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BACKGROUND:Bone grafting is one of the important steps in the treatment of thoracolumbar burst fractures.Because the fracture involves the spinal canal or is accompanied by spinal cord nerve damage,severe fracture bleeding and other factors,minimally invasive bone grafting for thoracolumbar burst fractures is restricted.At present,the minimally invasive treatment of thoracolumbar burst fractures is limited to percutaneous screw fixation under the tunnel.Minimally invasive percutaneous bone grafting of injured vertebrae is rarely reported,and percutaneous precise bone grafting under the endplate has not yet been reported. OBJECTIVE:To investigate the clinical effect of subcutaneous endplate bone graft support reduction combined with percutaneous pedicle screw short-segment fixation in the treatment of A3+B2 thoracolumbar burst fractures. METHODS:From June 2017 to December 2021,90 patients with A3+B2 type asymptomatic thoracolumbar burst fracture were randomly divided into 3 groups according to admission time.In group A,33 patients received the bone graft funnel accurately placed through the pedicle channel by percutaneous puncture under C-arm fluoroscopy,bone graft support reduction under the fracture endplate,percutaneous pedicle screw fixation.In group B,30 patients received multifissure intermuscular approach through pedicle bone graft support reduction combined with pedicle screw fixation.In group C,27 patients received percutaneous pedicle screw short-segment fixation under postural reduction.All patients were followed up for at least 18 months after surgery.The clinical data of the three groups,including preoperative,postoperative and last follow-up Cobb angle,anterior edge height ratio and visual analog scale pain score,were compared and analyzed. RESULTS AND CONCLUSION:(1)There were no significant differences in age,sex,injury segment and causative factors among the three groups(P>0.05).(2)All patients at follow-up had no neurological impairment,no obvious lumbar posterior deformity or intractable low back pain.(3)The operation time of group C was less than that of group A and group B(P<0.05).Intraoperative blood loss was less in group A and group C than in group B(P<0.05).(4)There were no significant differences in the anterior edge height ratio and Cobb angle among the three groups(P>0.05).Postoperative data in groups A and B were better than that in group C.At last follow-up,group A and group B outperformed group C(P<0.05).The height and Cobb angle of the vertebral body lost in the three groups were smaller in groups A and B than those in group C(P<0.05).(5)Visual analog scale pain score was better in groups A and C than that in group B after surgery(P<0.05).There was no significant difference in visual analog scale pain score among the three groups at last follow-up(P>0.05).(6)In group C,there was one case of loose internal fixation and displacement in 1 month after surgery,and the vertebral height was lost again with back pain,and after strict bed rest for 6 weeks,the vertebral height loss was not aggravated,the pain was relieved,and the internal fixation was removed after 1 year,and the height loss at the last follow-up was not aggravated.There were no cases of failure of internal fixation in groups A and B.(7)It is indicated that subcutaneous endplate bone graft support reduction combined with percutaneous pedicle screw short-segment fixation in the treatment of A3+B2 thoracolumbar burst fracture has the advantages of less trauma,less bleeding and light postoperative pain symptoms,and the effect of injury vertebral reduction and height maintenance is the same as the reduction through pedicle bone grafting support and short segment fixation with pedicle screws through the multifidus space approach.
