scholarly journals Clinical effect of a novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation for thoracolumbar burst fractures

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Menghan Cai ◽  
Zhijun Xin ◽  
Weijun Kong ◽  
Qian Du ◽  
Wenjun Ji ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Vertebral Body ◽  
Bone Grafting ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Control Group ◽  
Observation Group ◽  
Thoracolumbar Burst Fractures ◽  
Transpedicular Screw ◽  
Transpedicular Screw Fixation

Abstract Background Short-segment transpedicular screw fixation is a common method for the treatment of thoracolumbar burst fractures (TBFs),but this technique has many problems. Therefore,the purpose of this article is to observe and evaluate the clinical efficacy of a novel transpedicular reducer that we designed for fractured vertebral body reduction and bone grafting in the treatment of TBFs. Methods From July 2018 to November 2020, 70 cases of TBFs were included. Thirty-five patients were treated with the novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation (observation group), and 35 patients were treated with short-segment transpedicular screw fixation (control group). Before the operation, after reduction, and 3 days, 3 months,and 12 months after the operation, the two groups were assessed, and compared with respect to the anterior and middle heights of the injured vertebrae, the ratios of the anterior and middle heights of the injured vertebral body to the respective heights of the adjacent uninjured vertebral bodies (AVBHr and MVBHr, respectively), and the Cobb angle of the patients. We compared the pain VAS score and quality of life GQOL-74 score at the last follow-up. Finally,we evaluated the distribution of bone grafts and bone healing 12 months after the operation. Results The anterior height, middle height, AVBHr, MVBHr, and Cobb angle of the injured vertebral body in the observation after reduction, and 3 days, 3 months and 12 months post-operatively were compared with those of the injured vertebral body before operation. All of these parameters were improved, and the difference was statistically significant (p < 0.05). These parameters in the observation group at the above time points were significantly better than thoes in the control group at the corresponding time points (p < 0.05). The VAS scores at the last follow-up were significantly better than those of the control group (p < 0.05), but the GQOL-74 score differences were not statistically significant (p > 0.05). The observation group showed no obvious defects on CT at 12 months after the operation, and the bone healing was good. Conclusion The novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation for TBFs has good clinical efficacy.

scholarly journals Clinical effect of a new type of transpedicular reducer for fracture reduction via pedicle and bone grafting combined with pedicle screw fixation for thoracolumbar burst fractures

2021 ◽  
Author(s):  
Menghan Cai ◽  
Zhijun Xin ◽  
Weijun Kong ◽  
Qian Du ◽  
Wenjun Ji ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Bone Grafting ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Fracture Reduction ◽  
Control Group ◽  
Thoracolumbar Burst Fractures ◽  
Transpedicular Screw ◽  
New Type ◽  
Transpedicular Screw Fixation

Abstract Background: Short-segment transpedicular screw fixation is a common method for the treatment of thoracolumbar burst fractures (TBFs),but this technique has many problems.Therefore,the purpose of this article is to observe and evaluate the clinical efficacy of a new type of transpedicular reducer that we designed for fractured vertebral body reduction and bone grafting in the treatment of TBFs.Methods:From July 2018 to November 2020, 70 cases of TBFs were included. 35 cases were treated with the new transpedicular reducer for fracture reduction via pedicle and bone grafting combined with pedicle screw fixation (observation group), 35 cases were treated with short-segment transpedicular screw fixation (control group).Before operation, after application of the transpedicular reducer(not needed in the control group),3 days after operation, 3 months after operation, 6 months after operation, and 12 months after operation, the two groups were recorded and compared respectively: the anterior and middle heights of the injured vertebrae, the ratios of the anterior and middle heights of the injured vertebral body to the respective heights of the adjacent uninjured vertebral bodies (AVBHr and MVBHr, respectively), and the Cobb angle of patients.And we compared the pain VAS score and quality of life GQOL-74 score at the last follow-up.At last,we evaluated the distribution of bone grafts and bone healing 12 months after the operation.Results:All 70 cases were followed up for at least 12 months.The observation group's anterior and middle heights of the injured vertebral, AVBHr and MVBHr were higher than those of the control group at 3 days,3 months,6 months and 12 months after operation, the cobb angle was smaller than that in control group, the pain VAS score and the quality of life GQOL-74 score at the last follow-up were better than those of the control group, and these difference were statistically significant (P <0.05). The observation group showed no obvious defects on CT at 12 months after operation, and the bone healing was good. Conclusion: The new type of transpedicular reducer for fracture reduction via pedicle and bone grafting combined with pedicle screw fixation for TBFs has a good clinical efficacy.

