scholarly journals Outcomes with fracture-level transpedicular screws used for thoracolumbar junction fractures

2020 ◽  
Vol 26 (4) ◽  
pp. 548-554
Author(s):  
S.V. Likhachev ◽  
◽  
V.V. Zaretskov ◽  
V.B. Arsenievich ◽  
V.V. Ostrovskij ◽  
...  
Keyword(s):  
Blood Loss ◽  
Vertebral Body ◽  
Demographic Data ◽  
Operating Time ◽  
Body Height ◽  
Thoracolumbar Junction ◽  
Kyphotic Angle ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Fracture Level

Background Short-segment transpedicular screw fixation (SSTSF) is the preferred treatment option for thoracolumbar burst fractures. Adding screws in the fractured body may be helpful in achieving and maintaining fracture reduction. However, the operative approach is disputed. Objective To compare clinical outcomes of transpedicular fixation with and without screws in the fractured vertebral body after isolated uncomplicated fractures at the thoracolumbar junction. Material and methods A retrospective cohort study enrolled 62 patients with Th11–L2 thoracolumbar burst fractures (AOSpine A3, A4) who underwent SSTSF with (n = 32) and without (n = 30) pedicle screws at the fracture level. Demographic data of the patients, operating time and blood loss were registered. Clinical evaluation using Visual analogue scale (VAS ) for pain, Oswestry Disability Index (ODI) to quantify disability and imaging parameters of segmental kyphosis, loss of correction, anterior vertebral body height (AVBH) at the fracture level, spinal canal stenosis (SCS) were measured preoperatively, at one week, 1 month, 6 and 12 months postoperatively. Results The patients of the two groups showed no statistically significant differences in the demographic data, VAS and ODI scores, measurements of kyphotic angle, AVBH, SCS preoperatively (p > 0.05). Screws at the fracture level did not affect the operating time and intraoperative blood loss relative to conventional no-screw group. Benefits with fracture screws were evident at 7 days (p < 0.01) measuring SCS, at 6 months (p < 0.01) and 12 (p < 0.01) months measuring kyphotic angle. There was better kyphosis correction (p < 0.01) and AVBH (p = 0.034) seen at 12 months after surgery. Conclusion Reinforcement of a broken vertebra with fracture-level screws has been shown to provide better stability of clinical and radiographic results as compared to those with conventional SSTSF.

scholarly journals Importance of load sharing column and canal violation in the management of thoracolumbar burst fractures.

2018 ◽  
Vol 20 (1) ◽  
pp. 73-79
Author(s):  
Fabrizio Borges Scardino ◽  
José Marcus Rotta ◽  
Ricardo Vieira Botelho
Keyword(s):  
Vertebral Body ◽  
Body Height ◽  
Spinal Fractures ◽  
Load Sharing ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Treatment Objective ◽  
Posterior Ligament ◽  
Canal Encroachment ◽  
Treatment Rules

Introduction: The ideal classification of spinal fractures should include every kind of fracture and suggest patterns of treatments. Vaccaro et al. proposed a classification and treatment rules according to a comprehensive severity score. In this one, fractures with exclusive lesion of the vertebral body, burst fractures, without either damage of the posterior ligament band or neurological deficit, are considered for conservative treatment. Objective: To demonstrate that some fractures, with an exclusive lesion of the load sharing column, the vertebral body, without any posterior ligament destruction, may be unable to share physiological loads and if associated with great compression of spinal canal, carries so much risk of neural damage that it should be submitted to surgery. Methods: This review is based on the discussion of the literature and is illustrated by a case description. Results: We demonstrate the importance of inclusion of the concepts, load sharing column and intensity of canal encroachment in therapeutic decision regarding thoracolumbar fractures. Conclusions: Patients with canal compression ≥ 50% should be considered for surgery. Patients with lesser degrees of canal encroach may be submitted to erect radiography and operated if there is an additional loss of vertebral body height or neurological symptoms.

