Fractured vertebra antedisplacement reconstruction technique: a feasible treatment choice for posttraumatic thoracolumbar kyphosis.

OBJECTIVE: The goal of this study was to evaluate the feasibility of the fractured vertebra antedisplacement reconstruction technique for the treatment of posttraumatic thoracolumbar kyphosis (PTK). METHODS: A total of 22 patients with PTK who were treated with the fractured vertebra antedisplacement reconstruction technique were retrospectively analyzed. The radiological evaluation included global kyphosis, thoracolumbar angle, and sagittal vertical axis. The clinical evaluation included visual analog scale pain score, Oswestry Disability Index score, SF-12 Health Survey score, and American Spinal Injury Association grade. The complications were recorded. RESULTS: The mean global kyphosis was 55.0° ± 12.6° preoperatively, 8.5° ± 5.0° postoperatively, and 10.3° ± 4.8° at the latest follow-up (p < 0.001). The average total kyphosis correction achieved was 44.7° ± 14.2°, with a range of 23.4°-79.4°, indicating a mean final correction of 80.1%. The mean thoracolumbar angle was 46.2° ± 13.2° preoperatively, 6.6° ± 4.5° postoperatively, and 7.6° ± 4.2° at the latest follow-up (p < 0.001). The mean sagittal vertical axis was improved significantly, from 51.1 ± 24.2 mm preoperatively to 28.5 ± 17.4 mm at the latest follow-up (p = 0.001). One patient (4.5%) experienced single intervertebral fusion nonunion, and 1 patient (4.5%) experienced distal screw loosening. No patients experienced any neurological deterioration. The visual analog scale pain score, Oswestry Disability Index score, SF-12 Health Survey score, and American Spinal Injury Association grade achieved significant improvement at the latest follow-up. CONCLUSIONS: Fractured vertebra antedisplacement reconstruction technique can effectively correct kyphosis, reconstruct spinal stability, and improve the patient's symptoms and neurological function. This technique is safer, minimally traumatic, and less technically demanding to avoid osteotomy-related complications. It is a feasible treatment choice for PTK.

Should the level of the posterior instrumentation combined with the intermediate screw be a short segment or a long segment in thoracolumbar fractures with fusion to the fractured segment?

PURPOSE: It was aimed to compare the results of long segment posterior instrumentation with intermediate pedicular screw + fusion at the level of the fractured segment including one vertebra above and one below the fractured vertebra (LSPI) and short segment posterior instrumentation with intermediate pedicular screw + fusion at the level of the fractured segment including one vertebra above and one below the fractured vertebra (SSPI) in the surgical treatment of thoracolumbar vertebral fractures. METHODS: Ninety patients with thoracolumbar vertebral (T11-L2) fractures operated between March 2015 and February 2022 were included in this retrospective study. The patients were divided into two groups as those who underwent LSPI (n, 54; age, 40.3) and those who underwent SSPI (n, 36; age, 39.7). Radiological evaluations like vertebral compression angle (VCA), vertebral corpus heights (VCH), intraoperative parameters, and complications were compared between the groups. RESULTS: Correction in early postoperative VCA was statistically significantly better in LSPI (p = 0.003). At 1-year follow-up, postoperative VCA correction was significantly more successful in LSPI (p = 0.001). There was no difference between the two groups in terms of correction loss in VCA measured at 1-year follow-up. There was no statistically significant difference between the two groups in terms of postoperative VCH, VCH at 1-year follow-up, and correction loss in VCH. CONCLUSION: LSPI provides better postoperative kyphosis correction of the fractured vertebra than SSPI. Regarding the segment level of posterior instrumentation, there was no difference between the two groups in terms of the loss of achieved correction of VCA, ABH, and PBH at 1-year follow-up. Operating a thoracolumbar fracture with LSPI will lengthen the operation and increase the number of intraoperative fluoroscopies compared to SSPI.

[Posterior short-segment fixation including the fractured vertebra for severe unstable thoracolumbar fractures].

