scholarly journals The Hardware Failure and Correction Loss of Short-segment Pedicle Screw Fixation Combined With Transforaminal Interbody Fusion in Treatment of Unstable Thoracolumbar Burst Fracture: Retrospective Study in Vietnam

2021 ◽  
Author(s):  
Ngoc Quyen Nguyen ◽  
Trong Hau Phan ◽  
Van Hong Vu
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Screw Fixation ◽  
Burst Fracture ◽  
Pedicle Screw Fixation ◽  
Correction Loss ◽  
Short Segment ◽  
Hardware Failure ◽  
Transforaminal Interbody Fusion

Abstract Background: Correction loss and hardware failure of short segment posterior pedicle screw fixation in treatment of thoracolumbar unstable burst fracture have been remaining a main concern. Several authors have introduced the procedures to solve these limitations including transforaminal interbody fusion (TIF). The purposes of this study were to evaluate the progressive kyphosis and implant failure of short-segment pedicle screw fixation combined with transforaminal interbody fusion in treatment of unstable thoracolumbar burst fracture.Methods: The retrospective study were enrolled in the patients with isolated unstable thoracolumbar burst fractures, Denis type IIB who were treated by posterior short fixation with TIF between January 2013 to January 2017. Patients were followed up for a minimum of one and half year. For evaluation of correction loss, % loss of anterior vertebral body heights (%AVB), vertebral kyphotic angle (VA) and regional kyphotic angle (RA) were collected preoperatively, postoperatively and at final follow-up. The hardware failure was assessed on radiological images at last follow-up. Results: There were 36 patients who met the inclusion criteria with a mean follow-up duration of 53 months. The mean correction loss of %AVB, VA and, RA were 10.2%, 2.9o and 5.6o, respectively. There were 6 patients (16.7%) with hardware failure at final follow-up. Conclusions: Short-segment posterior pedicle screw fixation with TIF using bone chip graft hasn’t prevented completely the hardware failure and progressive kyphosis in treatment of unstable thoracolumbar burst fracture.

scholarly journals Posterior fixation including the fractured vertebra in short segment fixation of unstable thoracolumbar junction burst fractures

2016 ◽  
Vol 9 (2) ◽  
pp. 81
Author(s):  
Md. Kamrul Ahsan ◽  
Zabed Zahangiri ◽  
M. A. Awwal ◽  
Naznin Zaman ◽  
Md. Hamidul Haque ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Burst Fracture ◽  
Pedicle Screw Fixation ◽  
Thoracolumbar Junction ◽  
Vertebral Height ◽  
Short Segment ◽  
The Mean ◽  
Short Segment Fixation

<p>The aim of this study was to evaluate the efficacy of inclusion of the fractured vertebra in short segment fixation in terms of clinical and the radiological outcomes in unstable thoracolumbar junction burst fractures at a minimum of 1 year follow-up. Records of 52 patients (age: 21-50 years) with thoracolumbar burst fracture (T10–L2) in Magerl Type A fractures underwent posterior pedicle screw fixation including the fractured vertebra. Clinical parameters were back pain using Visual Analogue Score (VAS) and disability using Oswestry disability index (ODI), neurological deficit (using ASIA grade) and radiologic parameters (Cobb angle, the kyphotic deformation and vertebral height) were measured before surgery and at 3, 6 and 12 months  post-operatively. The presence of screw breakage, screw pullout, peri-implant loosening, and rod breakage were considered as criteria for implant failure. The majority of fractures resulted due to falls (31 cases), and the remaining cases resulted from car accidents (21 cases). The fractured vertebral body level was L1, T12, L2, T11, and T10 in 23, 17, 6, 4 and 2 cases and achieved satisfactory clinical outcomes according to the modified Mcnab criteria 18, 25, 6 and 3 cases were considered to have excellent, good, fair, and poor outcome. The mean kyphotic angle at pre-, post-operative and final follow-up was 13.5 ± 6.3, 13.4 ± 4.3, 8.5 ± 6.  The average loss of kyphosis correction was 6.4 ± 5.2° at the final follow-up. The mean pre- and post-operative kyphotic deformation of vertebral body was 5.1 ± 3.2, 4.8 ± 2.3 and at final follow-up was 4.5 ± 4.0 (p&gt;0.05). The mean anterior and posterior vertebral height also showed significant improvements post-operatively, which were maintained at the final follow-up. The mean ODI and VAS scores at the end of 1 year were 17.4%, 1.7 respectively. There was no case of major complication after surgery and during the follow-up period. In conclusion, reduction of unstable thoracolumbar junction burst fracture can be achieved and maintained with the use of short-segment pedicle screw fixation including the fractured vertebra, avoiding the need for anterior reconstruction.</p><p> </p>

scholarly journals Modified Posterior Short-Segment Pedicle Screw Fixation at The Fracture Level for Treatment of Upper Lumbar Burst Fracture

