Treatment of thoracolumbar fractures with short-segment transpediclar screw fixation and vertebroplasty via paraspinal intermuscular approach / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical effects of short-segment transpedicular fixation and vertebroplasty via paraspinal intermuscular approach in treating thoracolumbar fractures.</p><p><b>METHODS</b>From January 2009 to January 2012,18 patients with thoracolumbar fractures without neurological symptoms were treated with short-segment transpedicular fixation and vertebroplasty via paraspinal intermuscular approach. There were 11 males and 7 females, aged from 52 to 76 years old with an average of 62.2 years. The duration from injuries to surgery ranged from 8 h to 7 d with an average of 4.2 d. According to the Denis fracture classification, 12 cases got compression fractures and 6 cases got burst fractures.</p><p><b>LOCATION</b>6 vertebra with T12, 9 with L1, 6 with L2, and 3 with L3. Anterior vertebral body height, the sagittal Cobb angle, the sagittal index (SI), condition of internal fixation failure and recurrent kyphosis were observed.</p><p><b>RESULTS</b>All patients were followed up for 12-28 months with an average of 16.5 months. Operation time was from 80 to 130 min with a mean of 95 min and bleeding volume during operation ranged from 100 to 180 ml with a mean of 145 ml. Anterior vertebral body height ratios preoperation, 3 days after operation and final follow-up was 54.3 +/- 2.8, 90.9 +/- 1.5, 88.6 +/- 1.7, respectively; sagittal Cobb angle was (27.8 +/- 2.5) degrees, (5.3 +/- 0.8) degrees, (6.3 +/- 1.4) degrees, respectively; sagittal index was 52.3 +/- 3.8, 89.2 +/- 5.2, 86.4 +/- 4.5, respectively. Data obtained 3 days after operation obviously improved than preoperation, and there was no statistically significant difference between 3 days after operation and last follow-up. No internal fixation failure, neurological complications and recurrent kyphosis were found.</p><p><b>CONCLUSION</b>Treatment of thoracolumbar fractures with short-segment transpediclar screw fixation and vertebroplasty via paraspinal intermuscular approach can retain the posterior ligament complex and restore the mechanical strength of the anterocentral column,which proved an ideal method for preventing the failure of internal fixation and reduction of post-traumatic segmental kyphosis.</p>

Treatment of thoracolumbar fractures with unilateral pedicle screw fixation through paraspinal approach / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the feasibility and efficacy of unilateral pedicle screw fixation in treating thoracolumbar fractures through paraspinal approach.</p><p><b>METHODS</b>From January 2006 to January 2009,21 patients with single level thoracolumbar fracture without neurological symptoms were treated with unilateral pedicle screw fixation through paraspinal approach. There were 14 males and 7 females,aged from 21 to 65 years old with a mean of 36.4 years. The duration from injury to operation ranged from 6 h to 5 d with an average of 3 d. According to the classification of Denis fracture, compression fractures happedned in 12 cases and burst fractures happened in 9 cases,including 1 case with T5 fracture, 2 cases with T7 fracture, 2 cases with T10 fracture, 3 cases with T11 fracture, 8 cases with T12 fracture, and 5 cases with L1 fracture. Based on the Flankel grade, all patients were classified as grade E. Anterior vertebral body height ratio, sagittal Cobb angle, condition of internal fixation failure, visual analogue score (VAS) were evaluated.</p><p><b>RESULTS</b>All patients were followed up from 12 to 36 months with an average of 20.5 months. No internal fixation failure was found. Anterior vertebral body height ratios at preoperative 3 days after operation and last follow-up were 54.3 +/- 2.8, 92.9 +/- 1.5, 93.8 +/- 1.7, respectively;sagittal Cobb angle at the three timepoints were (27.8 +/- 2.5) degrees, (5.3 +/- 0.8) degrees, (6.3 +/- 1.4) degrees, respectively; the difference was statistical significant (P < 0.05). VAS was (1.2 +/- 0.4) points at last follow-up and had obviously improved (P < 0.05).</p><p><b>CONCLUSION</b>Treatment of thoracolumbar fractures with unilateral pedicle screw fixation through paraspinal approach is safe with the advantages of micro-trauma and less blood loss,which can not only completely retain the posterior spinal complex structure, reinforce the spinal stability, raise the reductional quality, but also improve the strength of fixation and the distribution of stress force.</p>