Objective: To discuss the effectiveness of posterior short-segment fixation including the fractured vertebra for severe unstable thoracolumbar fractures using pedicle screw fixation. Methods: Between May 2008 and July 2013, 52 patients of severe unstable thoracolumbar fractures were treated through posterior short-segment fixation including the fractured vertebra using pedicle screw fixation. There were 33 males and 19 females with an age of 21-56 years (mean, 37.9 years). The causes of thoracolumbar burst fractures included fall from height in 32 cases, traffic accidents in 16 cases, and others in 4 cases. The load sharing classification (LSC) score was 7-9 (mean, 7.85). The levels involved included T 11 in 4 cases, T 12 in 19 cases, L 1 in 25 cases, and L 2 in 4 cases. According to Frankel classification, there were 2 cases of grade A, 4 cases of grade B, 8 cases of grade C, 11 cases of grade D, and 27 cases of grade E. The rate of spinal canal occupying was 24.2%-76.7% (mean, 47.1%). The time from injury to operation was 3-5 days (mean, 3.6 days). The effectiveness was assessed by the changes of injured vertebral Cobb angle, anterior vertebral height, and the Frankel grading at pre- and post-operation. Results: The operation time was 85-127 minutes (mean, 106.5 minutes). The intraoperative blood loss was 90-155 mL (mean, 137.6 mL). All the incision healed at first intension. Forty-seven patients were followed up 19-27 months (mean, 23.2 months), and no incision infection, screw loosening, or other internal fixation failures was found during follow-up. The injured vertebral Cobb angle and anterior vertebral height at immediate after operation or at last follow-up were significantly improved when compared with preoperative values ( P<0.001). There was a loss of injured vertebral Cobb angle and anterior vertebral height at last follow-up, but no significant difference was found between at immediate after operation and at last follow-up ( P>0.05). The Frankel grade improved by 0-2 grades at last follow-up, showing significant difference when compared with preoperative grades ( Z=15.980, P=0.003). Conclusion: Posterior short-segment fixation including the fractured vertebra for severe unstable thoracolumbar fractures (LSC≥7) using pedicle screw fixation can correct the kyphosis deformity, restore vertebral body height, and aviod the need of anterior reconstruction.

Posterior short-segment fixation including the fractured vertebra for severe unstable thoracolumbar fractures / 中国修复重建外科杂志

Objective: To discuss the effectiveness of posterior short-segment fixation including the fractured vertebra for severe unstable thoracolumbar fractures using pedicle screw fixation.

Restoration of Anterior Vertebral Height by Short-Segment Pedicle Screw Fixation with Screwing of Fractured Vertebra for the Treatment of Unstable Thoracolumbar Fractures.

BACKGROUND: The treatment of unstable thoracolumbar fractures remains controversial. Long-segment pedicle screw constructs may be stiffer and impart greater forces on adjacent segments compared with short-segment constructs. Short-segment pedicle screw fixation alone may be associated with instrumentation failure. Reinforcement fractured vertebra by the placement of an additional 2 screws at fracture level may be useful in thoracolumbar fractures for restoration of anterior vertebral height. MATERIAL AND METHODS: We retrospectively analyzed 35 patients (21 males, 14 females) with unstable thoracolumbar fractures. The patients were divided into 2 groups. In group I, patients were operated with posterior approach via the use of pedicle screws fixed long (2 levels above and 1 or 2 levels below of the fractured vertebra). In group II patients, short-segment stabilization with additional screwing at fracture level was made. Immediate postoperative radiologic evaluations were done by measuring the correction and maintenance of kyphotic angle at the fracture level, Cobb angle, and height of fractured vertebra. RESULTS: Average local kyphosis angle, anterior kyphotic angle at the fracture level, and Cobb angle were not statistically significantly different in the postoperative period (P > 0.05); however, postoperative anterior height of fractured vertebra was statistically significantly different between the 2 groups (P < 0.05). CONCLUSIONS: We compared a standard long-segment construct with a short-segment construct using instrumentation of the fractured segment. Short-segment pedicle screw fixation with screwing of fractured vertebra in unstable thoracolumbar fracture levels is an effective method to restoring anterior vertebral height for the treatment of unstable thoracolumbar fractures. It also provides anterior column support.

Unilateral short-segment pedicle screw fixation for treatment of thoracolumbar fractures / 局解手术学杂志

Objective To assess the operation results of unilateral and bilateral short-segment pedicle screw fixation combined with in-termediate screws in thoracolumbar fractures .Methods A total of 73 patients with thoracolumbar fracture were included in our study .Among the 73 patients, 48 cases were treated by bilateral short-segment pedicle screw fixation and the other 25 cases were treated by unilateral short-segment pedicle screw fixation,with a mean follow-up of 24.6 months.Surgical time,surgical blood loss,surgical draining loss,hospital stays, hospitalization cost,Cobb’s angle,kyphosis of the vertebral body ,anterior height of the fracture vertebral body ,VAS and ODI scores between the two groups were compared .Results There were significant differences in the surgical time and hospitalization cost between two groups (P0.05).Conclusion Unilateral short-segment pedicle screw fixation combined with intermediate screws can significantly correct the kyphosis and achieve the clinical effect of bilateral short -segment pedicle screw fixation technique .Meanwhile , the unilateral short-segment pedicle screw fixation technique can significantly reduce the surgical time and hospitalization cost ,which is an ef-fective method for thoracolumbar fracture .

