scholarly journals Effect of the Short-Segment Internal Fixation with Intermediate Inclined-Angle polyaxial Screw at the Fractured Vertebrae on the Treatment of Denis type B Thoracolumbar Fracture

2020 ◽  
Author(s):  
Chengjie Xiong ◽  
Biwang Huang ◽  
Tanjun Wei ◽  
Hui Kang ◽  
Feng Xu
Keyword(s):  
Internal Fixation ◽  
Vertebral Body ◽  
Body Height ◽  
Type B ◽  
Short Segment ◽  
Significant Difference ◽  
Surgical Options ◽  
Cobb’S Angle ◽  
Inclined Angle ◽  
Duration Of Operation

Abstract Backgroud Short-segment internal fixation with straight-forward monoaxial screw (SSIF-SFM) and long-segment internal fixation (LSIF) are two major surgical options for thoracolumbar (TL) fracture, however, limitations of both surgical options l are obvious. SSIF with inclined-angle polyxial screw (SSIF-IAP) have been developed to take advantage of their benefits and minimize their adverse effects . Methods 69 consecutive patients (47 males and 22 females; average 34.5 years ) who met the criteria for inclusion were enrolled in this study . Sagittal Cobb’s angle (SCA), anterior vertebral body height (AVBH), vertebral body index (VBI) and spinal canal encroachment (SCE) were measured and assessed . Functional recovery Visual Analogue Scale (VAS) and Oswestry disability index (ODI) were also evaluated. Results The value of incision length, mean blood loss, duration of operation and hospital stay in the SSIF–IAP group and SSIF-SFM group were significantly lower than those in the LSIF group. The AVBH and VBI in the SSIF–IA P group and LSIF group were significantly more improved than those in the SSIF–SFM group at 6 months and the latest follow-ups (p < 0.05). The correction losses of AVBH and VBI ( calculated by the reduction of AVBH and VBI) in the SSIF-IAP group and LSIF group were also significantly lower than those in the SSIF–SFM group at 6 months and the latest follow-ups (P<0.05). There was no significant difference of SCE among three groups. The VAS and ODI in the SSIF–IAP group and SSIF-SFM group were significantly lower than those in the LSIF group at 6 months and the latest follow-ups (P<0.05). Conclusion SSIF-IAP can achieve comparable treatment outcomes compared with LSIF, but it was less invasive compared with LSIF . The SSIF–IA was an effective and reliable operative technique for patients with Denis type B TL fracture.

scholarly journals Effect of the Short-Segment Internal Fixation with Intermediate Inclined-Angle polyaxial Screw at the Fractured Vertebra on the Treatment of Denis type B Thoracolumbar Fracture

2020 ◽  
Author(s):  
chengjie xiong ◽  
Biwang Huang ◽  
Tanjun Wei ◽  
Hui Kang ◽  
Feng Xu
Keyword(s):  
Internal Fixation ◽  
Vertebral Body ◽  
Body Height ◽  
Type B ◽  
Short Segment ◽  
Average Value ◽  
Significant Difference ◽  
Surgical Options ◽  
Inclined Angle ◽  
Duration Of Operation

Abstract Background: Short-segment internal fixation with intermediate straight-forward monoaxial screws (SSIF-SFM) and long-segment internal fixation (LSIF) are the tow major surgical options for thoracolumbar (TL) fracture. However, SS IF-SFM might not provide adequate support to the spine and LSIF is un necessarily extensive. SSIF with intermediate inclined-angle polyxial screw (SSIF-IAP) might offer an alternative solution for the treatment of TL fracture. Methods: A retrospective study was conducted. 69 patients (47 males and 22 females; average 34.5 years) with Denis type B TL fracture who met the criteria for inclusion were enrolled. Sagittal Cobb’s angle (SCA), anterior vertebral body height (AVBH), vertebral body index (VBI) and spinal canal encroachment (SCE) were measured and assessed. Visual analogue scale (VAS) and oswestry disability index (ODI) were also evaluated. Results: The average value of incision length, blood loss, duration of operation and hospital stay in the SSIF–IAP group and SSIF-SFM group were significantly decreased compared with those in the LSIF group. The AVBH and VBI in the SSIF-IAP group and LSIF group were significantly improved than those in the SSIF–SFM group at 6-month and the latest follow-ups (p < 0.05). The correction losses of AVBH and VBI (calculated by the reduction of AVBH and VBI) in the SSIF-IAP group and LSIF group were also significantly decreased compared with those in the SSIF–SFM group at 6-month and the latest follow-ups (P < 0.05). There was no significant difference of SCE among the three groups postoperatively. The VAS and ODI in the SSIF-IAP group and SSIF-SFM group were significantly decreased compared with those in the LSIF group at 6-month and the latest follow-ups (P < 0.05). Conclusion: Both SSIF- IAP and LSIF can improve the biomechanical stability as compared with SSIF -SFM . Moreover, SSIF-IAP was an effective and reliable operative technique for patients with Denis type B TL fracture.

