Mechanics of Anatomic Reduction of Thoracolumbar Burst Fractures| Comparison of Distraction Versus Distraction Plus Lordosis, in the Anatomic Reduction of the Thoracolumbar Burst Fracture

Abstract Background: For fresh thoracolumbar burst fracture, a new method which can not only promote the fracture healing, but also retain the movement segment, and restore the spinal movement function to the maximum extent is needed. The purpose of this study is to determine the performance of stabilization of a semi-rigid stabilization system combined with transpedicular intracorporeal bone grafting for thoracolumbar burst fractures.Methods Six thoracolumbar cadaver spines were used for testing. A controlled L2 burst fracture was created. The L1-3 motions were determined.Results In extension, flexion and lateral bending, the semi-rigid fixator stabilized the segment to a range of motion(ROM) and neutral zone(NZ) below the magnitude of the intact spine, but showed increased ROM and NZ of axial rotation (P < 0.05) compared with the intact spine.Conclusions Restoration of stability with the semi-rigid dynamic system combined with transpedicular intracorporeal bone grafting is possible in flexion, extension, right and left lateral bending for thoracolumbar burst fracture but for axial rotation.

Download Full-text

Minimally Invasive Spine Surgery for Unstable Thoracolumbar Burst Fractures: A Case Series

The Surgery Journal ◽

10.1055/s-0036-1594248 ◽

2016 ◽

Vol 02 (04) ◽

pp. e131-e138 ◽

Cited By ~ 2

Author(s):

Nitin Agarwal ◽

Phillip Choi ◽

Raymond Sekula

Keyword(s):

Pedicle Screw ◽

Screw Fixation ◽

Burst Fracture ◽

Pedicle Screw Fixation ◽

Thoracolumbar Burst Fracture ◽

Thoracolumbar Burst Fractures ◽

Percutaneous Pedicle Screw ◽

Percutaneous Pedicle Screw Fixation

Introduction Traumatic thoracolumbar burst fracture is a common pathology without a clear consensus on best treatment approach. Minimally invasive approaches are being investigated due to potential benefits in recovery time and morbidity. We examine long-term resolution of symptoms of traumatic thoracolumbar burst fractures treated with percutaneous posterior pedicle screw fixation. Methods Retrospective clinical review of seven patients with spinal trauma who presented with thoracolumbar burst fracture from July 2012 to April 2013 and were treated with percutaneous pedicle screw fixation. Electronic patient charts and radiographic imaging were reviewed for initial presentation, fracture characteristics, operative treatment, and postoperative course. Results The patients had a median age of 29 years (range 18 to 57), and 57% were men. The median Thoracolumbar Injury Classification and Severity Scale score was 4 (range 2 to 9). All patients had proper screw placement and uneventful postoperative courses given the severity of their individual traumas. Five of seven patients were reached for long-term follow-up of greater than 28 months. Six of seven patients had excellent pain control and stability at their last follow-up. One patient required revision surgery for noncatastrophic hardware failure. Conclusion Percutaneous pedicle screw fixation for the treatment of unstable thoracolumbar burst fracture may provide patients with durable benefits and warrants further investigation.

Download Full-text

Healing Pattern of Thoracolumbar Burst Fracture after Posterior Short-segmental Fixation

10.21203/rs.2.22095/v1 ◽

2020 ◽

Author(s):

Changxiang Liang ◽

Guihua Liu ◽

Guoyan Liang ◽

Xiaoqing Zheng ◽

Dong Yin ◽

...

Keyword(s):

Risk Factor ◽

Clinical Outcomes ◽

Burst Fracture ◽

Neurological Impairment ◽

Complete Healing ◽

Smoking History ◽

Thoracolumbar Burst Fractures ◽

Burst Fractures ◽

History Of ◽

Segmental Fixation

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.

Download Full-text

A comparison of single and incremental impact approaches for producing experimental thoracolumbar burst fractures

Journal of Neurosurgery Spine ◽

10.3171/spi-07/08/199 ◽

2007 ◽

Vol 7 (2) ◽

pp. 199-204 ◽

Cited By ~ 1

Author(s):

Xiang-Yang Wang ◽

Li-Yang Dai ◽

Hua-Zi Xu ◽

Yong-Long Chi

Keyword(s):