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Objectives:To explore the safety and early effectiveness of decompression under full-endoscope and percutaneous pedicle screw fixation in the treatment of single-level thoracolumbar burst fractures.Methods:The clinical data of 9 patients with single-segment thoracolumbar burst fracture treated with spinal canal decompression under full-endoscope and percutaneous pedicle screw fixation from April 2021 to June 2022 in our hospital were analyzed retrospectively,including 7 males and 2 females.The age ranged from 23 to 61(39.3±9.1)years old.According to AO classification,there were 6 cases of type A,2 cases of type B and 1 case of type C.Fracture segments were T12 in 2 cases,L1 in 3 cases,L2 in 3 cases,and L3 in 1 case.According to the classification of American Spinal Injury Association(ASIA)grading,there were 2 cases of type C,2 cases of type D,and 5 cases of type E.The decompression and percutaneous pedicle screw fixation were operated through the same incision in the injured vertebrae for screw placing.The operation-related indexes and complications were recorded.The patients'low back pain was evaluated by visual analogue scale(VAS)score before operation,on 3rd day after operation and at the last follow-up.The sagittal Cobb angle,height ratio of vertebral anterior edge,and the rate of spinal canal occupation were measured on spinal X-ray and CT images,and the recovery of neurological function was evaluated at the last follow-up.Results:All 9 patients successfully completed the operation,and the operative time was 105-145min(1 12.4± 21.2min),bleeding volume was 50-110mL(83.9±19.6mL),and hospitalization time was 7-13d(9.1±1.3d).No serious complications such as wound infection,cerebrospinal fluid leakage,aggravated nerve injury occurred.The follow-up time was 6-13months(8.4±3.9 months),all the fractures healed successfully,and the healing time was 3-6 months(4.7±1.6 months).The VAS score of low back pain on the 3rd day after operation and at final follow-up significantly improved compared with that before operation(P＜0.05),and it was also significantly improved at the last follow-up compared with that on the 3rd day after operation(P＜0.05).The Cobb angle,anterior height ratio of injured vertebrae,and invasion rate of spinal canal were significantly improved compared with those before operation(P＜0.05),respectively,but there was no statistical difference between the last follow-up and postoperative 3d(P＞0.05).One patient recovered from grade C to grade D of ASIA classification,while another three patients with neurological injury recovered completely.Conclusions:Decompression under full-endoscope and percutaneous pedicle screw fixation through the same incision in the injured vertebrae for screw placement in the treatment of single-level thoracolumbar burst fractures can obtain effective nerve root and spinal canal decompression,with good correction and small operative trauma,which is a safe and effective option.
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Objectives:To investigate the clinical efficacy and safety of posterior reduction and fixations in patients with thoracolumbar burst fractures with Load-sharing classification(LSC)score of 7 and 8 points.Methods:The data of 36 patients with LSC score of 7 and 8 who underwent posterior reduction and internal fixation between October 2009 and December 2014 were retrospectively analyzed.There were 21 males and 15 females,with an average age of 42.67±14.67 years(range 21 to 67 years).The fractured vertebrae were T12-Ll.LSC score was graded according to the imaging data including X-ray radiographs,CT and MRI.The index vertebral Cobb angle and anterior vertebral height were collected at preoperative,postoperative 1 week and final follow-up,respectively.Visual analogue scale(VAS)was used to evaluate residual back pain at final follow-up.The complications were recorded for safety evaluation.Results:All the patients were followed up for 49.83±18.20 months on average(23-86 months),of which 19 cases had internal fixations removed,and the follow-up period for patients after internal fixation removal was 28.00±20.12 months on average(3-69 months).Fracture healing was achieved in all the patients without significant residual pain,or broken screw or rod,or significant kyphosis,or pedicle screw cutting vertebral body or loosening of the internal fixation.For imaging evaluation,the postoperative sagittal Cobb angle was significantly improved to 6.67°±5.06° from the preoperative 15.87°±8.35°,and the postoperative height of anterior margin of the fractured vertebral body recovered to 2.88±0.32cm from 1.81±0.49cm before operation,all with statistically significant differences(P＜0.05).The vertebral body height at the final follow-up was 2.81±0.41cm,and there was no statistically significant difference between postoperative and the final follow-up vertebral body heights(P＞0.05).At the final follow-up,the neurological functions of all the patients recovered compared with the conditions at the time of injury,with no loss of intervertebral space height.The anterior edge height of the vertebral body recovered to(94.92±18.41)％,the middle edge height recovered to(81.16±11.82)％,and the posterior edge height recovered to(97.48±7.63)％,all with significant differences compared to those before surgery(P＜0.05).Conclusions:The posterior reduction and internal fixation for patients with thoracolumbar burst fracture with LSC scores of 7 and 8 can achieve good preservation of vertebral stability at later stage,high safety,and satisfactory clinical efficacy and imaging results.
