A Comparative Outcome Analysis of Two Posterior Only Approach for Thoracolumbar Fracture

2018 ◽  
Vol 15 (02/03) ◽  
pp. 106-112
Author(s):  
Deepak Kumar Singh ◽  
Surendra Kumar Gupta ◽  
Rakesh Kumar ◽  
Faran Ahmad ◽  
Kuldeep Yadav ◽  
...  
Keyword(s):  
Blood Loss ◽  
Functional Outcome ◽  
Pedicle Screw ◽  
Posterior Approach ◽  
Operative Time ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Thoracolumbar Fracture ◽  
Posterior Decompression ◽  
Average Operative Time

Abstract Objectives Most common surgical intervention in thoracolumbar fracture is pedicle screw fixation with posterior decompression through traditional posterior approach. Nowadays, we are doing combined anteroposterior decompression with anteroposterior fixation through posterior only approach. So, we attempt to compare these two approaches in terms of surgical and functional outcome. Method This is a retrospective study. We included 47 patients of traumatic thoracolumbar fracture between September 2016 and January 2018. Fourteen patients were treated by three-column fixation through posterior only approach and 33 patients were treated with traditional posterior approach. In three-column fixation, transpedicular corpectomy with dynamic mesh cage placement with B/L pedicle screw fixation with 360 canal decompression was done, whereas in traditional posterior approach, only posterior decompression with B/L pedicle screw fixation was done. Parameters for comparison include patients’ parameters, fracture types, operative duration, average blood loss, kyphotic correction, and neurological and functional improvement after 1 week and 3 months postoperatively. Result The average operative time (150 ± 13.01 minutes) and blood loss (263 ± 40.84 mL) in combined decompression and fixation through posterior only approach were higher than average operative time (120.3 ± 25.43 minutes) and average blood loss (108 ± 27.32 mL) in traditional posterior approach. In traditional surgeries, there was an observed correction of 11.7° ± 3.6° in kyphosis, while in combined surgeries the observed correction in kyphosis was 15.3° ± 4.3°. There is no statistically significant neurological and functional outcome than traditional posterior approach. Conclusion Combined anteroposterior decompression and stabilization through posterior only approach is convenient for complete decompression of cord, stabilization, and restoration of vertebral height, and there is statistically significant kyphotic correction, pain relief (visual analogue scale), but there is no statistically significant neurological and functional outcome than traditional posterior approach. Most neurosurgeons are familiar to posterior approach; hence, they should be used in unstable thoracolumbar fracture whenever needed, while avoiding various dreaded complication of combined approach.

scholarly journals Flexion-distraction injuries of the thoracolumbar spine: open fusion versus percutaneous pedicle screw fixation

2013 ◽  
Vol 35 (2) ◽  
pp. E2 ◽  
Author(s):  
Andrew J. Grossbach ◽  
Nader S. Dahdaleh ◽  
Taylor J. Abel ◽  
Gregory D. Woods ◽  
Brian J. Dlouhy ◽  
...  
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Pedicle Screw ◽  
Operative Time ◽  
Spinal Injury ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Percutaneous Pedicle Screw ◽  
Percutaneous Pedicle Screw Fixation

