Inclusion of the fracture level in short segment fixation of thoracolumbar fractures

Abstract Background It is generally acknowledged that short-segment pedicle screw instrumentation is the preferred surgical method for thoracolumbar fractures. However, the use of short-segment instrumentation with or without intermediate screws at the fracture level remains controversial. This review will evaluate the evidence available to date regarding the efficacy of including the fracture level in trans-pedicular screw short segment fixation, to assess clinical and radiological outcome. Objectives Our primary objective is evaluating the efficacy and outcome of including the fractured level vertebra in short segment fixation. And concerns regarding the use of pedicle screws into the fractured vertebra as to whether it is safe to insert a screw through a broken bone. Our secondary objective analyzing the importance of posterior pedicle screw fixation in unstable thoracolumbar fractures. Methods The following electronic databases will be searched from 1992 to 2018: PubMed, Google scholar search engine. Cochrane database of systematic reviews, EMBASE and science Direct, using the keywords “TLICS”, "index screw", “short segment fixation”, "Thoracolumbar spine trauma", "traumatic spine injury", "spinal cord injury", "spine trauma", "role", “reliability”.Studies will be eligible if they contain the target keywords in title or abstract, addressing our age group. Afterwards the full text of the articles will be reviewed to exclude full texts not fulfilling the criteria or deviating from the initial impression taken from the title/abstract reviewing. References/bibliography of the selected articles will be examined to evaluate potential for further research and possible inclusion in the analysis. Any differences will be sorted by discussion between study team (student, director, and co-directors). Results A total of 3010 studies were screened for eligibility , 8 studies were included in our systematic review for comparing the short segment fixation “including” the fracture level with “conventional” methods whether short or long segment fixation. Overall study population reached 512 patients. Analysis showed comparable results regarding clinical picture and radiography, showing highly statistically significant difference in favor of “including” index level in fixation in post operative kyphosis angle correction, loss of correction of kyphosis angle through follow up until 2 years and loss of correction of AVH, also statistically significant difference in rate of implant failure in favor for “including” group, and with no significant difference in operative time , blood loss and VAS for post-operative pain. Conclusion We conclude that Short segment fixation including the fracture level is a promising surgical option when it comes to thoraco-lumbar unstable fractures. In conclusion, inclusion of the fracture level into the construct offers a better kyphosis correction, in addition to fewer instrument failures, without additional complications, and with a comparable-if not better-clinical outcome, the radiologic correction achieved is maintained even at the end of 2 years and reflected in good functional outcomes. We recommend insertion of screws into pedicles of the fractured thoracolumbar vertebra when considering a short segment posterior fixation, especially in Magerl type C fractures. Large population prospective randomized controlled studies and clinical trials are recommended for more high level evidence data.

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The Loss of Correction in Thoracolumbar Burst Fracture Treated by Surgery. Can We Predict It?

Acta Medica Marisiensis ◽

10.2478/amma-2014-0020 ◽

2014 ◽

Vol 60 (3) ◽

pp. 99-101

Author(s):

S. Anghel ◽

D. Márton

Keyword(s):