scholarly journals Clinical Effect of a New Type of Transpedicular Reducer for Fracture Reduction via Pedicle and Bone Grafting Combined With Pedicle Screw Fixation for Thoracolumbar Burst Fractures

2021 ◽  
Author(s):  
menghan cai ◽  
Zhijun Xin ◽  
Weijun Kong ◽  
Qian Du ◽  
Wenjun Ji ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Vertebral Body ◽  
Bone Grafting ◽  
Clinical Effect ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Fracture Reduction ◽  
Thoracolumbar Burst Fractures ◽  
New Type ◽  
Vertebral Bodies

Abstract BackgroundShort-segment transpedicular screw fixation is a common method for the treatment of thoracolumbar burst fractures (TBFs). When it is used, the anterior middle columns of the fractured vertebral body lack good support, resulting in fractured vertebral bodies decreased height and difficult to reduct.Therefore,the purpose of this study was to evaluate the clinical effect of a new type of transpedicular reducer that we designed for fractured vertebral body reduction and bone grafting in the treatment of TBFs.MethodsA total of 9 patients with TBFs who agreed to be treated with the new transpedicular reducer for fracture reduction via pedicle and bone grafting combined with pedicle screw fixation were retrospectively analysed. We measured the anterior and middlel heights of the injured vertebrae, the ratios of the anterior and middlel heights of the injured vertebral body to the respective heights of the adjacent uninjured vertebral bodies (AVBHr and MVBHr, respectively), and the Cobb angle of patients at different stages before and after surgery, and evaluated the distribution of bone grafts and bone healing 3 days and 12 months after the operation.ResultsThe anterior height of the injured vertebrae before the operation; after application of the transpedicular reducer; and 3 days, 3 months, 6 months and 12 months after the operation were 17.56±3.74 mm; 27.70±2.53 mm; and 29.08±2.52 mm, 28.36±1.93 mm, 28.12±1.42 mm, and 27.96±0.72 mm, respectively. The mid-heights of the injured vertebrae were 21.36±4.20 mm; 26.74±1.00 mm; and 27.70±2.01 mm, 27.05±2.45 mm, 26.94±1.84 mm, and 26.83 ±2.45 mm, respectively. The Cobb angles of the injured vertebrae were 3.80±1.44°; 1.26±1.00°; and 0.72±0.70°, 1.03±0.65°, 1.12±0.63°, and 1.34±0.56°, respectively. The allogeneic bones were distributed in the anterior and middle columns 3 days after the operation, and the bone had healed well 12 months after the operation.ConclusionThe new transpedicular reducer has a good reduction, allogeneic bone support, and clinical treatment effect for TBFs through pedicle fracture reduction and bone grafting combined with pedicle screw fixation.

scholarly journals Study on clinical effects of pedicle screw combined with immobilized implantation bone by wirerope and hallow compression screw immobilization in treating spondylolysis of lumbar vertebra of multiple segments of adults

2020 ◽  
Vol 6 (3) ◽  
pp. 19
Author(s):  
Dongdong Zhao ◽  
Feng Li ◽  
Yao Wu ◽  
Xiaoyan Zhang
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Control Group ◽  
Clinical Effects ◽  
Observation Group ◽  
Intraoperative Blood Loss ◽  
Compression Screw ◽  
Lumbar Spondylolysis ◽  
Duration Of Surgery

Objective: To observe clinical effects of pedicle screw fixation combined with cable wires and bone graft and cannulated compression screws on adult multi-segment lumbar spondylolysis.Methods: 70 cases of patients with multi-segment lumbar spondylolysis were selected in our hospital. According to different surgical schemes, these patients were divided into the observation group (35 cases) and the control group (35 cases). The observation group received pedicle screw fixation combined with cable wires and bone graft and the control group received cannulated compression screw fixation. Macnab criteria were adopted to implement a therapeutic evaluation of two groups of patients to make an observation and comparison of the excellent and good rate of surgery and a series of indicators including perioperative clinical effects, intraoperative blood loss, duration of surgery, hospital length of stay (HLOS), visual analogue scale (VAS), Oswestry disability index and Japanese Orthopaedic Association (JOA) score.Results: The excellent and good rate of the observation group was 97.14%, and that of the control group was 82.86%, the difference between two groups was statistically significant (χ2 = 6.248, p = .012). The differences in intraoperative blood loss, duration of surgery and HLOS between two groups were statistically significant (t = -4.55, t = -4.55, t = -4.55; p < .05). Oswestry index, VAS score and JOA score of the observation group were (2.4 ± 0.9), (28.5 ± 6.4) and (27.1 ± 3.1) respectively, and these of the control group were (3.5 ± 1.2), (37.1 ± 7.8) and (21.3 ± 2.7) respectively, the differences between two groups were statistically significant (t = 4.338, t = 5.043, t = 8.347, p < .05).Conclusions: Pedicle screw combined with immobilized implantation bone by wirerope has an excellent clinical effect on the treatment of adult multi-segment lumbar spondylolysis, and it has a series of advantages such as fast postoperative recovery, small surgical trauma and so on. In addition, this technique can also restore the stability of spinal segments and relieve pains to a greater degree.

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>

Rotational stability of thoracolumbar junction fixation systems

2021 ◽  
pp. 21-28
Author(s):  
A. A. Afaunov ◽  
K. K. Takhmazyan ◽  
M. L. Mukhanov ◽  
I. V. Basankin ◽  
M. Yu. Ageyev
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Thoracolumbar Spine ◽  
Pedicle Screw Fixation ◽  
Thoracolumbar Junction ◽  
Rotational Stability ◽  
Physiological Limits ◽  
Transpedicular Screw ◽  
Rotation Motion ◽  
Transpedicular Screw Fixation

Objective To compare the rotational stability of fusion constructs using bisegmental fixation of Th12-L2 vertebrae with anterior stabilization or pedicle screw fixation.Material and Methods The strength, rigidity and limit of elasticity in the “injured vertebral motion segments (VMS) – bisegmental anterior stabilization” system under dislocating rotational loads were estimated. The data obtained were compared with the similar characteristics of the “injured VMS – bisegmental 4-screw transpedicular metal construction” system and intact spine segments.Results Under rotational loads the limits of elasticity of injured spine segments of Th12-L2 with anterior stabilization and transpedicular screw fixation (TSF) is 45.5 and 41.7%, respectively, and the general strength is 66.4% and 80%, respectively, as compared with those intact VMS. Rigidity parameters of anterior-stabilized and pedicle screw fixated VMS with unstable damage of L1 are 60.2 and 93.9%, accordingly, in comparison with those intact VMS.Conclusion No significant differences were observed between bisegmental anterior stabilization and bisegmental pedicle screw fixation of thoracolumbar junction in terms of the key mechanical properties. When treating patients with unstable thoracolumbar spine injuries using bisegmental anterior stabilization or transpedicular fixation with 4-screw spinal system possible rotation motion amplitude of operated segments must not exceed 50% of maximum physiological limits.

