Treatment of thoracolumbar fractures by temporary posterior instrumentation with selective fusion schemes

Abstract Objective: This retrospective study investigated the clinical and radiographic outcomes following temporary transpedicular posterior instrumentation between two cohorts of patients with thoracolumbar fractures (TLF) who underwent selective or bi-segments intervertebral articular process fusion.Materials and Methods: Patients with TLF who underwent the temporary posterior fixation with selective fusion (Group SF), or bi-segments fusion (Group BF) were studied. Superior intervertebral articular process and interlaminar fusion were performed in Group SF, whereas in Group BF, the patients underwent bi-segments fusion in both superior and inferior articular processes, as well as interlaminar fusion. We measured the distal and proximal intervertebral mobility, regional kyphotic angle, and vertebral height before and after surgery in both groups. Greenough Low-Back Outcome Score was used to assess the clinical outcomes.Results: Sixty-five patients with TLF from T12 to L2 fractures were enrolled in the study period: 23 patients in the Group SF and 22 patients in the Group BF. All the patients experienced fracture healing (mean follow-up time: 19.7 months). The mean postoperative functional outcomes were 65.0±2.0 points for the Low-Back Outcome Score in the Group SF and 65.2±1.8 for the Group BF. A progressive regional kyphotic angle was observed with time regardless of fusion but was not significantly different between the two groups. There was a statistical difference between unfused inferior proximal adjacent and inferior distal adjacent segment regardless of fracture segments.Conclusion: The strategy of selective fusion is reported to be useful for the treatment of patients with TLF. The motion in the un-fused and adjacent segment could be better regained after instrumentation removal in the selectively fusion group.

Download Full-text

Late Results of Thoracolumbar Fractures After Posterior Instrumentation and Transpedicular Bone Grafting

Spine ◽

10.1097/00007632-200101010-00016 ◽

2001 ◽

Vol 26 (1) ◽

pp. 88-99 ◽

Cited By ~ 144

Author(s):

Christian Knop ◽

Henry F. Fabian ◽

Leonard Bastian ◽

Michael Blauth

Keyword(s):

Bone Grafting ◽

Posterior Instrumentation ◽

Late Results ◽

Thoracolumbar Fractures ◽

Transpedicular Bone Grafting

Download Full-text

MANAGEMENT OF UNSTABLE THORACOLUMBAR FRACTURES BY POSTERIOR INSTRUMENTATION WITH TRANSPEDICULAR PEDICLE SCREWS AND CONNECTING RODS

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2015/1834 ◽

2015 ◽

Vol 4 (73) ◽

pp. 12734-12741

Author(s):

Jayaram B S ◽

Yatish R ◽

Suhas D ◽

Lokesh M

Keyword(s):

Posterior Instrumentation ◽

Pedicle Screws ◽

Thoracolumbar Fractures

Download Full-text

Posterior Instrumentation for Thoracolumbar Fractures

Journal of the American Academy of Orthopaedic Surgeons ◽

10.5435/00124635-200411000-00007 ◽

2004 ◽

Vol 12 (6) ◽

pp. 424-435 ◽

Cited By ~ 59

Author(s):

Mark R. Mikles ◽

Robert P. Stchur ◽

Gregory P. Graziano

Keyword(s):

Posterior Instrumentation ◽

Thoracolumbar Fractures

Download Full-text

Posterior Instrumentation for Unstable Thoracolumbar Fractures

Journal of Kathmandu Medical College ◽

10.3126/jkmc.v6i4.20120 ◽

2018 ◽

Vol 6 (4) ◽

pp. 150-155

Author(s):

Bimal Kumar Pandey ◽

Anjana Rajbhandari

Keyword(s):