Reliability Analyses of Radiographic Measures of Vertebral Body Height Loss in Thoracolumbar Burst Fractures

2019 ◽  
Vol 129 ◽  
pp. e191-e198
Author(s):  
Jae-Young Hong ◽  
Sung-Woo Choi ◽  
Gi Deok Kim ◽  
HyunKwon Kim ◽  
Byung-Joon Shin ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Body Height ◽  
Height Loss ◽  
Vertebral Body Height ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures

scholarly journals Short term radiological outcome of inserting screw at fracture level in posterior short segment fixation in thoracolumbar burst fractures

2017 ◽  
Vol 4 (3) ◽  
pp. 71-76
Author(s):  
Rabindra Lal Pradhan ◽  
Bimal Kumar Pandey ◽  
Krishna Raj Khanal
Keyword(s):  
Vertebral Body ◽  
Body Height ◽  
Fracture Site ◽  
Implant Failure ◽  
Vertebral Body Height ◽  
Short Segment ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Short Segment Fixation

Background: Unstable thoracolumbar burst fractures are treated surgically by short segment fixation but may be associated with high implant failure. Supplementation of anterior column by insertion of screw at fracture site makes it more biomechanically stable.Objectives: The purpose of this prospective study was to evaluate radiological parameters in thoracolumbar fractures treated with intermediate screw fixation with a minimum follow up of two years.Methods: This prospective study was conducted from 2011 till 2012 where unstable  thoracolumbar fractures treated with short segment posterior instrumentation with screw at fracture site were evaluated. All patients (average age 34.64 were followed up for at least 24 months and were classified according to Thoracolumbar Injury Classification and Severity Score and load sharing classifi cation. Out of total 32 patients, four lost to follow up. Radiological parameters like vertebral body height and segmental kyphosis were evaluated and pain was evaluated by Visual Analogue Scale score.Results: Preoperative pain showed mean Visual Analogue Scale Score score of 8.29 that improved to 0.97 at fi nal follow up. Average preoperative loss of vertebral body height was 48.19 %, which improved to 11.4 % after surgery (p<.001). Final vertebral body collapse was 12.98 % with mean percentage loss of vertebral height at 1.57%. Average segmental kyphotic angle was 22.54 before surgery, which corrected to 5.89 immediately after surgery (p<0.001). Final segmental kyphosis was 8.46. Loss of kyphosis correction was 2.57. Two patients had implant failure, but was solidly united during implant removal in both cases.Conclusion: Excellent maintenance of reduction in thoracolumbar burst fractures with short segment fixation with intermediate screws at fracture site with limited decompression resulted in improved neurologic function and satisfactory clinical outcomes, with a low incidence of implant failure and progressive deformity.

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 The Retrospective Analysis of Posterior Short-Segment Pedicle Instrumentation without Fusion for Thoracolumbar Burst Fracture with Neurological Deficit

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Zhouming Deng ◽  
Hui Zou ◽  
Lin Cai ◽  
Ansong Ping ◽  
Yongzhi Wang ◽  
...  
Keyword(s):  
Blood Loss ◽  
Vertebral Body ◽  
Burst Fracture ◽  
Body Height ◽  
Operation Time ◽  
Thoracolumbar Burst Fracture ◽  
Vertebral Body Height ◽  
Kyphotic Angle ◽  
Short Segment ◽  
The Mean

This study aims to investigate the efficacy of posterior short-segment pedicle instrumentation without fusion in curing thoracolumbar burst fracture. All of the 53 patients were treated with short-segment pedicle instrumentation and laminectomy without fusion, and the restoration of retropulsed bone fragments was conducted by a novel custom-designed repositor (RRBF). The mean operation time and blood loss during surgery were analyzed; the radiological index and neurological status were compared before and after the operation. The mean operation time was 93 min (range: 62–110 min) and the mean intraoperative blood loss was 452 mL in all cases. The average canal encroachment was 50.04% and 10.92% prior to the surgery and at last followup, respectively (P<0.01). The preoperative kyphotic angle was 17.2 degree (±6.87 degrees), whereas it decreased to 8.42 degree (±4.99 degrees) at last followup (P<0.01). Besides, the mean vertebral body height increased from 40.15% (±9.40%) before surgery to 72.34% (±12.32%) at last followup (P<0.01). 45 patients showed 1-2 grades improvement in Frankel’s scale at last followup. This technique allows for satisfactory canal clearance and restoration of vertebral body height and kyphotic angle, and it may promote the recovery of neurological function. However, further research is still necessary to confirm the efficacy of this treatment.