2020 ◽  
Author(s):  
Xubiao Chen ◽  
Shixin Lu ◽  
Songjie Yang ◽  
Junshen Huang ◽  
Jiajun Huang ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Burst Fracture ◽  
Conventional Technique ◽  
Pedicle Screw Fixation ◽  
Conventional Group ◽  
Modified Technique ◽  
Short Segment ◽  
Burst Fractures

Abstract Introduction Upper lumbar burst fractures (L1or L2) are often followed by bilateral pedicle screw fixation at the level of fracture using posterior short-segment pedicle instrumentation. However, it can aggravate the trauma to the fractured vertebra. We have introduced a modified technique of posterior short-segment instrumentation for the treatment of upper lumbar burst fracture. The aim of this study was to compare the clinical and radiologic results of modified technique versus conventional technique using posterior short-segment pedicle instrumentation in the treatment of upper lumbar burst fractures. Methods The data from 64 patients with upper lumbar burst fracture who had undergone posterior short-segment instrumentation from April 2014 to November 2018 in our clinic were evaluated in the present retrospective study. All the patients were divided into 2 groups according to the surgical technique, including 27 patients (modified order of intraoperative pedicle screw placement) in modified group and 37 patients (conventional order of intraoperative pedicle screw placement) in conventional group. The clinical outcomes and radiological parameters were evaluated preoperatively, postoperatively, at 3-month follow-up and final follow-up.Results Technical success was achieved in all 64 patients. The operation time of modified group(130.4±32.4min) is significantly longer than conventional group (115.3±26.8min, p<0.05). Significant improvement in the anterior vertebral height(AVH) ratio (97.9%±6.7% in modified group, 94.1%±7.8% in conventional group, p<0.05) was found postoperatively, (100.1%±9.7% in modified group, 89.6%±6.7% in conventional group, p<0.01) at the 3-month follow-up and(98.8%±7.7% in modified group, 90.9%±7.6% in conventional group, p<0.01) at the final follow-up. And post-operative correction of AVH ratio was significantly better in modified group (45.0%) than in conventional group (38.8%, p<0.01). There was 1 case of wound infection in both groups respectively. No instrument loosening or failure, or breakage was observed during follow-up.Conclusions Modified technique and conventional technique of posterior short-segment pedicle screw fixation for upper lumbar burst fractures both provided immediate stability and reduction of post-traumatic segmental kyphosis. In addition, modified technique of posterior short-segment pedicle screw fixation seems to be a promising method for upper lumbar burst fractures because it led to better reduction of fractured vertebra than in patients who received conventional technique.

scholarly journals “Short Segment pedicle screw fixation for the treatment of unstable thoracolumbar fracture”- a study of 50 cases.

2015 ◽  
Vol 31 (1) ◽  
pp. 30-33
Author(s):  
Sukriti Das ◽  
Md Atikur Rahman ◽  
Md Manirul Islam ◽  
Md Mahfuzur Rahman ◽  
Md Reaz Ahmed Howlader ◽  
...  
Keyword(s):  
Bone Graft ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Burst Fracture ◽  
Pedicle Screw Fixation ◽  
Thoracolumbar Burst Fracture ◽  
Short Segment ◽  
Hardware Failure ◽  
Neurological Improvement ◽  
Frankel Grade

Introduction: Short segment pedicle screw fixation is a popular procedure for treating unstable thoracolumbar burst fracture. But due to lack of adequate neurological improvement, progressive kyphosis and hardware failure- the efficacy of different methods remain debatable. Method : 50 patients with isolated thoracolumbar burst fractures were treated by short segment pedicle screw fixation and transforaminal thoracolumbar inter body fusion (TLIF) between January 2010 to December 2013. All patients were followed up for a minimum 2 years. Demographic data, Neurological improvement (Frankel) grade and Hardware failure related complication were evaluated. Results: All patients recovered with solid bony fusion by inter vertebral bone graft and pedicle screw without complications like misplacement of screw, nerve or vessel lesion or hardware failure. The post-operative radiographic demonstration reveals- good fracture reduction and it was well maintained until the bone graft fusion. Neurological recovery of the one to three Frankel grade was seen in 42 patients with partial neurological deficit. Among the 30 patients 3 grade improvements was seen in 4 patients, 2 grade of improvement was observed in 20 patients and 1 grade of improvement was found in 18 patients. 3 patients with Franke-D on admission showed no improvement. 5 patients with no paraplegia/hemiplegia on admission remained neurological intact. Conclusion: Posterior short segment pedicle fixation in conjunction with TLIF seems to be a feasible option in the management of selected thoracolumbar burst fracture with good neurological improvement. Bangladesh Journal of Neuroscience 2015; Vol. 31 (1): 30-33

scholarly journals Posterior thoracolumbar hemivertebra resection and short-segment fusion in congenital scoliosis: surgical outcomes and complications with more than 5-year follow-up

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Beixi Bao ◽  
Qingjun Su ◽  
Yong Hai ◽  
Peng Yin ◽  
Yaoshen Zhang ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Surgical Outcomes ◽  
Screw Fixation ◽  
Congenital Scoliosis ◽  
Pedicle Screw Fixation ◽  
Rigid Fixation ◽  
Short Segment ◽  
Hemivertebra Resection ◽  
Main Curve

