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

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.

Early Clinical Results of Short Same-Segment Posterior Fixation in Thoracolumbar Burst Fractures

2018 ◽  
Vol 20 (3) ◽  
pp. 211-217 ◽  
Author(s):  
Misbah Mehraj ◽  
Farid H. Malik
Keyword(s):  
Lumbar Spine ◽  
Sagittal Plane ◽  
Posterior Instrumentation ◽  
Body Height ◽  
Posterior Fixation ◽  
Spine Fractures ◽  
Short Segment ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Thoracic And Lumbar Spine

Background. We did a prospective study to study the efficiency of Short Segment Posterior Instrumentation using a Universal Spine System with incorporation of the fractured vertebra in post-traumatic thoracic and lumbar spine fractures. Material and methods. 25 cases in the age group of I5-50 years with thoracic and lumbar spine fractures were included in the study. The operative decision was made on the basis of instability of spine fractures with or without neurological deficit. Patients were followed up for an average period of twelve months, reporting for assessment at 3-monthly intervals. The final result was analyzed on the basis of neurological recovery as per Frankel’s Grading, spine stability as per kyphotic angle by Cobb’s method, vertebral body height and complications. Results. Post-operatively at the final follow-up visit, 36% patients had Frankel’s grade E neurological status. The mean sagittal plane kyphosis pre-operatively was 31.16°, which reduced to 21.52° post-operatively, which represents 30.93% reduction. Mean anterior body compression was 38.6°, which decreased to 23.4° post-operatively, corresponding to 15% increase. Conclusions. 1. Although conventional short segment posterior fixation (SSPF) has become an increasingly popular method of treatment of thoracolumbar burst fractures, providing the advantage of incorporating fewer motion segments in the fixation, a review of literature demonstrated that SSPF led to 9-55% incidence of implant failure and long term loss of kyphosis correction. 2. Short segment posterior fixation with pedicle fixation at the level of the fractured vertebra (short same-segment fixation) provides more biomechanical stability than traditional SSPF.

Biomechanical comparison of three fixation techniques for unstable thoracolumbar burst fractures

2008 ◽  
Vol 8 (4) ◽  
pp. 341-346 ◽  
Author(s):  
Frank L. Acosta ◽  
Jenni M. Buckley ◽  
Zheng Xu ◽  
Jeffrey C. Lotz ◽  
Christopher P. Ames
Keyword(s):  
Burst Fracture ◽  
Axial Rotation ◽  
Short Segment ◽  
Thoracolumbar Burst Fractures ◽  
Spinal Reconstruction ◽  
Burst Fractures ◽  
Flexion Extension ◽  
Circumferential Fusion ◽  
Fixation Techniques ◽  
Biomechanical Comparison

Object Increased structural stability is considered sufficient justification for higher-risk surgical procedures, such as circumferential fixation after severe spinal destabilization. However, there is little biomechanical evidence to support such claims, particularly after traumatic lumbar burst fracture. The authors sought out to compare the biomechanical performance of the following 3 fixation strategies for spinal reconstruction after decompression for an unstable thoracolumbar burst fracture: 1) short-segment anterolateral fixation; 2) circumferential fixation; and 3) extended anterolateral fixation. Methods Thoracolumbar spines (T10–L4) from 7 donors (mean age at death 64 ± 6 years; 1 female and 6 males) were tested in pure moment loading in flexion–extension, lateral bending, and axial rotation. Thoracolumbar burst fractures were surgically induced at L-1, and testing was repeated sequentially for each of the following fixation techniques: short-segment anterolateral, circumferential, and extended anterolateral. Primary and coupled 3D motions were measured across the instrumented site (T12–L2) and compared across treatment groups. Results Circumferential and extended anterolateral fixations were statistically equivalent for primary and off-axis range-of-motions in all loading directions, and short-segment anterolateral fixation offered significantly less rigidity than the other 2 methods. Conclusions The results of this study strongly suggest that extended anterolateral fixation is biomechanically comparable to circumferential fusion in the treatment of unstable thoracolumbar burst fractures with posterior column and posterior ligamentous injury. In cases in which an anterior procedure may be favored for load sharing or canal decompression, extension of the anterior instrumentation and fusion one level above and below the unstable segment can result in near equivalent stability to a 2-stage circumferential procedure.

scholarly journals Radiological Outcome of Short Segment Posterior Instrumentation and Fusion for Thoracolumbar Burst Fractures

2015 ◽  
Vol 9 (3) ◽  
pp. 427 ◽  
Author(s):  
Truc Tam Vu ◽  
Yuichiro Morishita ◽  
Itaru Yugue ◽  
Tetsuo Hayashi ◽  
Takeshi Maeda ◽  
...  
Keyword(s):  
Posterior Instrumentation ◽  
Radiological Outcome ◽  
Short Segment ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures

Controversies in Managing of Thoracic-Lumbar Upper Burst Fractures

2018 ◽  
Vol 1 (2) ◽  
Author(s):  
Sahat Edison Sitorus
Keyword(s):  
Decision Making ◽  
Spinal Cord ◽  
Posterior Instrumentation ◽  
Burst Fracture ◽  
Surgical Decompression ◽  
Neurologic Deficit ◽  
Retroperitoneal Approach ◽  
Burst Fractures ◽  
Lateral Fixation

Upper burst fracture of Th12-L1 has unique anatomy because it contains lower spinal cord, medullary cone, and diaphragm which separates between the thoracic and lumbar spine.The presence or absence of neurologic deficit is the single most important factor in the decision making. The presence of profound but incomplete neural deficit in association with canal compromise represents an urgent indication of surgical decompression. Antero-lateral direct decompression with trans-thoracic trans-pleural–retroperitoneal approach given the proximity the cord and conus is the most effective method, with inter-vertebral instrumentation with or without lateral fixation or posterior instrumentation.

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

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.

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