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BACKGROUND: The morbidity rate of thoracolumbar burst fracture is high; however, the simple posterior distraction and reduction technique has poor patient satisfaction on maintaining vertebral height and reducing complications. Therefore, we attempt to explore a better therapeutic regimen. OBJECTIVE: To assess the efficacy of inverse arch roof breaking technique combined with pedicle screw and bone graft in treatment of thoracolumbar burst fractures. METHODS: This was a retrospective study of 78 patients with thoracolumbar burst fractures. All the patients suffered from fresh closed fractures, and all of them were operated by posterior approach. The time from injury to surgery ranged from 4 to 14 days, with an average of 7.8 days. They were randomly assigned to two groups. The 38 cases in the simple distraction group were treated with simple vertebra pedicle screw-rod system distraction and reduction fixation. The 40 cases in the inverse arch roof breaking and bone graft group were treated with inverse arch roof breaking technique combined with pedicle screw and bone graft in fractured vertebra. All patients signed the informed consent. The study was approved by the Hospital Ethics Committee. Operation time, intraoperative blood loss, fracture healing time, anterior height ratio of injured vertebrae, Cobb angle, visual analogue score, Barthel Index and postoperative complications were measured between the two groups. RESULTS AND CONCLUSION: (1) The follow-up period for all patients was 10-22 months. (2) Operation time and intraoperative blood loss were better in the simple distraction group than in the inverse arch roof breaking and bone graft group (P < 0.01). (3) The ratio of anterior height of injured vertebra and Cobb angle were significantly different between the two groups (P < 0.01). Above indexes were better in the inverse arch roof breaking and bone graft group than in the simple distraction group. (4) There were significant differences in fracture healing time and life activity function (Barthel index) between the two groups (P < 0.01), and above indexes were better in the inverse arch roof breaking and bone graft group than in the simple distraction group. (5) No deep infection was found in both groups. There were no complications such as internal fixation failure and excessive loss of vertebral height in arch roof breaking and bone graft group. In the simple distraction group, there were 3 cases of screw pull-out because of failed internal fixation, 2 cases of titanium rod breakage, and 10 cases of obvious vertebral height loss. (6) These findings suggest that compared with simple distraction and reduction fixation, inverse arch roof breaking technique combined with pedicle screw and bone graft can provide bony support to compression center of fractured vertebra. The efficacy was identified in reconstructing the height of anterior and middle columns. This method has the advantages of high mechanical strength, strong vertebral height maintenance, high bone healing rate and few complications, which will be the ideal choice in the treatment of thoracolumbar burst fracture.
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ObjectiveTo analyze the relationship between the factors causing thoracolumbar burst fracture and the corresponding clinical manifestations, so as to improve the early warning and diagnosis of thoracolumbar burst fracture, reduce the misdiagnosis and missed diagnosis, and improve the success rate of first aid. MethodsThe clinical data of thoracolumbar burst fractures treated in the Intensive Care Unit of Depretment of Emergency of our hospital from Jan. 2009 to Dec. 2018 were retrospectively analyzed. The clinical data, including age, sex, hospital duration, causes, complications, discharge, and prognosis, were analyzed retrospectively. Results A total of 83 patients with thoracolumbar burst fracture, including 69 males (83.13%) and 14 females (16.87%), were selected for this study. The average age was (44.64±15.26) years. The causes of the injury included: High falling injury (53 cases, 63.86%), traffic accident injury (17 cases, 20.48%), and heavy object injury (12 cases, 14.46%). There were 31 cases (37.35%) of craniocerebral injury, 53 cases (63.86%) of chest injury, 37 cases (44.58%) of abdominal injury, 44 cases (53.01%) of other fracture. Among the 53 cases of chest injury, there were 19 cases (35.85%) with hemopneumothorax, 13 cases (13.21%) with simple hemothorax, 7 cases (24.53%) with simple pneumothorax, 8 cases (15.09%) with mediastinal hemorrhage, 7 cases (13.21%) with mediastinal emphysema, 11 cases (20.75%) with flail chest, and 5 cases (9.43%) with diaphragmatic hernia. Among 37 cases of abdominal injuries, there were 8 cases (21.62%) with rupture of spleen, 3 cases (8.11%) with subcapsule hematomas, and 4 cases (10.81%) with simultaneous injury of liver and spleen. The missed diagnoses at the initial diagnosis included: 5 cases (100.00%) of diaphragmatic hernia, 5 cases (62.50%) of mediastinal hemorrhage, 4 cases (57.14%) of mediastinal emphysema, 2 cases (18.18%) of flail chest, and 2 cases (15.38%) of simple hemothorax. Missed diagnosis rate of the other complications were all under 10.00%. The main complications were bronchopneumonia (37 cases, 44.58%) and traumatic hemorrhagic shock (17 cases, 20.48%). There were 8 cases (9.64%) complicated with multiple organ dysfunction syndrome (MODS), with more than 3 systems involved. There were 39 patients (46.99%) had paraplegia and 3 cases (3.61%) died at discharge. ConclusionThoracolumbar burst fractures are more common in young and middle-aged men, with high falling being the primary cause and hemopneumothorax being the main clinical manifestation. Diaphragmatic hernia, mediastinal hemorrhage and mediastinal emphysema are easy to have missed diagnosis. Nearly 50% patients have traumatic paraplegia, which is worthy of attention and in-depth study.