Abstract Background Treatment of congenital hemivertebra is challenging and data on long-term follow-up (≥ 5 years) are lacking. This study evaluated the surgical outcomes of posterior thoracolumbar hemivertebra resection and short-segment fusion with pedicle screw fixation for treatment of congenital scoliosis with over 5-year follow-up. Methods This study evaluated 27 consecutive patients with congenital scoliosis who underwent posterior thoracolumbar hemivertebra resection and short-segment fusion from January 2007 to January 2015. Segmental scoliosis, total main scoliosis, compensatory cranial curve, compensatory caudal curve, trunk shift, shoulder balance, segmental kyphosis, and sagittal balance were measured on radiographs. Radiographic outcomes and all intraoperative and postoperative complications were recorded. Results The segmental main curve was 40.35° preoperatively, 11.94° postoperatively, and 13.24° at final follow-up, with an average correction of 65.9%. The total main curve was 43.39° preoperatively, 14.13° postoperatively, and 16.06° at final follow-up, with an average correction of 60.2%. The caudal and cranial compensatory curves were corrected from 15.78° and 13.21° to 3.57° and 6.83° postoperatively and 4.38° and 7.65° at final follow-up, with an average correction of 69.2% and 30.3%, respectively. The segmental kyphosis was corrected from 34.30° to 15.88° postoperatively and 15.12° at final follow-up, with an average correction of 61.9%. A significant correction (p < 0.001) in segmental scoliosis, total main curve, caudal compensatory curves and segmental kyphosis was observed from preoperative to the final follow-up. The correction in the compensatory cranial curve was significant between preoperative and postoperative and 2-year follow-up (p < 0.001), but a statistically significant difference was not observed between the preoperative and final follow-up (p > 0.001). There were two implant migrations, two postoperative curve progressions, five cases of proximal junctional kyphosis, and four cases of adding-on phenomena. Conclusion Posterior thoracolumbar hemivertebra resection after short-segment fusion with pedicle screw fixation in congenital scoliosis is a safe and effective method for treatment and can achieve rigid fixation and deformity correction.

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.

Vertebroplasty plus short segment pedicle screw fixation in a burst fracture model in cadaveric spines

2015 ◽  
Vol 22 (5) ◽  
pp. 883-888 ◽  
Author(s):  
Andrew J. Grossbach ◽  
Stephanus V. Viljoen ◽  
Patrick W. Hitchon ◽  
Nicole A. DeVries Watson ◽  
Nicole M. Grosland ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Burst Fracture ◽  
Pedicle Screw Fixation ◽  
Fracture Model ◽  
Short Segment

Clinical outcomes and complications associated with pedicle screw fixation—augmented lumbar interbody fusion

2004 ◽  
Vol 1 (3) ◽  
pp. 261-266 ◽  
Author(s):  
Dennis J. Rivet ◽  
David Jeck ◽  
James Brennan ◽  
Adrian Epstein ◽  
Carl Lauryssen
Keyword(s):  
Carbon Fiber ◽  
Pedicle Screw ◽  
Interbody Fusion ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Lumbar Interbody Fusion ◽  
Content Type ◽  
Repeated Surgery ◽  
Fine Print

Object. The authors conducted a prospective study to evaluate the clinical and radiological outcomes and complications associated with uni- and bilateral transforaminal lumbar interbody fusion (TLIF) performed using carbon fiber Brantigan I/F Cages and pedicle screw fixation. Methods. Forty-two consecutive patients who had undergone uni- or bilateral TLIF between February 1999 and July 2000 were prospectively evaluated. Clinical outcome was graded using a modified Prolo Scale, the McGill Pain Index Scale, a follow-up questionnaire, and charts. An independent radiologist assessed radiological outcomes. All patients were followed for at least 1 year. Based on Prolo Scale scores, an excellent or good 1-year outcome was achieved in 73% of patients; 90% of patients responded that they would undergo the procedure again. At 1 year, radiographic fusion was demonstrated in 74% and was statistically related to clinical outcome (p < 0.05). There were no deaths or major hardware failures. Complications requiring repeated surgery included one case of cerebrospinal fluid (CSF) leakage and one case in which the hemovac drain was retained. There were four cases involving minor wound infections, eight involving CSF leaks, and none requiring repeated surgery. On routine follow-up radiography one pedicle screw was found to be broken; the patient remained asymptomatic and fusion occurred. Conclusions. Unilateral and bilateral TLIF involving placement of carbon fiber cages and pedicle screw fixation are effective treatment options in patients with indications for lumbar arthrodesis. The procedures result in acceptable rates of fusion and clinical success, and a minimal incidence of morbidity when performed by an experienced surgeon.

scholarly journals Short segment pedicle screw fixation of thoracolumbar fracture: a case series of 33 patients

2017 ◽  
Vol 3 (4) ