A3 (kyphosis angle ≥ 20°,n =16),and Group B consisted of subgroups B1 (kyphosis angle ≤ 10°,n =16),B2 (kyphosis angle between 10° and 20°,n =16) and B3 (kyphosis angle ≥ 20°,n =18).Length of hospital stay,operation time,blood loss,visual analogue scale (VAS) and Oswestry disability index (ODI) were compared between groups.Segmental kyphosis angle and vertebral wedge angle were compared between subgroups before operation,after operation and at the final follow-up.Results All patients were followed-up for 12-37 months (mean,21.2 months).There were no significant differences between the two groups in aspects of length of hospital stay,blood loss,VAS and ODI (P ＞ 0.05).Operation time was (60.62 ± 9.59) min in Group A,significantly less than that in Group B [(74.78 ± 17.66) min] (P ＜ 0.05).No breakage or malfunction of fixation occurred.There were no significant differences between the two groups in preoperative segmental kyphosis angle (P ＞ 0.05),while the correction of segmental kyphosis angle in Group B was better than Group A at the final follow-up [(7.97 ± 5.09) ° vs.(3.76 ± 1.67) °] (P ＜ 0.05).At the final follow-up,the correction of segmental kyphosis angle was similar between Group A1 and Group B1 (P ＞ 0.05),but the correction in Group B2 was better than GroupA2 (P ＜0.05) and the correction in Group B3 better than Group A3 (P ＜ 0.05).Besides,the correction of vertebral wedge angle was similar between Group A1 and Group B1 (P ＞ 0.05),but the correction in Group B2 was better than Group A2(P ＜0.05) and the correction in Group B3 was better than Group A3 (P ＜ 0.05).Loss of segmental kyphosis angle and vertebral wedge angle in Group A were greater than these in Group B (P ＜ 0.05).Conclusions Combined use of lordorizing screw with percutaneous transvertebral fixation improves the correction of thoracolumbar kyphosis angle in single-level thoracolumbar burst fractures.When the preoperative segmental kyphosis over 20°,lordorizing screw fixation should be recommended so as to achieve better correction of kyphotic deformity.
ABSTRACT
Objective The aim of this study was to compare recent clinical efficacy between a novel guidance method for percutaneous pedicle screw placement and the conventional fluoroscopic method for long segments thoracolumbar vertebral fracture without nerve injury. Methods A total of 38 patients with thoracolumbar vertebral fracture in our hospital from September 2010 to December 2012 were divided into group A and group B.Eighteen patients in group A underwent 200 percutaneous pedicle screw fixation by conventional fluoroscopic meth-od.Twenty patients in group B underwent 210 percutaneous pedicle screw fixation by a novel guidance method.All the operation for 38 cases were performed by the same surgeon.The time of insertion,radiation exposure,and accuracy of the screw placement between the two groups were compared.The accuracy of screws was evaluated and graded by two consecutive postoperative CT of operation segment for two groups. Results The mean time for a single pedicle screw placement was (13.11 ±2.32)minutes in group A and (10.35 ±1.92)minutes in group B,respectively.The average radiation exposure was (8.11 ±1.15)s in group B and (13.07 ±2.06)s in group A respectively.The differ-ences were statistically significant for both screw placement and radiation exposure times (P 0.05).Conclusion The novel guidance system can significantly reduce the insertion time and radiation expo-sure for long segments percutaneous pedicle screw placement,which provides the same accuracy for screw placement compared with the con-ventional method.
ABSTRACT
Pyogenic spondylitis is a frequently observed disease in orthopedics, and the number of cases is increasing. Some patients with pyogenic spondylitis suffer from vertebral destruction due to infection. The disease is typically treated with antibiotics, bed rest, spinal support, and lesion curettage; however, vigorous drug therapy against vertebral body destruction by pyogenic spondylitis has not been attempted. In this report, a case of pyogenic spondylitis with spinal destruction caused by infection and treated with once-weekly teriparatide administration is presented. Vertebral body erosion in cortical and cancellous areas by the infection was rapidly repaired after 6 weeks of once-weekly teriparatide treatment. Treatment with once-weekly teriparatide appears to be a new strategy for patients with severe osteoporosis suffering from pyogenic spondylitis.
Subject(s)
Humans , Anti-Bacterial Agents , Bed Rest , Bone Density , Curettage , Drug Therapy , Orthopedics , Osteoporosis , Quality of Life , Spondylitis , TeriparatideABSTRACT
Pyogenic spondylitis is a frequently observed disease in orthopedics, and the number of cases is increasing. Some patients with pyogenic spondylitis suffer from vertebral destruction due to infection. The disease is typically treated with antibiotics, bed rest, spinal support, and lesion curettage; however, vigorous drug therapy against vertebral body destruction by pyogenic spondylitis has not been attempted. In this report, a case of pyogenic spondylitis with spinal destruction caused by infection and treated with once-weekly teriparatide administration is presented. Vertebral body erosion in cortical and cancellous areas by the infection was rapidly repaired after 6 weeks of once-weekly teriparatide treatment. Treatment with once-weekly teriparatide appears to be a new strategy for patients with severe osteoporosis suffering from pyogenic spondylitis.