scholarly journals The Association between Sagittal Index, Canal Compromise, Loss of Vertebral Body Height, and Severity of Spinal Cord Injury in Thoracolumbar Burst Fractures

2016 ◽  
Vol 07 (S 01) ◽  
pp. S057-S061
Author(s):  
Mehmet Onur Yüksel ◽  
Mehmet Sabri Gürbüz ◽  
Şevki Gök ◽  
Numan Karaarslan ◽  
Merih İş ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Burst Fracture ◽  
Body Height ◽  
Neurological Injury ◽  
Vertebral Body Height ◽  
Predictive Values ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Cord Injury ◽  
Sagittal Index

ABSTRACT Aim: Our aim was to determine whether a combination of sagittal index (SI), canal compromise (CC), and loss of vertebral body height (LVBH) is associated with the severity of neurological injury in patients with thoracolumbar burst fractures. Materials and Methods: Seventy-four patients with thoracolumbar burst fracture undergoing instrumentation between 2010 and 2015 were analyzed retrospectively. The degree of neurological injury was determined using the American Spinal Injury Association (ASIA) scoring system. The association between the morphology of the fracture and the severity of neurological injury was analyzed. Results: There was a strong association between fracture morphology and the severity of neurological injury. Of the patients, 77.5% with SI ≥20°, 81.6% with CC ≥40%, and 100% with LVBH ≥50% had lesion according to ASIA. All of 7 patients with ASIA A had SI ≥20°, CC ≥40%, and LVBH ≥50%. On the other hand, 79% of the patients with ASIA E had SI <20°, 83.7% of the patients with ASIA E had CC <40%, and all of the patients with ASIA E had LVBH <50%. SI, CC, and LVBH were lower in neurologically intact patients (ASIA E), whereas they were higher in patients with neurological deficits (ASIA A, B, C, D) (P = 0.001; P < 0.01). These measurements had 100% negative predictive values and relatively high positive predictive values. Conclusion: SI, CC, and LVBH are significantly associated with the severity of neurological injury in patients with thoracolumbar burst fractures. The patients with SI >25°, the patients with CC >40%, and the patients with LVBH >50% are likely to have a more severe neurological injury.

Functional Outcomes of Nerve Root Sparing Posterior Corpectomy in Lumbar Vertebral Burst Fractures

2021 ◽  
pp. 219256822098412
Author(s):  
Abhinandan Reddy Mallepally ◽  
Nandan Marathe ◽  
Abhinav Kumar Shrivastava ◽  
Vikas Tandon ◽  
Harvinder Singh Chhabra
Keyword(s):  
Blood Loss ◽  
Burst Fracture ◽  
Operating Time ◽  
Deformity Correction ◽  
Neurological Status ◽  
Height Loss ◽  
Vas Score ◽  
Post Surgery ◽  
Burst Fractures ◽  
The Difference

Study Design: Retrospective observational. Objectives: This study aimed to document the safety and efficacy of lumbar corpectomy with reconstruction of anterior column through posterior-only approach in complete burst fractures. Methods: In this retrospective study, we analyzed complete lumbar burst fractures treated with corpectomy through posterior only approach between 2014 and 2018. Clinical and intraoperative data including pre and post-operative neurology as per the ISNCSCI grade, VAS score, operative time, blood loss and radiological parameters, including pre and post-surgery kyphosis, height loss and canal compromise was assessed. Results: A total of 45 patients, with a mean age of 38.89 and a TLICS score 5 or more were analyzed. Preoperative VAS was 7-10. Mean operating time was 219.56 ± 30.15 minutes. Mean blood loss was 1280 ± 224.21 ml. 23 patients underwent short segment fixation and 22 underwent long segment fixation. There was no deterioration in post-operative neurological status in any patient. At follow-up, the VAS score was in the range of 1-3. The difference in preoperative kyphosis and immediate post-operative deformity correction, preoperative loss of height in vertebra and immediate post-operative correction in height were significant (p < 0.05). Conclusion: The posterior-only approach is safe, efficient, and provides rigid posterior stabilization, 360° neural decompression, and anterior reconstruction without the need for the anterior approach and its possible approach-related morbidity. We achieved good results with an all posterior approach in 45 patients of lumbar burst fracture (LBF) which is the largest series of this nature.