Object Flexion-distraction injuries occur due to distractive forces causing disruption of the posterior and middle spinal columns. These fractures classically consist of a fracture line through the posterior bony elements; involvement of the posterior ligamentous complex is, however, common. Surgical treatment is often required for these unstable injuries to avoid neurological deterioration and posttraumatic kyphosis, and the surgery traditionally consists of an open posterior approach with instrumented fusion. Percutaneous pedicle screw fixation for these injuries, with the goal of minimal tissue disruption and preservation of normal anatomy while achieving adequate stabilization, has recently been reported in the literature, but to date, a direct comparative study comparing open and percutaneous fixation has not been reported. The authors report their experience treating these fractures with both techniques and review the available literature. Methods Patients with flexion-distraction injury who were treated between May 2003 and March 2013 were prospectively followed. American Spinal Injury Association scores and degree of kyphotic angulation were recorded at admission, discharge, and follow-up. Data regarding intraoperative blood loss and operative time were obtained from a chart review. Patients treated with open versus minimally invasive procedures were compared. Results The authors identified 39 patients who suffered flexion-distraction injuries and were treated at their institution during the specified period; one of these patients declined surgery. All had injury to the posterior ligamentous complex. Open surgical procedures with pedicle screw fixation and posterolateral fusion were performed in 27 patients, while 11 patients underwent minimally invasive pedicle screw placement. Overall, there was improvement in kyphotic angulation at the time of discharge as well as most recent follow-up in both the open surgery and minimally invasive surgery (MIS) groups. The authors found no significant difference in American Spinal Injury Association score or the degree of kyphotic angulation between the MIS and open surgery groups. There was a trend toward shorter operative time for the MIS group, and patients who underwent minimally invasive procedures had significantly less blood loss. Conclusions Minimally invasive percutaneous pedicle screw fixation appears to have similar efficacy in the treatment of flexion-distraction injuries and it allows for reduced blood loss and tissue damage compared with open surgical techniques. Therefore it should be considered as an option for the treatment of this type of injury.

scholarly journals Personalized Rapid Prototyping Template for Direct C1 Pedicle Screw Fixation of Unstable C1 Semi-Ring Fractures

2020 ◽  
Author(s):  
Wei-xin Dong ◽  
Yong Hu ◽  
William Ryan Spiker ◽  
Zhen-shan Yuan ◽  
Jian-bin Zhong ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Blood Loss ◽  
Rapid Prototyping ◽  
Vertebral Artery ◽  
Pedicle Screw ◽  
Operative Time ◽  
Screw Fixation ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Intraoperative Blood Loss

Abstract Background: Placement of C1 pedicle screws carries an inherent risk of injury to the spinal cord and vertebral artery. Use of a personalized rapid prototyping template may be able to improve the safety of C1 pedicle fixation. To evaluate the clinical and radiographic outcomes of direct posterior C1 pedicle screw fixation using a personalized rapid prototyping template for unstable C1 semi-ring fractures.Methods: From May of 2010 to September of 2015, 38 patients with unstable C1 semi-ring fractures were treated with direct posterior C1 pedicle screw fixation. A standard open technique was utilized in 20 patients (Free-hand group) and 18 patients underwent C1 pedicle screw fixation with the aid of a personalized rapid prototyping template (RP group). The operative time, intraoperative blood loss, preoperative ADI, LMD and VAS were recorded. The postoperative ADI, LMD and VAS score were recorded at 180 days postoperatively.Results: No spinal cord or vertebral artery injuries were encountered in either group. Similarly, no post-operative instrumentation failures or cases of postoperative C1-2 instability were reported in either group. There was no statistically significant difference in intraoperative blood loss and operative time between RP and Free-hand group. In both groups, all patients obtained radiographic fusion at 6 months, reported no residual neck pain and were found to have a full range of motion at final follow up.Conclusion: Use of a personalized rapid prototyping template for the placement of direct posterior C1 pedicle screws is safe and effective in the treatment of unstable C1 semi-ring fractures with similar radiographic and clinical outcomes to more traditional techniques.

scholarly journals Analysis of outcome of percutaneous versus open pedicle screw fixation in the treatment of thoraco-lumbar spine fractures: a prospective comparative study

2021 ◽  
Vol 7 (2) ◽  
pp. 343
Author(s):  
Raj Kumar ◽  
Bhaskar Sarkar ◽  
Syed Ifthekar ◽  
Samarth Mittal ◽  
Pankaj Kandwal ◽  
...  
Keyword(s):  
Blood Loss ◽  
Comparative Study ◽  
Pedicle Screw ◽  
Vertebral Body ◽  
Operative Time ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Prospective Comparative Study