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Objective: To discuss the effectiveness of posterior short-segment fixation including the fractured vertebra for severe unstable thoracolumbar fractures using pedicle screw fixation.
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Objective To explore the effect of pedicle fixation for treatment of thoracolumbar burst fractures in patients with osteoporosis,and to provide more evidence for the treatment.Methods Retrospectively analyzed the clinical data of 121 patients with osteoporotic vertebral burst fracture from June 2012 to October 2015.And these patients were divided into two groups according to different operation methods, namely the control group (n=56) who were given short segment fixation and the observation group (n=65) who were given single segment fixation.The visual analogue scale(VAS),Oswestry disability index(ODI),vertebral height,kyphotic angle and bone mineral density of the two groups were analyzed before surgery and 3 days,1 month,3 months and 12 months after surgery.Results The VAS score,ODI score,vertebral height,and Cobb angle of the injured vertebra were significantly improved in both of the two groups,and the difference was statistically significant (P0.05).The ODI score of the observation group was better than that of the control group 3 days and 3 months after surgery with statistically significant difference (P<0.05),and there was no significant difference between the two groups till the end of follow-up.Pedicle fixation at the injured vertebra significantly improved the vertebral height and Cobb angle with statistically significant difference (P<0.05).And the anti-osteoporosis treatment significantly increased the bone mineral density (P<0.05).Conclusion Pedicle fixation at the injured vertebra is useful in pain relief as well as function and anatomical structure restoring.And anti-osteoporosis treatment is necessary for the bone mineral density increase.
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Objective To systematically evaluate the efficacy and safety of posterior short segment and long segment pedicle screw internal fixation in the treatment of thoracolumbar burst fracture. Methods By searching the database, including PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, a comprehensive study was carried out to make a comparison between the posterior short segment and the long segment pedicle screws internal fixation in treatment of thoracolumbar burst fracture, and Meta analysis was performed. Results A total of 14 related studies and 658 patients were enrolled in the study, including 320 patients in short segment group and 338 cases in long segment group, and Meta analysis was performed. The results suggested that there was no significant difference between the short segment group and the long segment group in terms of the deformity angle of the injured vertebra measured after operation and at the last follow?up, and sagittal index at the last follow?up ( MD=-0. 22,95%CI -2. 73,2. 28,P=0. 86;MD=-0. 28,95%CI -2. 23,1. 67, P=0. 78;MD=0. 47, 95%CI -3. 45, 4. 39, P=0. 81 ) . Besides, both groups had no statistical difference in post?operative COBB angle,anterior vertebral height and compression rate of injured vertebrae ( MD=0. 21,95%CI -0. 65,1. 06,P=0. 64; MD=-0. 46,95%CI -1. 40,0. 49,P=0. 34; MD=0. 47,95%CI -2. 28, 3. 21, P= 0. 74 ) , while the differences in COBB angle, anterior vertebral height, compression rate, correction loss were statistically significant at the last follow?up (MD=5. 11,95%CI 2. 81,7. 40,P<0. 0001;MD=-11. 89,95%CI-15. 28,-8. 50,P<0. 00001;MD=6. 46,95%CI 3. 85,9. 07,P<0. 00001) . There was no significant difference in VAS scores and the ODI scores between the two groups at the last follow?up ( MD =0. 01,95%CI -0. 15,0. 17,P=0. 9; MD=-0. 47,95%CI -2. 68,1. 74,P=0. 86),while the two groups showed statistically significant difference in fixation failure ( RR = 0. 08, 95%CI 0. 01, 0. 15, P = 0. 02 ) . Conclusion Posterior long segment pedicle screw internal fixation is more effective in treating thoracolumbar burst fracture than short segment surgery. It can reduce the COBB angle,restore the anterior height of the injured vertebra,and decrease the anterior vertebral pressure.