Posterior Instrumentation ◽

Thoracolumbar Fractures ◽

Type B ◽

Vertebral Height ◽

Kyphotic Angle ◽

Short Segment ◽

Medical College ◽

Loss Of Correction ◽

Type C

Background: About 90 percent of all spinal injuries involve the thoracolumbar region. Unstable fractures need surgical treatment to achieve a painless, balanced and stable spine preserving or recovering neurological function, highest degree of spinal motion and to allow early patient mobilization.Objective: This study was carried out to evaluate radiological outcome of posterior instrumentation in thoracolumbar fractures.Methodology: A total of 110 patients with thoracolumbar fracture were included in the study, which was carried out at Kathmandu Medical College Teaching Hospital from December 2011 to December 2016. Unstable Arbeitsgemeinschaft fur Osteosynthesefragen type A and type B fractures were treated with short segment instrumentation and type C with long segment instrumentation. Radiological evaluation of postoperative correction of kyphotic angle and vertebral height was measured and was compared with immediate postoperative correction and loss of correction in two years final follow up.Results: Mean postoperative correction of vertebral kyphotic angle was 25° and loss of correction in final follow up was 5°. Mean postoperative vertebral height correction was 24% and its loss in final follow up was 2%. There was no significant difference in loss of correction of vertebral kyphosis and vertebral height in short segment and long segment fi xation in final follow up.Conclusion: Long segment posterior instrumentation results in good reduction and its maintenance for Arbeitsgemeinschaft fur Osteosynthesefragen type C thoracolumbar fractures whereas similar results can be achieved with short segment posterior instrumentation in type A and type B fractures. Journal of Kathmandu Medical College,Vol. 6, No. 4, Issue 22, Oct.-Dec., 2017, Page: 150-155

Download Full-text

The influence of correction loss in thoracolumbar fractures treated by posterior instrumentation: A minimum 7-year follow-up

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2010.07.129 ◽

2011 ◽

Vol 18 (4) ◽

pp. 500-503 ◽

Cited By ~ 6

Author(s):

Jinhui Shi ◽

Xin Mei ◽

Jiayong Liu ◽

Weimin Jiang ◽

Muhammad Z Moral ◽

...

Keyword(s):

Posterior Instrumentation ◽

Thoracolumbar Fractures ◽

Correction Loss

Download Full-text

Long-Term Follow-Up Results of Thoracolumbar Fractures After Posterior Instrumentation

Spine ◽

10.1097/00007632-199508000-00011 ◽

1995 ◽

Vol 20 (15) ◽

pp. 1704-1708 ◽

Cited By ~ 37

Author(s):

Erol Tasdemiroglu ◽

Phillip A. Tibbs

Keyword(s):

Posterior Instrumentation ◽

Thoracolumbar Fractures ◽

Long Term Follow Up

Download Full-text

Timing of surgery in thoracolumbar trauma: is early intervention safe?

Neurosurgical FOCUS ◽

10.3171/2014.5.focus1473 ◽

2014 ◽

Vol 37 (1) ◽

pp. E7 ◽

Cited By ~ 19

Author(s):

Christopher Paul O'Boynick ◽

Mark F. Kurd ◽

Bruce V. Darden ◽

Alexander R. Vaccaro ◽

Michael G. Fehlings

Keyword(s):

Spinal Cord ◽

Posterior Instrumentation ◽

Thoracolumbar Spine ◽

Spine Fractures ◽

Thoracolumbar Fractures ◽

Surgical Timing ◽

Cord Injury ◽

Thoracolumbar Spine Fractures ◽

Support Cost ◽

Early Fixation

The understanding of the optimal surgical timing for stabilization in thoracolumbar fractures is severely limited. Thoracolumbar spine fractures can be devastating injuries and are often associated with significant morbidity and mortality. The role of early surgical stabilization (within 48–72 hours of injury) as a vehicle to improve outcomes in these patients has generated significant interest. Goals of early stabilization include improved neurological recovery, faster pulmonary recovery, improved pain control, and decreased health care costs. Opponents cite the potential for increased bleeding, hypotension, and the risk of further cord injury as a few factors that weigh against early stabilization. The concept of spinal cord injury and its relationship to surgical timing remains in question. However, when neurological outcomes are eliminated from the equation, certain measures have shown positive influences from prompt surgical fixation. Early fixation of thoracolumbar spine fractures can significantly decrease the duration of hospital stay and the number of days in the intensive care unit. Additionally, prompt stabilization can reduce rates of pulmonary complications. This includes decreased rates of pneumonia and fewer days on ventilator support. Cost analysis revealed as much as $80,000 in savings per patient with early stabilization. All of these benefits come without an increase in morbidity or evidence of increased mortality. In addition, there is no evidence that early stabilization has any ill effect on the injured or uninjured spinal cord. Based on the existing data, early fixation of thoracolumbar fractures has been linked with positive outcomes without clear evidence of negative impacts on the patient's neurological status, associated morbidities, or mortality. These procedures can be viewed as “damage control” and may consist of simple posterior instrumentation or open reductions with internal fixation as indicated. Based on the current literature it is advisable to proceed with early surgical stabilization of thoracolumbar fractures in a well-resuscitated patient, unless extenuating medical conditions would prevent it.

Download Full-text