<p><strong>Background:</strong> Aim of the study was to evaluate the effectiveness between percutaneous and open pedicle screw fixation in the treatment of traumatic thoracolumbar burst fractures with spinal injury.</p><p><strong>Methods:</strong> A prospective comparative study including thirty patients with thoracolumbar burst fracture were equally divided into an open pedicle screw fixation (OPSF) group and a percutaneous pedicle screw fixation (PPSF) group. Demographic characteristics, clinical and radiological outcomes, and adverse events were assessed and compared between the 2 groups.</p><p><strong>Results:</strong> Demographic and clinical features including age, gender, fracture level, mechanism of injury and neurological status in both groups were not significantly different (all p&gt;0.05). The PPSF group exhibits significantly lower operative time, intraoperative blood loss, and hospital stay compared with the OPSF group (all p&lt;0.05). There was no significant difference in the sagittal Cobb′s angle (CA), fracture vertebral body angle (VBA), anterior vertebral body height (AVBH) on pre-operative, immediate post-operative and final follow up between the two surgical techniques (all p&gt;0.05). Visual analogue scale (VAS) remarkably decreased in both groups after surgery but difference was not statically significant (p=0.808). Common postoperative complications in both groups were superficial infections, pressure ulcer and urinary tract infection (UTI) worsening. Hardware failure was seen only in one case of PPSF group.</p><p><strong>Conclusions:</strong> Patients with thoracolumbar burst fractures can be effectively managed with PPSF/OPSF. There were no significant differences in radiological and clinical outcomes and post-op complications between 2 groups but blood loss, operative time and hospitalization stay were less in percutaneous group, which may represent a potential benefit.</p><p><strong> </strong></p>

scholarly journals A single-stage posterior approach with open reduction and pedicle screw fixation in subaxial cervical facet dislocations

2015 ◽  
Vol 23 (1) ◽  
pp. 35-41 ◽  
Author(s):  
Jin Hoon Park ◽  
Sung Woo Roh ◽  
Seung Chul Rhim
Keyword(s):  
Pedicle Screw ◽  
Disc Herniation ◽  
Closed Reduction ◽  
Open Reduction ◽  
Posterior Approach ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Herniated Disc ◽  
The Mean ◽  
Cervical Facet

OBJECT The optimal treatment for cervical facet dislocations is controversial, but the generally accepted process recommends an initial closed reduction with the next step determined according to the success of the closed reduction and the presence of traumatic disc herniation. This study aimed to show the efficacy of a posterior approach performed with an open reduction and pedicle screw fixation with removal of disc particles, if required, in the management of subaxial cervical dislocations. METHODS Between March 2012 and September 2013, 21 consecutive patients with cervical facet dislocations were enrolled. The affected levels were as follows: 4 at C3–4; 2 at C4–5; 5 at C5–6; and 10 at the C6–7 level. Seven patients had traumatic disc herniations. Closed reduction was not attempted; a prompt posterior cervical surgery was performed instead. After open reduction, pedicle screw fixation was performed. In cases with traumatic disc herniation, herniated disc fragments were excised via a posterolateral approach and successful decompressions were determined by postoperative MRI studies. Clinical outcomes were assessed using the American Spinal Injury Association (ASIA) grading system. Radiological outcomes were assessed by comparing the degree of subluxation and the angle of segmental lordosis between pre- and postoperative CT scans. RESULTS All patients improved neurologically. The mean segmental angles improved from 7.3° ± 8.68° to −5.9° ± 4.85°. The mean subluxation improved from 23.4% ± 16.52% to 2.6% ± 7.19%. Disc fragments were successfully removed from the 7 patients with herniated discs, as shown on MRI. CONCLUSIONS Open reduction followed by pedicle screw fixation or posterolateral removal of herniated disc fragments is a good treatment option for cervical facet dislocations.

scholarly journals Short segment pedicle screw fixation of thoracolumbar fracture: a case series of 33 patients

2017 ◽  
Vol 3 (4) ◽  
pp. 681
Author(s):  
Naushad Hussain ◽  
Nirmal Dhananjay Patil ◽  
Hiren Patel ◽  
Akash Shakya
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Wedge Angle ◽  
Body Height ◽  
Pedicle Screw Fixation ◽  
Thoracolumbar Fracture ◽  
Vertebral Body Height ◽  
Short Segment ◽  
Screw Insertion