scholarly journals Short Segment versus Long Segment Pedicle Screws Fixation in Management of Thoracolumbar Burst Fractures: Meta-Analysis

2017 ◽  
Vol 11 (1) ◽  
pp. 150-160 ◽  
Author(s):  
Tarek Ahmed Aly
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Meta Analysis ◽  
Pedicle Screw Fixation ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Significant Difference

<p>Posterior pedicle screw fixation has become a popular method for treating thoracolumbar burst fractures. However, it remains unclear whether additional fixation of more segments could improve clinical and radiological outcomes. This meta-analysis was performed to evaluate the effectiveness of fixation levels with pedicle screw fixation for thoracolumbar burst fractures. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Springer, and Google Scholar were searched for relevant randomized and quasirandomized controlled trials that compared the clinical and radiological efficacy of short versus long segment for thoracolumbar burst fractures managed by posterior pedicle screw fixation. Risk of bias in included studies was assessed using the Cochrane Risk of Bias tool. Based on predefined inclusion criteria, Nine eligible trials with a total of 365 patients were included in this meta-analysis. Results were expressed as risk difference for dichotomous outcomes and standard mean difference for continuous outcomes with 95% confidence interval. Baseline characteristics were similar between the short and long segment fixation groups. No significant difference was identified between the two groups regarding radiological outcome, functional outcome, neurologic improvement, and implant failure rate. The results of this meta-analysis suggested that extension of fixation was not necessary when thoracolumbar burst fracture was treated by posterior pedicle screw fixation. More randomized controlled trials with high quality are still needed in the future.</p>

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

2016 ◽  
Vol 02 (04) ◽  
pp. e131-e138 ◽  
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.

scholarly journals Does Tranexamic Acid Reduce Perioperative Bleeding in Short Segment Pedicle Screw Fixation in Thoracolumbar Spine Fractures?

2015 ◽  
Vol 53 (199) ◽  
pp. 169-173 ◽  
Author(s):  
Rabindra Lal Pradhan ◽  
Bimal Kumar Pandey
Keyword(s):  
Tranexamic Acid ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Thoracolumbar Spine ◽  
Pedicle Screw Fixation ◽  
Control Group ◽  
Thoracolumbar Fractures ◽  
Short Segment ◽  
Perioperative Bleeding ◽  
Thoracolumbar Spine Fractures

Introduction: Blood loss with spinal surgery is common potential cause of morbidity and often requires blood transfusion. Tranexamic acid (TXA), is effective in reducing bleeding in patients undergoing knee arthroplasty. TXA used in spine surgery studies have included different cases leading to inconsistence of surgical procedures. Purpose of this prospective observational study was to examine effect of TXA decreasing bleeding in short segment pedicle screw fixation for thoracolumbar fractures. Methods: 38 patients' undergoing short segment pedicle screw for thoracolumbar fractures were enrolled in study from July to August 2013. There were 28 male and 10 female patients, with an average age of 36.5 years. Patients received 10 mg/kg of TXA or a control 30 minutes intravenously before skin incision and 3 hours post-operative and oral medication for three days. Intraoperative bleeding was estimated by weighing surgical sponges, blood collected by suction container and by subtracting all irrigation fluid. Postoperative bleeding was measured from volume in vacuum drainage bag. Results: Twenty (20) patients were in control group and eighteen(18) to TXA group. There were no statistical differences between groups in terms of age, gender, co-morbidities, and operating time, preoperative Hemoglobin, PT and INR. Intra-operative bleeding in TXA group was significant than in control group. Post-operative drainage and Hemoglobin in first 48 h was reduced compared with placebo in TXA group. Need for post-operative transfusion was nil in TXA group. Conclusions: Administration of TXA before surgery significantly reduces perioperative bleeding in patients undergoing short segment pedicle screw fixation for thoracolumbar spine fractures.  Keywords: bleeding; spinal surgery; tranexamic acid.

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