Effect of the Short-Segment Internal Fixation with Intermediate Inclined-Angle Screw at the Fractured Vertebrae on the Treatment of Denis type B thoracolumbar fracture

2020 ◽  
Author(s):  
Chengjie Xiong ◽  
Biwang Huang ◽  
Tanjun Wei ◽  
Hui Kang ◽  
Feng Xu
Keyword(s):  
Internal Fixation ◽  
Vertebral Body ◽  
Mechanical Stability ◽  
Body Height ◽  
Type B ◽  
Short Segment ◽  
Significant Difference ◽  
Surgical Options ◽  
Inclined Angle ◽  
Duration Of Operation

Abstract Background Short-segment internal fixation with straight-forward screw (SSIF-SF) and long-segment internal fixation (LSIF) are two major surgical options for thoracolumbar (TL) fracture, however, limitations of two surgical options are obvious. SSIF with inclined-angle screw (SSIF-IA) have been lately developed to take advantage of their benefits and minimize their adverse effects. METHODS Three different treatments were randomly performed in 69 consecutive TL fracture. 26 were allocated to treatment with SSIF–IA, 24 were assigned to treatment with SSIF–SF, 19 patients were randomized to treatment with LSIF. Sagittal Cobb’s angle (SCA), anterior vertebral body height (AVBH), vertebral body index (VBI) and spinal canal encroachment (SCE) were measured and assessed. Functional recovery Visual Analogue Scale (VAS) and Oswestry disability index (ODI) were also evaluated. RESULTS The value of incision length, mean blood loss, duration of operation and hospital stay in the SSIF–IA group and SSIF-SF group were significantly lower than those in the LSIF group. During 6 months and the latest follow-ups, the AVBH and VBI in the SSIF-IA group and LSIF group were significantly more improved than those in the SSIF–SF group (p < 0.05). The correction losses of AVBH and VBI of the fractured vertebrae in the SSIF-IA group and LSIF group were significantly lower than those in the SSIF–SF group (P<0.05). There was no significant difference of SCA among three groups. The average ODI scores in SSIF-IA and SSIF-SF group were significantly lower than those in the LSIF group. CONCLUSIONS The bio-mechanical stability of SSIF-IA was comparable to LSIF, but less invasive as compared with LSIF. SSIF–IA was effective and reliable operative technique for patients with Denis type B TL fracture.

scholarly journals Is It Necessary to Reduce Thoracolumbar Compression Fractures  with Intermediate Screws in the Fractured Vertebra?

2021 ◽  
Author(s):  
ZeJun Xing ◽  
Shuai Hao ◽  
XiaoFei Wu
Keyword(s):  
Blood Loss ◽  
Body Height ◽  
Pedicle Screws ◽  
Operation Time ◽  
Short Segment ◽  
Compression Fractures ◽  
Significant Difference ◽  
Before And After ◽  
Screw Group

Abstract PurposeTo compare the efficacy and safety of percutaneous short-segment pedicle screws fixation (PPSF) with or without intermediate screws (IS) for the treatment of thoracolumbar compression fractures.MethodsFrom January 2016 to March 2019, a retrospective study of 38 patients with thoracolumbar compression fractures conducted. The patients were divided into a 4-screw group (without IS) and a 6-screw group (with IS) according to whether pedicle screws were placed in the fractured vertebrae. Combined positional reduction effects with the technique of pre-contoured lordotic rods were used to reduce the fracture by lengthening the anterior column of the fractured vertebrae. The posterior structure of the fractured vertebrae was undertaken as the fulcrum point for both groups. The operation time, intra-operative blood loss, visual analogue scale (VAS), anterior vertebral body height (AVBH), segment kyphosis（SK）before and after operation and complications were recorded.ResultsAlthough the operation time and blood loss in the 6-screw group were higher than in the 4-screw group, difference was not significant (P＞0.05). There was no significant difference in VAS, AVBH and SK between the two groups (P＞0.05). Nevertheless, these results were significant differences between the preoperative and the immediate postoperative, between preoperative and follow-up groups (P < 0.001). No neurologic injury was observed in either groups. ConclusionsIn the treatment of thoracolumbar compression fractures, percutaneous short-segment pedicle screws fixation without intermediate screws in the 4-screw construct may obtain the same clinical effect as that in the 6-screw construct.

scholarly journals Efficacy of Computed Tomography-assisted Limited Decompression in the Surgical Management of Thoracolumbar Fractures With Neurological Deficit

2021 ◽  
Author(s):  
Landa Shi ◽  
Dean Chou ◽  
Yuqiang Wang ◽  
Mirwais Alizada ◽  
Yilin Liu
Keyword(s):  
Quality Of Life ◽  
Postoperative Complications ◽  
Vertebral Body ◽  
Burst Fracture ◽  
Body Height ◽  
Height Loss ◽  
Vertebral Body Height ◽  
Single Segment ◽  
Significant Difference

Abstract Objective: to investigate the effect of CT-assisted limited decompression in the management of single segment A3 lumbar burst fracture. Method: A retrospective study of 106 cases with a single-level Magerl type A3 lumbar burst fractures treated with short-segment posterior internal fixation and limited decompression from January 2015 to June 2019 was performed. Patients were divided into two groups: CT-assisted and non-CT-assisted. Perioperative factors, clinical outcomes, postoperative complications, imaging parameters and health-related quality of life (HRQoL) were evaluated. Results: There was no significant difference between the two groups in the kyphosis, anterior vertebral body height loss, posterior vertebral body height loss, operative time, and postoperative complications. The visual analogue score (VAS) and spinal canal encroachment in the CT-assisted group were lower than those in the non-CT-assisted group (P < 0.05). The Japanese Orthopaedic Association score (JOA), the simplified HRQoL scale and American Spinal Injury Association (ASIA) Spinal Cord Injury Grade in the CT-assisted group were higher than those in the non-CT-assisted group (P < 0.05).Conclusion: CT-assisted limited decompression in the treatment of single-segment A3 lumbar burst fracture can achieve better fracture reduction and surgical results, and improve the long-term recovery of neurological function and quality of life of the patients.

scholarly journals Inclusion of the fractured level into the construct of short segment fixation in patients with thoracolumbar fractures: clinical and radiological outcome

2021 ◽  
Vol 36 (1) ◽  
Author(s):  
Ali R. Hamdan ◽  
Radwan Nouby Mahmoud ◽  
Ahmed G. Tammam ◽  
Eslam El-Sayed El-Khateeb
Keyword(s):  
Cobb Angle ◽  
Vertebral Body ◽  
Compression Ratio ◽  
Body Height ◽  
Surgical Approaches ◽  
Thoracolumbar Fractures ◽  
Vertebral Body Height ◽  
Short Segment ◽  
The Mean ◽  
Short Segment Fixation

Abstract Background Thoracolumbar fractures represent a widespread injuries that can cause significant disability and strain the healthcare system. Different surgical approaches are described in the literature. This study was conducted to evaluate the fractured level inclusion in short-segment fixation of thoracolumbar junction spine fractures. Results Preoperative neurological deficit was reported in seven patients ranging from ASIA grade C to D. All of these patients improved to grade E by the end of the follow-up period, except for one patient who improved from grade C to D. The mean Oswestry Disability Index was 19.87%. The mean postoperative Cobb angle was 11.77° which significantly improved compared to a preoperative value of 19.37°. There was a significant improvement in the postoperative anterior and posterior vertebral body height compared to the preoperative values. The vertebral body compression ratio significantly improved during the postoperative period to a mean of 84% compared to 76% preoperative. Conclusions There was significant improvement of the postoperative values of the mean Cobb angle, the anterior and the posterior vertebral body height as well as the vertebral body compression ratio compared to the preoperative values.

scholarly journals Finite Element Analysis of Stability of Internal Fixation Reconstruction Methods for Lumbar Total Vertebral Resection