Results of treatment of unstable thoracolumbar burst fractures using pedicle instrumentation with and without fracture-level screws

2015 ◽  
Vol 157 (5) ◽  
pp. 831-836 ◽  
Author(s):  
Ali İhsan Ökten ◽  
Yurdal Gezercan ◽  
Kerem Mazhar Özsoy ◽  
Tuncay Ateş ◽  
Güner Menekşe ◽  
...  
Keyword(s):  
Thoracolumbar Burst Fractures ◽  
Results Of Treatment ◽  
Burst Fractures ◽  
Fracture Level

scholarly journals Lesión dural asociada a fracturas de charnela toracolumbar y lumbares con compromiso del muro posterior. Relación con las variables del sistema de clasificación AOSpine. [Thecal sac injury secondary to burst fractures of the thoracolumbar and lumbar spine, and its association with the AOSpine Classification System variables].

2019 ◽  
Vol 84 (3) ◽  
pp. 216-223
Author(s):  
Guillermo Alejandro Ricciardi ◽  
Ignacio Gabriel Garfinkel ◽  
Gabriel Genaro Carrioli ◽  
Daniel Oscar Ricciardi
Keyword(s):  
Vertebral Body ◽  
Neurological Deficit ◽  
Classification System ◽  
Spinal Canal ◽  
Body Wall ◽  
Thoracolumbar Spine ◽  
Cauda Equina ◽  
Acute Angle ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures

Introducción: Las lesiones del saco dural con atrapamiento de la cauda equina entre los fragmentos óseos pueden estar asociadas con fracturas toracolumbares.Objetivo: Realizar un análisis retrospectivo de las variables clínico-radiográficas y el sistema de clasificación AOSpine y la posibilidad de lesión dural asociada en una serie de fracturas toracolumbares por estallido, tratadas en nuestro Centro.Materiales y Métodos: Estudio retrospectivo, observacional de una serie de pacientes con fracturas toracolumbares con compromiso del muro posterior operados en nuestra institución, entre enero de 2012 y diciembre de 2017.Resultados: Se incluyeron 46 pacientes, 16 casos con lesión del saco dural asociada. Las variables porcentaje de ocupación del canal, distancia interpedicular, ángulo del fragmento retropulsado y déficit neurológico asociado mostraron diferencias estadísticamentesignificativas según la comparación en función de la presencia o ausencia de lesión dural (p = 0,046, p = 0,007, p = 0,046 y p = 0,004, respectivamente).Conclusiones: Según nuestros resultados, la lesión dural traumática podría ser contemplada en la planificación del tratamiento de fracturas toracolumbares ante fragmentos voluminosos del muro posterior con ángulo agudo, compromiso severo del canal raquídeo, distancia interpedicular elevada y daño neurológico asociado, tal como se propone en la bibliografía. AbstractIntroduction: Fractures of the thoracolumbar spine can trigger thecal sac injuries due to the impingement of the cauda equina between bone fragments.Objective: To carry out a retrospective analysis of clinical and radiological variables, the AOSpine Classification System and the possibility of secondary thecal sac injury in a series of thoracolumbar burst fractures treated at our center.Materials and Methods: A retrospective, observational study of a series of patients with thoracolumbar fractures with compromise of the posterior vertebral body wall, who underwent surgery at our center between January 2012 and December 2017.Results: Forty-six patients were included, 16 of which had secondary thecal sac injury. The differences in the variables—percentage of spinal canal involvement, interpedicular distance, angle of the retropulsed fragment, neurological deficit and type C fractures—were statistically significant according to the comparison made with the presence or absence of thecal sac injury (p=0.046, p=0.007, p=0.046, p=0.004, p=0,001 respectively).Conclusions: This study suggests that traumatic thecal sac injury could be suspectedwhen managing burst fractures with prominent fragments in the posterior vertebral body wall, acute angle of the retropulsed fragment, severe compression of the spinal canal, wide interpedicular distance, neurological deficit and fracture displacement (fracturetype C according to the AOSpine Classification System).

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