<p class="abstract"><strong>Background:</strong> Pedicle screw instrumentation in case of fracture spine provides stable fixation. However in absence of experience and proper technique of pedicle screw insertion, it is associated with many complications. We aim to study the results of patients with thoracolumbar fracture stabilized with short segment pedicle screw instrumentation.</p><p class="abstract"><strong>Methods:</strong> 33 cases of thoracolumbar wedge compression fracture spine presenting to Nair Hospital were included in the study. All patients were operated by the senior author via a posterior approach and short segment pedicle screw fixation. Patients were followed up for one year.<strong></strong></p><p class="abstract"><strong>Results:</strong> 33 patients with a mean age were 37.6 years of which 3 were females and 30 were males in our study. Fall from height (93.93%) was the most common mode of injury followed by road traffic accident (6.07%). D12 and L1 were the most common vertebrae involved. Statistically significant (p=0.01) correction in the vertebral body height occurred in the immediate postop period and there was 4.1% loss of correction at final follow-up. There was statistically significant improvements in the Regional angle (p=0.03) and anterior wedge angle (p=0.03). Residual regional angle at final follow-up was found to be &gt;5° in 3 patients. Neurological improvement was seen in 23 (74.19%) patients (p=0.01). No improvements were seen in 8 (25.81%) patients. None of our patients had postoperative worsening of the neurological status. None of the patients had pedicle wall breach on final follow up CT scan.</p><p class="abstract"><strong>Conclusions:</strong> Short segment fixation in case of wedge fracture can restore the vertebral body height, mean regional angle and mean anterior wedge angle and provide good outcome. There are poor chances of recovery of patient with Frankel grade A. Meticulous dissection and careful technique of pedicle screw insertion, adequate decompression, good contouring of the rod with correction of kyphosis can provide excellent results.</p>

scholarly journals Comparison of the Unilateral and the Bilateral Pedicle Screw Fixation without Using an Interbody Cage: Randomized Clinical Trial

2021 ◽  
Vol 9 (B) ◽  
pp. 398-402
Author(s):  
Alexey Lychagin ◽  
Vadim Cherepanov ◽  
Marina Lipina ◽  
Ivan Vyazankin
Keyword(s):  
Surgical Treatment ◽  
Lumbar Spine ◽  
Blood Loss ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Interbody Cage ◽  
Surgery Timing ◽  
Bilateral Pedicle Screw ◽  
Blood Loss Volume

BACKGROUND: Lumbar spine instability is one of the main causes of low back pain and has become more prevalent in recent years. Bilateral pedicle screw fixation is used to perform posterior lumbar stabilization, which is complemented by the installation of an interbody cage. AIM: The aim of the study was evaluating of the results of unilateral and bilateral pedicle screw fixation without using of an interbody cage. METHODS: A prospective randomized study of 96 patients was carried out. Forty-seven patients were assigned to the group of the unilateral pedicle screw fixation versus 49 patients were moved to the group of the bilateral pedicle screw fixation of the lumbar spine. Of the 96 patients, 80 patients eventually were included in the study. However, seven patients in the first group and nine patients were lost to follow-up. Surgery timing, blood loss volume, clinical outcomes (scores on the Oswestry disability index [ODI], EQ-5D and visual analogue scale [VAS]) were evaluated in 6–12 months after surgical treatment. All the patients included in this study underwent functional and control computed tomography in 12 months after surgery. RESULTS: Both groups showed a significant improvement in VAS, EQ-5D, and ODI in 1 year after surgical treatment. The two groups significantly differed in the surgery timing (unilateral – 90.2 min; and bilateral – 129.4 min) and blood loss volume (unilateral – 152.7 ml; and bilateral – 230.1 ml), p < 0.05. CONCLUSIONS: Unilateral and bilateral pedicle screw fixation showed similar clinical results, while results in both types of fixation differed in slight manner. However, the duration of surgical treatment and intraoperative blood loss volume proved to be lower for the unilateral fixation group, which indicates that the use of the unilateral fixation can be the choice of performing posterior stabilization at a single-level instability of the spine without using an interbody cage.

scholarly journals Posterior short segment pedicle screw fixation for the treatment of thoracolumbar fracture

2020 ◽  
Vol 35 ◽  
Author(s):  
Mourad Aoui ◽  
Nizar Sahnoun ◽  
Mohamed Abid ◽  
Mahdi Maatoug ◽  
Majdi Hsairi ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Thoracolumbar Fracture ◽  
Short Segment
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