2020 ◽  
Author(s):  
Shengcheng Wan ◽  
Zhaoyi Wu ◽  
Yuanwu Cao ◽  
Xiaoxing Jiang ◽  
Zixian Chen ◽  
...  
Keyword(s):  
Finite Element ◽  
Lumbar Spine ◽  
Internal Fixation ◽  
Vertebral Body ◽  
Spinal Stability ◽  
Lateral Bending ◽  
Short Segment ◽  
Short Segment Fixation ◽  
Anterior Support ◽  
Artificial Vertebral Body

Abstract Objective To compare the effect of different fixation methods on spinal stability after total en bloc spondylectomy(TES) of lumbar spine.Method The finite element models were established based on the CT scan of a healthy volunteer. After the validity of the models was confirmed, the models with different posterior fixation methods of the lumbar spine were established with and without the artificial vertebral body, respectively. The motions of flexion, extension, lateral bending and rotation under supine and standing conditions were simulated. The angular displacement of T11-L3 and stress of internal fixations were compared and analyzed.Results The finite element models of spinal reconstruction after TES were obtained. When the anterior support existed, the movement of the spine after TES was not affected by the gravity of the upper body. The movements in the opposite direction on the same plane were similar. All three methods provided enough stability to the spine. The improved short-segment fixation shared stress of the artificial vertebral body with no obvious negative effect. The long-segment fixation had stronger fixation effect with the huge loss of the range of motion of lumbar spine. When the anterior support failed, obvious rotation showed in lateral bending in all models. The short-segment fixation and the long-segment fixation failed to maintain the spinal stability with fixations breakage or functional loss. The improved short-segment fixations showed strong ability in maintaining the spinal stability. The vertebral body screws can prevent the failure of anterior fixation by sharing great stress of the whole internal fixation system. The improved short-segment had huge advantages over the others.Conclusion After TES, the improved short-segment fixation can provide more stability to the spine. The vertebral body screws can prevent the failure of the internal fixation by reducing the stress of the anterior support. This fixation method should be promoted in clinical practice while the effect requires more observation.

scholarly journals Biomechanical finite element analysis of vertebral column resection and posterior unilateral vertebral resection and reconstruction osteotomy

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ye Han ◽  
Xiaodong Wang ◽  
Jincheng Wu ◽  
Hanpeng Xu ◽  
Zepei Zhang ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Vertebral Body ◽  
Vertebral Column ◽  
Vertebral Compression Fractures ◽  
Lateral Bending ◽  
Short Segment ◽  
Vertebral Column Resection ◽  
Compression Fractures ◽  
Short Segment Fixation ◽  
Vertebral Resection

Abstract Background Regarding the repair of vertebral compression fractures, there is a lack of adequate biomechanical verification as to whether only half of the vertebral body and the upper and lower intervertebral discs affect spinal biomechanics; there also remains debate as to the appropriate length of fixation. Methods A model of old vertebral compression fractures with kyphosis was established based on CT data. Vertebral column resection (VCR) and posterior unilateral vertebral resection and reconstruction (PUVCR) were performed at T12; long- and short-segment fixation methods were applied, and we analyzed biomechanical changes after surgery. Results Range of motion (ROM) decreased in all fixed models, with lumbar VCR decreasing the most and short posterior unilateral vertebral resection and reconstruction (SPUVCR) decreasing the least; in the long posterior unilateral vertebral resection and reconstruction (LPUVCR) model, the internal fixation system produced the maximum VMS stress of 213.25 mPa in a lateral bending motion and minimum stress of 40.22 mPa in a lateral bending motion in the SVCR. Conclusion There was little difference in thoracolumbar ROM between PUVCR and VCR models, while thoracolumbar ROM was smaller in long-segment fixation than in short-segment fixation. In all models, the VMS was most significant at the screw-rod junction and greatest at the ribcage–vertebral body interface, partly explaining the high probability of internal fixation failure and prosthesis migration in these two positions.

scholarly journals Bone-filling mesh container versus percutaneous kyphoplasty in treating Kümmell’s disease

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Z.-K. Duan ◽  
J.-F. Zou ◽  
X.-L. He ◽  
C.-D. Huang ◽  
C.-J. He
Keyword(s):  
Vertebral Body ◽  
Operation Time ◽  
Cement Leakage ◽  
Percutaneous Kyphoplasty ◽  
Relieve Pain ◽  
Significant Difference ◽  
Kummell’S Disease ◽  
Cobb’S Angle ◽  
Bone Filling ◽  
Kümmell’S Disease

