Results of treatment of unstable thoracolumbar burst fractures using pedicle instrumentation with and without fracture-level screws

2015 ◽  
Vol 157 (5) ◽  
pp. 831-836 ◽  
Author(s):  
Ali İhsan Ökten ◽  
Yurdal Gezercan ◽  
Kerem Mazhar Özsoy ◽  
Tuncay Ateş ◽  
Güner Menekşe ◽  
...  
Keyword(s):  
Thoracolumbar Burst Fractures ◽  
Results Of Treatment ◽  
Burst Fractures ◽  
Fracture Level

scholarly journals Modified pedicle screw placement at the fracture level for treatment of thoracolumbar burst fractures: a study protocol of a randomised controlled trial

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e024110 ◽  
Author(s):  
Zhi-Chao Hu ◽  
Xiao-Bin Li ◽  
Zhen-Hua Feng ◽  
Ji-Qi Wang ◽  
Lan-Fang Gong ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Clinical Outcome ◽  
Pedicle Screw ◽  
Controlled Trial ◽  
Pedicle Screws ◽  
Pedicle Screw Placement ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Randomised Controlled ◽  
Fracture Level

IntroductionThe optimal treatment for burst fractures of the thoracolumbar spine is controversial. The addition of screws in the fractured segment has been shown to improve construct stiffness, but can aggravate the trauma to the fractured vertebra. Therefore, optimised placement of two pedicle screws at the fracture level is required for the treatment of thoracolumbar burst fractures. This randomised controlled study is the first to examine the efficacy of diverse orders of pedicle screw placement and will provide recommendations for the treatment of patients with thoracolumbar burst fractures.Methods and analysisA randomised controlled trial with blinding of patients and the statistician, but not the clinicians and researchers, will be conducted. A total of 70 patients with single AO type A3 or A4 thoracolumbar fractures who are candidates for application of short-segment pedicle screws at the fractured vertebral level will be allocated randomly to the distraction-screw and screw-distraction groups at a ratio of 1:1. The primary clinical outcome measures will be the percentage loss of vertebral body height, screw depth in the injured vertebrae and kyphosis (Cobb angle). Secondary clinical outcome measures will be complications, Visual Analogue Scale scores for back and leg pain, neurological function, operation time, intraoperative blood loss, Japanese Orthopaedic Association score and Oswestry Disability Index. These parameters will be evaluated preoperatively, intraoperatively, on postoperative day 3, and at 1, 3, 6, 12 and 24 months postoperatively.Ethics and disseminationThe Institutional Review Board of the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University have reviewed and approved this study (batch: LCKY2018-05). The results will be presented in peer-reviewed journals and at an international spine-related meeting after completion of the study.Trial registration numberNCT03384368; Pre-results.

The Use of Screw at the Fracture Level in the Treatment of Thoracolumbar Burst Fractures

2009 ◽  
Vol 22 (6) ◽  
pp. 417-421 ◽  
Author(s):  
Osman Guven ◽  
Baris Kocaoglu ◽  
Murat Bezer ◽  
Nuri Aydin ◽  
Ufuk Nalbantoglu
Keyword(s):  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Fracture Level

scholarly journals Outcomes with fracture-level transpedicular screws used for thoracolumbar junction fractures

2020 ◽  
Vol 26 (4) ◽  
pp. 548-554
Author(s):  
S.V. Likhachev ◽  
◽  
V.V. Zaretskov ◽  
V.B. Arsenievich ◽  
V.V. Ostrovskij ◽  
...  
Keyword(s):  
Blood Loss ◽  
Vertebral Body ◽  
Demographic Data ◽  
Operating Time ◽  
Body Height ◽  
Thoracolumbar Junction ◽  
Kyphotic Angle ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Fracture Level