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We aimed to describe the surgical technique and clinical outcomes of paraspinal-approach reduction and fixation (PARF) in a group of patients with Denis type B thoracolumbar burst fracture (TLBF) with neurological deficiencies. A total of 62 patients with Denis B TLBF with neurological deficiencies were included in this study between January 2009 and December 2011. Clinical evaluations including the Frankel scale, pain visual analog scale (VAS) and radiological assessment (CT scans for fragment reduction and X-ray for the Cobb angle, adjacent superior and inferior intervertebral disc height, and vertebral canal diameter) were performed preoperatively and at 3 days, 6 months, and 1 and 2 years postoperatively. All patients underwent successful PARF, and were followed-up for at least 2 years. Average surgical time, blood loss and incision length were recorded. The sagittal vertebral canal diameter was significantly enlarged. The canal stenosis index was also improved. Kyphosis was corrected and remained at 8.6±1.4o (P>0.05) 1 year postoperatively. Adjacent disc heights remained constant. Average Frankel grades were significantly improved at the end of follow-up. All 62 patients were neurologically assessed. Pain scores decreased at 6 months postoperatively, compared to before surgery (P<0.05). PARF provided excellent reduction for traumatic segmental kyphosis, and resulted in significant spinal canal clearance, which restored and maintained the vertebral body height of patients with Denis B TLBF with neurological deficits.
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Humanos , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Fijación Interna de Fracturas/métodos , Vértebras Lumbares/lesiones , Músculos Paraespinales/lesiones , Fracturas de la Columna Vertebral/cirugía , Vértebras Torácicas/lesiones , Resultado del TratamientoRESUMEN
OBJECTIVE: To compare the effectiveness of short segmental pedicle screw fixation with and without fusion in the treatment of thoracolumbar burst fracture. METHODS: A retrospective analysis was made on the clinical data of 57 patients with single segment thoracolumbar burst fractures, who accorded with the inclusion criteria between February 2012 and February 2014. The patients underwent posterior short segmental pedicle screw fixation with fusion in 27 cases (fusion group) and without fusion in 30 cases (non-fusion group). There was no significant difference in gender, age, cause of injury, time between injury and admission, fracture segment and classification, and neurologic function America Spinal Injury Association (ASIA) classification between 2 groups, which had the comparability (P>0.05). The operative time, blood loss, and hospitalization days were compared between 2 groups. The height of the injured vertebra, the kyphotic angle, and the range of motion (ROM) were measured on the X-ray film. The functional outcomes were evaluated by using the Greenough low-back outcome score and the visual analogue scale (VAS) for back pain. The neurologic functional recovery was assessed by ASIA grade. RESULTS: The operative time was significantly shortened and the blood loss was significantly reduced in the non-fusion group when compared with the fusion group (P0.05). The patients were followed up for 2.0-3.5 years (mean, 3.17 years) in the fusion group and for 2-4 years (mean, 3.23 years) in the non-fusion group. X-ray films showed that 2 cases failed bone graft fusion, the fusion time was 12-17 weeks (mean, 15.6 weeks) in the other 25 cases. Complication occurred in 2 cases of the fusion group (1 case of incision deep infection and 1 case of hematoma at iliac bone donor site) and in 1 case of the non-fusion group (fat liquefaction); primary healing of incision was obtained in the others. The Cobb angle, the height of injured vertebrae showed no significant difference between 2 groups at pre-operation, immediate after operation, and last follow-up (P>0.05). The ROM of injured vertebrae showed no significant difference between 2 groups at 1 year after operation (before implants were removed) (P>0.05). The implants were removed at 1 year after operation in all cases of the non-fusion group, and in 11 cases of the fusion group. At last follow-up, the ROM of injured vertebrae in the non-fusion group was significantly higher than that in the fusion group (P0.05). CONCLUSIONS: Fusion is not necessary when thoracolumbar burst fracture is treated by posterior short segmental pedicle screw fixation, which can preserve regional segmental motion, shorten the operative time, decrease blood loss, and eliminate bone graft donor site complications.
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RESULTS: The operation was successfully completed in all patients; the average operation time was 150 minutes (range, 90-240 minutes); the average bleeding volume was 350 mL (range, 50-500 mL); the average postoperative drainage was 80 mL (range, 20-150 mL); and the average VAS score was 2.3 (range, 1.5-4.7) at 3 days after operation. The incisions healed primarily. All the patients were followed up 12-19 months (mean, 15 months). All fractures healed at 3-9 months (mean, 6 months). No complications of broken nails, broken rod, and screw loosening occurred. At last follow-up, the vertebral canal patency rate was significantly improved when compared with preoperative value (t=27.395, P=0.000). The Cobb angle, and the anterior and posterior heights of of traumatic vertebra were significantly improved at 1 week, 1 year, and last follow-up when compared with preoperative ones (P0.05). The neurological function was improved in different degrees; 1 case was rated as grade A, 4 cases as grade B, 7 cases as grade C, 15 cases as grade D, and 26 cases as grade E, showing significant difference when compared with preoperative one (Z=-5.477, P=0.000).