Burst Fracture ◽

Axial Rotation ◽

Similar Degree ◽

Thoracolumbar Burst Fractures ◽

Single Impact ◽

Burst Fractures ◽

Flexion Extension ◽

The Impact ◽

Flexibility Parameters

Object. Experimental burst fracture models are often developed by using either single or incremental impacts. In both protocols, the weight-drop technique produces the impact. However, to the authors' knowledge in no study have researchers attempted to compare the equivalence of the spine burst fracture produced using the different impact protocols. This study was performed to investigate whether the single and incremental trauma approaches produce equivalent degrees of severity in thoracolumbar burst fractures. Methods. Twenty bovine thoracolumbar spines comprising three vertebrae were divided evenly into the single impact and incremental impact groups. The specimens in the incremental impact group were subjected to three axial compressive impacts of increasing energy (78.4, 107.8, and 137.2 J), whereas specimens in the other group were subjected to a single impact (137.2 J). Before and after the final trauma, multidirectional flexibility of each specimen was measured under flexion/extension, right/left lateral bending, and right/left axial rotation, thus quantifying the instability of the fracture. The flexibility parameters were then compared between the two groups. Results. A significant increase in flexibility parameters was found after the final trauma in both groups, indicating the instability of the spine (p < 0.01). No significant differences in flexibility parameters were observed in either intact status or injured status between the two groups (p > 0.05). Conclusions. In this study the authors have confirmed that the single and incremental impact protocols produced a similar degree of severity in producing an in vitro bovine burst fracture. The results of this study support the use of the incremental impact protocol in future experimental biomechanical studies.

Download Full-text

Biomechanical Evaluation of Short-Segment Posterior Instrumentation With Crosslinks in an Unstable Human Burst Fracture Model

ASME 2009 4th Frontiers in Biomedical Devices ◽

10.1115/biomed2009-83066 ◽

2009 ◽

Author(s):

George M. Wahba ◽

Nitin N. Bhatia ◽

Thay Q. Lee

Keyword(s):

Clinical Studies ◽

Posterior Instrumentation ◽

Burst Fracture ◽

Fracture Model ◽

Short Segment ◽

Thoracolumbar Burst Fractures ◽

Burst Fractures ◽

Sufficient Stability ◽

Biomechanical Evaluation ◽

Serious Injuries

Unstable thoracolumbar burst fractures are serious injuries and their management remains controversial. Some authors advocate the use of short-segment posterior instrumentation (SSPI) for certain burst fractures which offers several benefits including preservation of motion segments; however, clinical studies have shown mixed results. Whether crosslinks contribute sufficient stability to this construct has not been determined, therefore the objective of this study was to evaluate the biomechanical characteristics of short-segment posterior instrumentation, with and without crosslinks, in an unstable human burst fracture model.

Download Full-text

Comparison of operative and nonoperative treatment for thoracolumbar burst fractures in patients without neurological deficit: a systematic review

Journal of Neurosurgery Spine ◽

10.3171/spi.2006.4.5.351 ◽

2006 ◽

Vol 4 (5) ◽

pp. 351-358 ◽

Cited By ~ 97

Author(s):

Kenneth C. Thomas ◽

Christopher S. Bailey ◽

Marcel F. Dvorak ◽

Brian Kwon ◽

Charles Fisher

Keyword(s):

Neurological Deficit ◽

Data Extraction ◽

Scientific Evidence ◽

Burst Fracture ◽

Nonoperative Treatment ◽

Thoracolumbar Burst Fractures ◽

Posttraumatic Kyphosis ◽

Burst Fractures ◽

Related Quality ◽

Health Related

Object Despite extensive published research on thoracolumbar burst fractures, controversy still surrounds which is the most appropriate treatment. The objective of this study was to evaluate the scientific literature on operative and nonoperative treatment of patients with thoracolumbar burst fractures and no neurological deficit. Methods In their search of the literature, the authors identified all possible relevant studies concerning thoracolumbar burst fracture without neurological deficit. Two independent observers performed study selection, methodological quality assessment, and data extraction in a blinded and objective manner for all papers identified during the search. In a synthesis of the literature, the authors obtained evidence for both operative and nonoperative treatments. Conclusions There is a lack of evidence demonstrating the superiority of one approach over the other as measured using generic and disease-specific health-related quality of life scales. There is no scientific evidence linking posttraumatic kyphosis to clinical outcomes. The authors found that there is a strong need for improved clinical research methodology to be applied to this patient population.

Download Full-text

Burst fracture of the thoracolumbar spine: correlation between kyphosis and clinical result of the treatment

Coluna/Columna ◽

10.1590/s1808-185120151402146349 ◽

2015 ◽

Vol 14 (2) ◽

pp. 129-133 ◽

Cited By ~ 1

Author(s):

Rodrigo Arnold Tisot ◽

Juliano da Silveira Vieira ◽

Renato Tadeu dos Santos ◽

Augusto Alves Badotti ◽

Diego da Silva Collares ◽

...