Abstract Summary Kümmell’s disease (eponymous name for osteonecrosis and collapse of a vertebral body due to ischemia and non-union of anterior vertebral body wedge fractures after major trauma) cannot heal spontaneously. Bone-filling mesh container (BFMC) can significantly relieve pain, help the correction of kyphosis, and may prevent cement leakage. This pilot study may provide the basis for the design of future studies. Purpose To compare the effectiveness and safety of BFMC and percutaneous kyphoplasty (PKP) for treatment of Kümmell’s disease. Methods From August 2016 to May 2018, 40 patients with Kümmell’s disease were admitted to Guizhou Provincial People’s Hospital. Among them, 20 patients (20 vertebral bodies) received PKP (PKP group) and the other 20 received BFMC (BFMC group). Operation time, Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), Cobb’s angle changes, and related complications were recorded. Results All patients underwent operations successfully. VAS scores and ODI of both groups at each postoperative time point were lower than preoperatively, with statistically significant difference (p < 0.05). Postoperative Cobb’s angle of both groups postoperatively was lower than preoperatively (p < 0.05). Cement leakage occurred in eight vertebrae (8/20) in the PKP group and in one vertebra (1/20) in the BFMC group. No complications such as pulmonary embolism, paraplegia, or perioperative death occurred during operation in both groups. Adjacent vertebral refractures occurred in five patients (5/20) in the PKP group and in four patients (4/20) in the BFMC group, with no significant difference in the incidence rate of refractures in both groups but the material is too small to verify statistically. Conclusions Both PKP and BFMC technologies can significantly relieve pain and help the correction of kyphosis while treating Kümmell’s disease. Moreover, the BMFC may prevent cement leakage.

NEUROLOGICAL OUTCOME IN ASSOCIATION WITH COLUMN RESTORATION AND CONSOLIDATION OF UNSTABLE THORACIC AND LUMBAR SPINE FRACTURES — ASSESSMENT BY CLINICAL EXAMINATION AND IMAGE STUDIES

2016 ◽  
Vol 19 (02) ◽  
pp. 1650008
Author(s):  
Myung-Sang Moon ◽  
Dong-Hyeon Kim ◽  
Sang-Jae Kim ◽  
Min-Geun Yoon
Keyword(s):  
Vertebral Body ◽  
Body Height ◽  
Fracture Dislocation ◽  
Unstable Fracture ◽  
Type I ◽  
Type Iv ◽  
Difference Formula ◽  
Significant Difference ◽  
Posterior Element ◽  
Element Type

A total of 116 surgically treated patients with unstable fractures of the thoracic and lumbar spines were subjected to this study on basis of the simple radiographic and CT findings of the injured spinal column and neurological changes at the injured cord and/or roots level. Among them 50 patients were paraplegics and 66 patients were non-paraplegics. Spine fracture patterns shown on axial CT images were classified into five types on the basis of the fracture severity of vertebral body associating the canal compromise by the encroached fracture fragments from middle column and posterior element. Type I: vertical linear fracture through mid-anterior and posterior elements; Type II: retropulsed fragment in the canal with intact posterior element; Type III: retropulsed fragment in the canal with fracture of the posterior element; Type IV: severe comminution of body and disruption of posterior element around the canal; Type V: fracture-dislocation of comminuted vertebral body and neural arch (with or without double margin sign and with or without vacant facet sign). Displacement of vertebral body on lateral plane radiograms showed significant difference ([Formula: see text] < 0.001) between the non-paralytics and paralytics, but there were no differences in kyphotic angles and anterior body height loss between the two groups. Neurological injury was highly complicated in cases of the fracture-dislocation (20 out of 22 patients: 90.9%). Unstable fracture which occurred in the thoracic level showed high incidence of neurological injuries [24 out of 28 patients (85.7%)]; complete paralysis in 20 (71.4%) out of 28 patients in comparison with that of the thoracolumbar and lumbar fractures. Anteroposterior (AP) diameter of the compromised neural canal and percentile surface area of the compromised canal showed significant differences between the paralytics and non-paralytics (canal diameter: [Formula: see text] < 0.05, canal compromise: [Formula: see text] < 0.05). Neural deficit was highly complicated in type IV and V fractures. In conclusion, it was found that clinical neurological assessment and CT-based fracture classification were the valid approaches in managing the fractured spine.

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