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Objective To compare the clinical effect of the two operating methods: screws through fractured pedical arch operating method versus traditional operating method in the treatment of thoracolumbar burst fractures, to confirm the clinical advantages of screws through fractured pedical arch operating method in the treatment of thoracolumbar fractures. Methods A total of 62 cases suffered from thoracolumbar burst fractures were divided into two groups:screws through fractured pedical arch operating method group (n=27) and traditional operating method group (n=35). Each group was undergone the corresponding operation. The clinical results were evaluated between two groups. Results Patients in the screws through fractured pedical arch group by contrast to traditional group, margin height, Cobb's angle, internal fixation failure rates and area of vertebral canal were different, there was significant differences (P<0.01). Conclusion Screws through fractured pedical arch operating method had many advantages, which had a promising clinical applica-tion in the treatment of thoracolumbar burst fractures.
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OBJECTIVE: To analyze the clinical results of a partial vertebrectomy with titanium mesh implantation and pedicle screw fixation using a posterior approach to reconstruct the spine in the treatment of thoracolumbar burst fractures. METHOD: From January 2006 to August 2008, 20 patients with severe thoracolumbar fractures were treated.For vertebral bodies associated with one injured intervertebral disk, subtotal vertebrectomy surgery and single-segment fusion were performed. For vertebral bodies with two injured adjacent intervertebral disks, partial vertebrectomy surgery and two-segment fusion were performed. RESULTS: All 20 patients were followed up for 12 to 24 months (average of 18 months). There were no complications such as wound infections, hemopneumothorax or abdominal infections in any of the patients. The neurological status of all of the patients was improved by at least one American Spinal Injury Association grade by the last follow-up. The anterior vertebral body height was an average of 50.77% before surgery, 88.51% after surgery and 87.86% at the last follow up; the sagittal Cobb angle was improved, on average, from 26.15° to 5.39° and was 5.90° at the last follow up. The percentage of spinal stenosis was improved, on average, from 26.07% to 4.93%° and was 6.15% at the last follow up. There were significant differences ...
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Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Fijación Interna de Fracturas/métodos , Vértebras Lumbares/lesiones , Tornillos Pediculares , Mallas Quirúrgicas , Fracturas de la Columna Vertebral/cirugía , Vértebras Torácicas/lesiones , Titanio/uso terapéutico , Estudios de Seguimiento , Vértebras Lumbares , Tempo Operativo , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Fracturas de la Columna Vertebral , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Vértebras TorácicasRESUMEN
Objective-To-discuss-the-clinical-efficacy-of-limited-decompression-and-pedicle-screw-fixation-for-thoracolumbar-burst-fractures.-Methods-From-October-2005-to-October-2011,-38-patients-with-thoracolumbar-burst-fractures-were-treated-by-lumbar-pedicle-screw-fixation-combined-with-limited-decompression-.The-X-ray-measurements-and-evaluations-of-neurological-functions-before-and-after-surgery-were-reviewed-.-Results-All-the-38-cases-were-followed-up-for-36-months.The-bone-fusion-was-obtained-in-all-the-cases-,-without-pedicle-screw-breakage-,-bending-,-or-prolapse-.Evaluation-of-the-efficacy-at-36-months-after-surgery:excellent-in-36-cases,-good-in-1-case,-and-poor-in-1,-with-a-good-or-excellent-rate-of-97.4%-(37/38).The-preoperative-anterior-height-of-fractured-vertebrae-was-(14.23-±2.51)-mm,-which-was-significantly-lower-than-that-6-months-postoperatively-[(25.68-±3.95)-mm,-q=22.319,-P<0.05],-24-months-postoperatively-[(26.23-±3.15)-mm,-q=23.391,-P<0.05],-and-36-months-postoperatively-[(25.64-±2.86)-mm,-q=22.241,-P<0.05].The-preoperative-Cobb-angle-was-(24.39°±2.54°),-which-was-significantly-more-than-that-36-months-after-surgery[(15.54°±1.05°),-q=27.448,-P<0.05].The-preoperative-VAS-scores-were-(6.1-±1.1)-points,-which-were-significantly-higher-than-that-36-months-after-operation-[(1.2-±0.6)-points,-q=33.930,-P<0.05].There-were-significant-differences-in-the-Frankel-grades-before-and-after-the-operation-(Z-=-2.190,-P-=0.029).-Conclusion-Limited-decompression-and-pedicle-screw-fixation-for-thoracolumbar-burst-fractures-can-not-only-provide-instant-stability-,-but-also-have-advantages-of-high-satisfaction-rate-,-minimal-invasion-,-and-long-term-prevention-of-kyphosis-and-fixation-failure-.