Short-term effectiveness of pedicle fixation at the fractured vertebra via paravertebral intermuscular ap-proach for thoracolumbar fractures / 医学研究生学报

Objective Pedode foxatoon at the level of fracture vetebral technology is widely used in rebuilding spnal fracture recently.The purpose of minimally invasive surgery for thoracolumbar fractures is to reduce the injury , fix segments, and rebuild the stability of the spine .This study aimed to investigate the short-term clinical effect of pedicle fixation at the fractured vertebra via the pa-ravertebral intermuscular approach for the treatment of thoracolumbar fractures . Methods We treated 24 cases of thoracolumbar fracture by pedicle fixation at the fractured vertebra via the paravertebral intermuscular approach , rebuilt spinal stability , and corrected kyphotic deformity .We evaluated the improvement of pain symptoms and life quality using The Visual Analogue Scale ( VAS) and The MOS 36-Item Short-Form Health Survey (SF-36), and assessed the corrected status of vertebral height loss and kyphotic deformity by radiographic measurement .All the patients were followed up for over 12 months. Results The VAS score of the patients was signifi-cantly higher while the SF-36 score remarkably lower before surgery than the scores in 12 months which were ([7.65 ±0.13] -[1.54 ±0.07], P<0.05) and ([90.21 ±2.02]-[117.21 ±1.02], P<0.05).Imaging evaluation showed desirable correction of the reduced height of the injured vertebrae and kyphotic deformity . Conclusion Pedicle fixation at the fractured vertebra via the pa-ravertebral intermuscular approach , with its advantages of minimal invasiveness and fewer segments of fixation , can effectively correct vertebral height reduction and kyphotic deformity .

Efficacy analysis of pedicle screw internal fixation of fractured vertebrae in the treatment of thoracolumbar fractures.

The present study aimed to discuss the method and effect of posterior internal fixation of thoracolumbar fractures strengthened by the vertical stress pedicle screw fixation of fractured vertebrae. Patients with single thoracolumbar fractures were examined retrospectively. Fourteen patients (group A) had been treated with vertical stress pedicle screw fixation of a fractured vertebra and sixteen patients (group B) received traditional double-plate fixation, as a control. All patients were diagnosed with fresh fractures with a complete unilateral or bilateral pedicle and no explosion of the inferior half of the vertebral body or inferior endplate. In group A, patients received conventional posterior distraction and lumbar lordosis restoration, as well as pedicle screws in the fractured vertebra in a vertical direction to relieve stress to achieve a local stress balance. All patients were followed up postoperatively for 4-18 months (average, 12.6 months). The vertical stress pedicle screw fixation assisted in the reduction of vertebrae fracture, which reduced the postoperative Cobb's angle loss. There was a significant difference in the change of Cobb's angle between the two groups one year after surgery (P<0.01). Conditional application of pedicle screws in a single thoracolumbar fracture enhances the stability of the internal fixation system and is conducive to the correction of kyphosis and maintenance of the corrective effects.

Biomechanical comparison of two types of posterior pedicle instrumentation / 中华创伤骨科杂志

Objective To compare the biomechanical properties between the two-level fixation by im- plantation of pedicle-screws into the adjacent upper and lower vertebrae of the fractured vertebra and the three-level fixation by implantation of pedicle screws into the fractured vertebra and its adjacent upper and lower vertebrae in the treatment of thoracolumbar burst fractures.Methods Eight fresh frozen calf spines were used in this study.Each specimen was tested in four models:intact model as the control,L1 burst fracture model,two-level fixation model, and three-level fixation model.The L1 burst fracture model was created on a biaxial material testing machine (MTS858 Bionix test system,America).During the experiment,the flexion,extension,bilateral bending and axial rotation loadings were applied to the specimens and the range of motion(ROM)was measured with a three-dimensional laser analysis apparatus and the stiffness was calculated subsequently.One-way statistical analysis was used.Results The ROMs under six different loadings in the fracture model became larger obviously(P＜0.05)and the stiffness decreased(P＜0.05).The ROMs in both fixation models were smaller than those in the other models(P＜0.01)and the stiffness increased distinctly(P＜0.05).There were no significant differences in ROMs and stiffness between the two-level fixation and three-level fixation models(P＞0.05).Conclusion Two-level fixation provides similar biomechanical stability as three-level fixation does in the reconstruction of unstable thoracolumbar fractures.