Clinical outcomes of unstable thoracolumbar junction burst fractures: combined posterior short-segment correction followed by thoracoscopic corpectomy and fusion

Abstract Background: Vertebral cavity sometimes occurs after posterior short-segmental fixation for thoracolumbar burst fractures, but the risk factor of its formation is unclear. We aim to investigate their vertebral healing pattern and explore the risk factor of vertebral cavities.Methods: The thoracolumbar burst fractured patient treated with posterior short segmental fixation were followed up for minimal 3 years. Healing patterns were observed and divided into 4 healing types according to the integrity status of the endplates and the morphology of the cavities. The demographic characteristics and clinical outcomes were compared between patients with and without vertebra cavities at the last follow-up.Results: The incidence of vertebral cavities in our cohort was 59.6%. Accordingly, the healing pattern of the vertebra were classified as Complete Healing type or Endplate Cavity type, Spherical Cavity type or Burst Cavity type. The proportion of men, history of smoking, severity of neurological impairment and presence of A4 type fracture were significantly higher in the Vertebral Cavity group than the Intact Vertebra group. Clinical outcomes, including ASIA scales,VAS and ODI scores, were similar between the Intact Vertebra group and the Vertebral Cavity group. Conclusions: Vertebral cavities are commonly seen after posterior short-segmental fixation for thoracolumbar burst fractures. The healing pattern can be divided into four types. The presence of vertebral cavity may be related to gender, smoking history and the severity of the fracture. Most of the vertebral cavities are asymptomatic, but the clinical significance needs further study.

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Short-Segment Instrumentation with Fractured Vertebrae Augmentation by Screws and Bone Substitute for Thoracolumbar Unstable Burst Fractures

BioMed Research International ◽

10.1155/2019/4780426 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8

Author(s):

Jen-Chung Liao ◽

Wen-Jer Chen

Keyword(s):

Bone Substitute ◽

Bone Substitutes ◽

Control Group ◽

Study Group ◽

Short Segment ◽

Thoracolumbar Burst Fractures ◽

Burst Fractures ◽

Local Kyphosis ◽

Surgical Failure

Background. For thoracolumbar burst fractures, traditional four-screw (one above and one below) short-segment instrumentation is popular and has a high failure rate. Additional augmentation at the fractured vertebrae is believed to reduce surgical failure. The purpose of this study was to examine the clinical and radiographic results of patients who underwent short-segment posterior instrumentation with augmentation by screws and bone substitutes at the fractured vertebrae and to compare these data to those of patients who underwent long-segment instrumentation for thoracolumbar burst fractures. Methods. The study group had twenty patients who underwent short-segment instrumentation with additional augmentation by two screws and bone substitutes at the fractured vertebrae. The control group contained twenty-two patients who underwent eight-screw long instrumentation without vertebra augmentation. Local kyphosis and the anterior body height of the fractured vertebrae were measured. The severity of the fractured vertebrae was evaluated with the load sharing classification (LSC). Any implant failure or loss of correction >10° at the final follow-up was defined as surgical failure. Results. Both groups had similar distributions in terms of age, sex, the injured level, and the mechanism of injury before operation. During the operation, the study group had significantly less blood loss (136.0 vs. 363.6 ml, p=0.001) and required shorter operating times (146.8 vs. 157.5 minutes, p=0.112) than the control group. Immediately after surgery, the study group had better correction of the local kyphosis angle (13.4° vs. 11.9°, p=0.212) and restoration of the anterior height (34.7% vs. 31.0%, p=0.326) than the control group. At the final follow-up, no patients in the study group and only one patient in the control group experienced surgical failure. Conclusions. Patients with thoracolumbar burst fractures who received six-screw short-segment posterior fixators with augmentation at the level of the fractured vertebrae via injectable artificial bone substitute achieved satisfactory clinical and radiographic results, and this method could replace long-segment instrumentation methods used in unstable thoracolumbar burst fractures.

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