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OBJECTIVE: We compared the radiological and clinical outcomes between patients who underwent posterior fixation alone and supplemented with fusion following the onset of thoracolumbar burst fractures. In addition, we also evaluated the necessity of posterolateral fusion for patients treated with posterior pedicle screw fixation. METHODS: From January 2007 to December 2009, 46 consecutive patients with thoracolumbar burst fracture were included in this study. On the basis of posterolateral fusion, we divided our patients into the non-fusion group and the fusion group. The radiological assessment was performed according to the Cobb's method, and results were obtained at immediately, 3, 6, 12 months after surgery. The clinical outcomes were evaluated using the modified Mcnab criteria at the final follow-up. RESULTS: The demographic data and the mean follow-up period were similar between the two groups. Patients of both groups achieved satisfactory clinical outcomes. The mean loss of kyphosis correction showed that patients of both groups experienced loss of correction with no respect to whether they underwent the posterolateral fusion. There was no significant difference in the degree of loss of correction at any time points of the follow-up between the two groups. In addition, we also compared the effect of fixed levels (i.e., short versus long segment) on loss of correction between the two groups and there was no significant difference. There were no major complications postoperatively and during follow-up period. CONCLUSION: We suggest that posterolateral fusion may be unnecessary for patients with thoracolumbar burst fractures who underwent posterior pedicle screw fixation.
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Humanos , Estudios de Seguimiento , CifosisRESUMEN
In most thoracolumbar burst fractures, the spinal cord or cauda equina is compressed and displaced posteriorly by the retropulsed bone fragments in the spinal canal. We report a rare case of an L3 burst fracture in which the cauda equina was trapped in the crack of a bisected vertebral body with anterior displacement. To decompress the neural elements, we attempted a total laminectomy and facetecomy with manipulation of the retropulsed bone fragment and indirect instrumental reduction, but failed to relieve the cauda equina. Finally, we were able to relieve the cauda equina via a discectomy and bilateral removal of the bony portion that was entrapping the cauda equina. One month after the first surgical procedure, an anterior corpectomy of L3 and interbody fusion with a mesh cage and allograft to support the anterior column were performed.
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Cauda Equina , Discectomía , Desplazamiento Psicológico , Laminectomía , Canal Medular , Médula Espinal , Trasplante HomólogoRESUMEN
Objective To explore the clinical curative effect of AF system combined vertebra re-duction and posterolateral bone fusion treatment thoracolumbar burst fracture .Methods Seventeen pa-tients with thoracolumbar burst fracture using period stage , according to the system of AF clinical symptoms and image data line pressure decreased , and the pressure or not to hurt inside the vertebral pedicle autoge-nous bone grafts are grain filling and vertebral posterolateral line between the axon , lamina around small joints and bone , and postoperative follow-up X-ray inspection regularly , observe internal fixation and verte-bral vertebral height and adjacent intervertebral space changes , or after fixation and reset lost .Results following up 13 months, vertebral body height restore and maintain good , bolt looseness and broken and ver-tebral body height complications such as lost were no found in 17 cases.Conclusion Treatments of Poste-rior fixation combined short stage AF vertebral body and posterolateral bone fusion on thoracolumbar burst fracture are not only rebuild the vertebral height , but also make the vertebral obtained after three pillars in stable, reduce the internal fixation and compressed vertebral again such complications .