Anterior Approach ◽

Burst Fracture ◽

Regression Equations ◽

Kyphosis Angle ◽

Short Segment ◽

Loss Of Correction ◽

Short Segment Fixation ◽

Lumbar Fractures ◽

Fracture Level

Abstract Objective: This paper aims to differentially depict potential patterns of the loss of correction in surgically treated thoraco-lumbar burst fractures. These may eventually serve to foreseeing and even forestalling loss of correction. Methods: The study focused on 253 patients with surgically treated thoraco-lumbar fractures. This cohort of patients was clustered in four subgroups according to the fracture spine segment (T11-L1 or L1-L2) and surgery type (short segment fi xation or anterior approach). Relevant recorded and processed data were the fracture level, post-operative (Kpo) and last follow-up (Kf) kyphosis angle values. Correlation, regression and determination testing were performed for the last follow-up kyphosis angle and post-operative kyphosis angle, and regression equations were determined for each subgroup of patients. Results: The patterns of loss of correction were described through the following equations: Kf = 0.95*Kpo + 3.2° for the T11-L1 level fractured vertebrae treated by posterior short segment fixation; Kf = 0.98*Kpo + 3.4° for the L1-L2 level fractured vertebrae treated by posterior short segment fixation; Kf = 1.1*Kpo + 1.6° for the T11-L1 level fractured vertebrae treated by anterior approach; and Kf = 0.7*Kpo + 2.8° for the L1-L2 level fracture vertebrae treated by anterior approach. Conclusions: The loss of correction may be predicted, to a certain extent, for thoraco-lumbar fractured vertebrae treated surgically. The bestfit equations depicted for both type of surgery (short segment fixation and anterior approach) and both spinal segments (T11-L1 and L2-L3) are significantly different than the equations delineated for the collapse of non-surgically treated fractures.

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A comparative study between the Universal Spinal System® (USS) and the CD Horizon® Legacy™ (CDH) in the management of thoracolumbar fractures

SICOT-J ◽

10.1051/sicotj/2019039 ◽

2019 ◽

Vol 5 ◽

pp. 42

Author(s):

Ahmed Samir Barakat ◽

Ahmed Elattar ◽

Khaled Fawaz ◽

Ahmed Maher Sultan ◽

Wael Koptan ◽

...

Keyword(s):

Body Height ◽

Pain Reduction ◽

X Rays ◽

Thoracolumbar Fractures ◽

Short Segment ◽

Legacy System ◽

Neurological Improvement ◽

Clinical And Radiological Outcome ◽

One Year ◽

Short Segment Fixation

Introduction: For the treatment of unstable non-osteoporotic thoracolumbar fractures, the clinical and radiological outcome of short-segment fixation with the USS™ – Universal Spine System (DePuy Orthopedics, Inc., Warsaw, IN, USA) and the CD HORIZON® LEGACY™ 5.5 Spinal System, (Medtronic Sofamor Danek USA, Inc., Memphis, TN, USA) were compared. Methods: From March 2015 to January 2016, 40 consecutive patients with unstable traumatic thoracolumbar fractures who met our inclusion criteria were treated with either the USS system or CDH Legacy system. Segmental kyphosis angle (SKA) and anterior body height (ABH) of fractured vertebrae, and ASIA Impairment Scale (AIS) were evaluated. Radiological fusion was confirmed with plain X-rays and when indicated with computerized tomography (CT). Results: The mean immediate kyphotic angle correction was 16.6° for the Schanz and 6.4 for the Legacy system, and the immediate mean anterior vertebral body height correction was 0.92 cm for the Schanz and 0.51 cm for the Legacy system. Our study shows a significant statistical difference between Schanz and Legacy systems regarding post-operative segmental kyphosis and height correction immediately postoperatively, at 6 months and at one-year follow-up (p-value < 0.005). The degree of pain reduction and neurological improvement was not influenced by the screw system. Conclusion: Usage of USS in thoracolumbar fracture as a short-segment fixation led to a near anatomical reduction when compared to the Legacy system. However, there was no advantage regarding pain reduction and neurological outcome.

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Comparison of long segment fixation versus short segment fixation with pedicle screws at the level of the fracture in the management of Thoracolumbar fractures

Egyptian Spine Journal ◽

10.21608/esj.2013.3812 ◽

2013 ◽

Vol 5 (1) ◽

pp. 47-52

Author(s):

Amr El-Shehaby ◽

Khaled Saoud ◽

Ahmed Elayouty

Keyword(s):

Pedicle Screws ◽

Thoracolumbar Fractures ◽

Short Segment ◽

Short Segment Fixation

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Inclusion of the fractured level into the construct of short segment fixation in patients with thoracolumbar fractures: clinical and radiological outcome

Egyptian Journal of Neurosurgery ◽

10.1186/s41984-021-00137-7 ◽

2021 ◽

Vol 36 (1) ◽

Author(s):