Background Short-segment transpedicular screw fixation (SSTSF) is the preferred treatment option for thoracolumbar burst fractures. Adding screws in the fractured body may be helpful in achieving and maintaining fracture reduction. However, the operative approach is disputed. Objective To compare clinical outcomes of transpedicular fixation with and without screws in the fractured vertebral body after isolated uncomplicated fractures at the thoracolumbar junction. Material and methods A retrospective cohort study enrolled 62 patients with Th11–L2 thoracolumbar burst fractures (AOSpine A3, A4) who underwent SSTSF with (n = 32) and without (n = 30) pedicle screws at the fracture level. Demographic data of the patients, operating time and blood loss were registered. Clinical evaluation using Visual analogue scale (VAS ) for pain, Oswestry Disability Index (ODI) to quantify disability and imaging parameters of segmental kyphosis, loss of correction, anterior vertebral body height (AVBH) at the fracture level, spinal canal stenosis (SCS) were measured preoperatively, at one week, 1 month, 6 and 12 months postoperatively. Results The patients of the two groups showed no statistically significant differences in the demographic data, VAS and ODI scores, measurements of kyphotic angle, AVBH, SCS preoperatively (p > 0.05). Screws at the fracture level did not affect the operating time and intraoperative blood loss relative to conventional no-screw group. Benefits with fracture screws were evident at 7 days (p < 0.01) measuring SCS, at 6 months (p < 0.01) and 12 (p < 0.01) months measuring kyphotic angle. There was better kyphosis correction (p < 0.01) and AVBH (p = 0.034) seen at 12 months after surgery. Conclusion Reinforcement of a broken vertebra with fracture-level screws has been shown to provide better stability of clinical and radiographic results as compared to those with conventional SSTSF.

EFFICACY OF HARTSHILL FIXATION WITH SUBLAMINAR WIRING IN MAINTAINING ANATOMICAL CORRECTION AND NEUROLOGICAL RECOVERY IN BURST FRACTURES OF THORACOLUMBAR SPINE

2003 ◽  
Vol 07 (02) ◽  
pp. 135-144
Author(s):  
Manish Garg ◽  
Shobha S. Arora ◽  
Girish Kumar Singh
Keyword(s):  
Thoracolumbar Spine ◽  
Neurological Recovery ◽  
Neural Function ◽  
Clinical Indicators ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Post Test ◽  
Fracture Level ◽  
Test Probability

Hartshill fixation of thoracolumbar burst fractures is justified on grounds of providing early stabilization and correction of deformity. It is important to answer the question of whether it is able to sustain correction so that the costs and risks of surgery of this disabling problem can be justified. Reliable answers are also needed in view of the costs and risks of surgery prognostication. This before-after study is on 49/61 consecutive cases of burst fractures of thoracolumbar spine, admitted during October 1998 to November 2000. Patients were treated with Hartshill segmental spinal fixation two segments above and below the fracture and bone grafting, and followed-up for a mean of 28 months (18–43 months) to determine the fate of radiological parameters indicating correction of kyphosis and clinical indicators predicting neurological recovery. The mean pre-operative kyphosis angle of 19.59° (17.93–21.24) initially improved by 9.73° (8.07–11.39), p < 0.05 but reverted to 19.71° (17.73–21.69) during follow-up. Vertebral height measurements indicated similar findings. Mild pain persisted in 48/49 patients while 1/49 needed analgesics. Improvement of neural function was seen in 37/44 patients having a pre-operative deficit. 6/16 variables had a significant univariate relation with neurological recovery at p < 0.3 levels; namely initial Frankel's grade 1.85 (0.81–4.22), p = 0.14; fracture level 3.83 (0.58–25.10), p = 0.16; initial kyphosis 1.11 (0.93–1.32), p = 0.24; age 1.03 (0.96–1.11), p = 0.28; sex 0.39 (0.06–2.23), p = 0.29 and post-operative kyphosis 1.07 (0.93–1.22), p = 0.30. When combined, these variables were able to correctly classify recovery in 77.78% of cases at the probability cut-off of 0.75, sensitivity of 0.77 and specificity of 0.75, while the pre-test probability of recovery of 0.84 improved to 0.93 post-test, Negative Predictive Value (NPV) was 0.42., +Likelihood Ratio (LR) was 3.11 and -LR was 0.29. 77% of the area was under the Receiver Operator Characteristic (ROC) Curve. Although Hartshill fixation with segmental sub-laminar wiring failed to maintain kyphosis correction in thoracolumbar burst fractures, it resulted in reducing the recumbence and hospital stay, and facilitating early rehabilitation. However, the costs and the risks of such procedures have to be carefully weighed before they are recommended for wider use. We also have a rule for predicting neurological recovery in such patients.

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