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PURPOSE: Surgical treatment in the case of thoracolumbar burst fractures is very controversial. Posterior instrumentation is most frequently used, however, but the number of levels to be instrumented still remains a matter of debate. MATERIALS AND METHODS: A total of 94 patients who had a single burst fracture between T11 and L2 were selected and were managed using posterior instrumentation with anterior fusion when necessary. They were divided into three groups as follows; Group I (n = 28) included patients who were operated by intermediate segment fixation, Group II (n = 32) included patients operated by long segment fixation, and Group III (n = 34) included those operated by intermediate segment fixation with a pair of additional screws in the fractured vertebra. The mean follow-up period was twenty one months. The outcomes were analyzed in terms of kyphosis angle (KA), regional kyphosis angle (RA), sagittal index (SI), anterior height compression rate, Frankel classification, and Oswestry Disability Index questionnaire. RESULTS: In Groups II and III, the correction values of KA, RA, and SI were much better than in Group I. At the final follow up, the correction values of KA (6.3 and 12.1, respectively) and SI (6.2 and 12.0, respectively) were in Groups II and III found to be better in the latter. CONCLUSION: The intermediate segment fixation with an additional pair of screws at the fracture level vertebra gives results that are comparable or even better than long segment fixation and gives an advantage of preserving an extra mobile segment.
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Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Adulto Joven , Fracturas de la Columna Vertebral/diagnóstico por imagen , Vértebras Torácicas/lesiones , Resultado del TratamientoRESUMEN
OBJECTIVE: Surgical approaches to unstable burst fractures of the thoracolumbar spine are variable and include anterior decompression with interbody fusion and fixation, anterolateral approach and posterior approach. The purpose of this study is to compare the clinical and radiological results of single-stage interbody fusion with transpedicular screw fixation and pedicle screw fixation with lamina onlay fusion. METHODS: Thirty-five patients with thoracolumbar burst fractures were enrolled in the present study. The subject group was composed of 21 men and 14 women, with a mean age of 47.68+/-13.93 years(range, 19~76 years). Eighteen patients(Group I, anterior-posterior group) were treated with interbody fusion with transpedicular screw fixation with and 17 patients(Group II, posterior only group) were treated with pedicle screw fixation with onlay fusion. Both procedures were performed through single staged posterior approach. The neurological states, clinical outcomes and radiological outcomes were analyzed. Radiologic results were evaluated on the basis of kyphotic angle, percentage of anterior body compression and interbody height immediately after surgery and at the final follow-up examination. RESULTS: Kyphotic angle, anterior body compression rate and interbody height were corrected in both groups. While the correction was maintained in the patients in group I, kyphosis and anterior body compression rate were aggravated in the patients in group II at follow-up. Both groups showed the same or improved modified Frankel grades and pain scores. CONCLUSIONS: Group I showed better correction of kyphotic angle and percentage of anterior body compression than group II. Anterior column support plays an important role in maintaining the correction of kyphosis and this procedure can be effectively performed using single-stage unilateral posterior approach together with transpedicular screw fixation.
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Femenino , Humanos , Masculino , Descompresión , Estudios de Seguimiento , Incrustaciones , Cifosis , Columna VertebralRESUMEN
OBJECTIVE: Despite general agreement on the goals of surgical treatment in thoracolumbar burst fractures, considerable controversy exists regarding the choice of operative techniques. This study is to evaluate the efficacy of short-segment fixation for thoracolumbar burst fractures after long-term follow-up and to analyze the causes of treatment failures. METHODS: 48 out of 60 patients who underwent short-segment fixation for thoracolumbar burst fractures between January 1999 and October 2002 were enrolled in this study. Their neurological status, radiological images, and hospital records were retrospectively reviewed. Simple radiographs were evaluated to calculate kyphotic angles and percentages of anterior body compression (%ABC). RESULTS: The average kyphotic angles were 20.0degrees preoperatively, 9.6degrees postoperatively, and 13.1degrees at the latest follow-up. The average %ABC were 47.3% preoperatively, 31.2% postoperatively, and 33.3% at the latest follow-up. The treatment failure, defined as correction loss by 10?or more or implant failure, was detected in 6 patients (12.5%). 5 out of 6 patients had implant failures. 2 out of 5 patients were related with osteoporosis, and the other 2 were related with poor compliance of spinal bracing. 3 patients with poor initial postoperative alignment had implant failure. 4 patients with screws only on the adjacent vertebrae and not on the injured vertebra itself showed poor initial and overall correction. CONCLUSION: With proper patient selection, adequate intraoperative reduction with screw fixation involving the injured vertebra, and strict postoperative spinal bracing, the short-segment fixation is an efficient and safe method in the treatment of thoracolumbar burst fracture.