Ali R. Hamdan ◽

Radwan Nouby Mahmoud ◽

Ahmed G. Tammam ◽

Eslam El-Sayed El-Khateeb

Keyword(s):

Cobb Angle ◽

Vertebral Body ◽

Compression Ratio ◽

Body Height ◽

Surgical Approaches ◽

Thoracolumbar Fractures ◽

Vertebral Body Height ◽

Short Segment ◽

The Mean ◽

Short Segment Fixation

Abstract Background Thoracolumbar fractures represent a widespread injuries that can cause significant disability and strain the healthcare system. Different surgical approaches are described in the literature. This study was conducted to evaluate the fractured level inclusion in short-segment fixation of thoracolumbar junction spine fractures. Results Preoperative neurological deficit was reported in seven patients ranging from ASIA grade C to D. All of these patients improved to grade E by the end of the follow-up period, except for one patient who improved from grade C to D. The mean Oswestry Disability Index was 19.87%. The mean postoperative Cobb angle was 11.77° which significantly improved compared to a preoperative value of 19.37°. There was a significant improvement in the postoperative anterior and posterior vertebral body height compared to the preoperative values. The vertebral body compression ratio significantly improved during the postoperative period to a mean of 84% compared to 76% preoperative. Conclusions There was significant improvement of the postoperative values of the mean Cobb angle, the anterior and the posterior vertebral body height as well as the vertebral body compression ratio compared to the preoperative values.

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Efficacy of Using Intermediate Screws in Short-Segment Fixation for Thoracolumbar Fractures: A Meta-Analysis of Randomized Controlled Trials

World Neurosurgery ◽

10.1016/j.wneu.2017.10.157 ◽

2018 ◽

Vol 110 ◽

pp. e271-e280 ◽

Cited By ~ 5

Author(s):

Min-Ji Tong ◽

Qian Tang ◽

Cheng-Gui Wang ◽

Guang-Heng Xiang ◽

Qi Chen ◽

...

Keyword(s):

Randomized Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Thoracolumbar Fractures ◽

Short Segment ◽

Randomized Controlled ◽

Short Segment Fixation

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Comparative study of long segment versus short segment posterior fixation of thoracolumbar fractures with pedicle screws

10.17727/jmsr.2021/9-12 ◽

2021 ◽

Vol 9 (2) ◽

pp. 77-84

Author(s):

Vihar SJ ◽

Naveen DS ◽

Agrawal NK

Keyword(s):

Pedicle Screws ◽

Posterior Fixation ◽

Rigid Fixation ◽

Thoracolumbar Fractures ◽

Kyphotic Angle ◽

Short Segment ◽

Duration Of Surgery ◽

One Year ◽

Short Segment Fixation

Choice of long or short segment fixation for thoracolumbar fractures, benefits of either of these techniques has been a topic for analysis and assessment. Kyphotic angles in twenty patients diagnosed to have thoracolumbar vertebral fractures between December 2019 to December 2020 in Bapuji hospital and Chigateri general hospital, Davanagere, Karnataka, India were measured pre operatively, post operatively and at one year follow up and assessed. No statistical difference between the degrees of correction of initial kyphotic angle between long segment fixation and short segment posterior fixation in our study was found (p<0.6). Method of fixation of the thoracolumbar vertebral fracture did not correlate with initial degree of kyphosis (p=0.4). Amount of correction loss at one year follow up was found to be statistically significant in short segment fixation (p<0.05). Loss of kyphotic angle at one year follow up was higher in case of short segment fixation than long segment fixation and found to be statistically significant (p<0.005). Our study showed that long segment fixation helps in better correction of the kyphosis angle with lesser chance of loss of correction and can be opted when pedicles aren’t intact at the fracture level, as in cases of burst fractures. Short segment fixation provides better rigid fixation at the site of fracture with increased range of motion at the thoracolumbar segment and can be treatment of choice when the pedicles at the fractured level are intact, as in cases of compression fractures, having benefits of shorter duration of surgery and reduced risks.

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