Keyword(s):

Clinical Outcome ◽

Burst Fracture ◽

Thoracolumbar Spine ◽

Cross Sectional Study ◽

Statistical Correlation ◽

Lumbosacral Spine ◽

Cross Sectional ◽

Thoracolumbar Burst Fractures ◽

Burst Fractures ◽

Sf 36

<sec><title>OBJECTIVE:</title> To evaluate the correlation between kyphosis due to burst fractures of thoracic and lumbar spine and clinical outcome in patients undergoing conservative or surgical treatment.</sec><sec><title>METHODS:</title> A retrospective, cross-sectional study was conducted with 29 patients with thoracolumbar burst fractures treated by the Spine Group in a trauma reference hospital between the years 2002 and 2011. Patients were followed-up as outpatients for a minimum of 24 months. All cases were clinically evaluated by Oswestry and SF-36 quality of life questionnaires and the visual analogue scale (VAS) of pain. They were also evaluated by X-ray examinations and CT scans of the lumbosacral spine at the time of hospitalization and subsequently as outpatients by Cobb method for measuring the degree of kyphosis.</sec><sec><title>RESULTS:</title> There was no statistically significant correlation between the degree of initial kyphosis and clinical outcome measured by VAS and by most of the SF-36 domains in both patients treated conservatively and the surgically treated. The Oswestry questionnaire showed benefits for patients who received conservative treatment (p=0.047) compared to those surgically treated (p=0.335). The analysis of difference between initial and final kyphosis and final kyphosis alone in relation to clinical outcome showed no statistical correlation in any of the scores used.</sec><sec><title>CONCLUSION:</title> The clinical outcome of treatment of the thoracic and lumbar burst fractures was not influenced by a greater or lesser degree of initial or residual kyphosis, regardless of the type of treatment.</sec>

Download Full-text

Combined Anterior-Posterior Surgery Versus Posterior Surgery for Thoracolumbar Burst Fractures: A Systematic Review of the Literature

The Open Orthopaedics Journal ◽

10.2174/1874325001004010093 ◽

2010 ◽

Vol 4 (1) ◽

pp. 93-100 ◽

Cited By ~ 2

Author(s):

Pim P. Oprel ◽

Wim E Tuinebreijer ◽

Peter Patka ◽

Dennis den Hartog

Keyword(s):

Posterior Approach ◽

Randomized Clinical Trials ◽

Burst Fracture ◽

Cochrane Central Register ◽

Review Of The Literature ◽

Thoracolumbar Burst Fractures ◽

Posterior Surgery ◽

Burst Fractures ◽

Posterior Group ◽

Anterior Posterior

Study Design: A systematic quantitative review of the literature. Objective: To compare combined anterior-posterior surgery versus posterior surgery for thoracolumbar fractures in order to identify better treatments. Summary of Background Data: Axial load of the anterior and middle column of the spine can lead to a burst fracture in the vertebral body. The management of thoracolumbar burst fractures remains controversial. The goals of operative treatment are fracture reduction, fixation and decompressing the neural canal. For this, different operative methods are developed, for instance, the posterior and the combined anterior-posterior approach. Recent systematic qualitative reviews comparing these methods are lacking. Methods: We conducted an electronic search of MEDLINE, EMBASE, LILACS and the Cochrane Central Register for Controlled Trials. Results: Five observational comparative studies and no randomized clinical trials comparing the combined anteriorposterior approach with the posterior approach were retrieved. The total enrollment of patients in these studies was 755 patients. The results were expressed as relative risk (RR) for dichotomous outcomes and weighted mean difference (WMD) for continuous outcomes with 95% confidence intervals (CI). Conclusions: A small significantly higher kyphotic correction and improvement of vertebral height (sagittal index) observed for the combined anterior-posterior group is cancelled out by more blood loss, longer operation time, longer hospital stay, higher costs and a possible higher intra- and postoperative complication rate requiring re-operation and the possibility of a worsened Hannover spine score. The surgeons’ choices regarding the operative approach are biased: worse cases tended to undergo the combined anterior-posterior approach.

Download Full-text

Early Stabilizing Effects of HAC vs PMMA for Vertebroplasty in Compression Burst Fractures

10.1115/imece2000-2553 ◽

2000 ◽

Author(s):

Patrick W. Hitchon ◽

Derek A. Taggard ◽

Thomas N. Rogge ◽

Vijay K. Goel ◽

John S. Drake

Keyword(s):

Percutaneous Vertebroplasty ◽

Burst Fracture ◽

Exothermic Reaction ◽

Osteoporotic Bone ◽

Spinal Stabilization ◽

Thoracolumbar Burst Fractures ◽

Structural Support ◽

Multiple Strategies ◽

Burst Fractures ◽

Invasive Techniques

Abstract Multiple strategies exist for the management of thoracolumbar burst fractures. Particularly in osteoporotic bone and elderly patients, minimally invasive techniques for stabilization are desirable. PMMA has been used to enhance structural support during spinal stabilization as well as for percutaneous vertebroplasty. As an inert substance, PMMA is associated with an exothermic reaction making it less than ideal for use in close proximity to neural elements. As an alternative we are studying HAC vs. PMMA. HAC has the advantages of being osteoconductive, biocompatible, and non-exothermic. The purpose of the current study was to test the early stabilizing effect of HAC as compared to PMMA using an experimentally produced burst fracture and a subsequent percutaneous vertebroplasty for stabilization.

Download Full-text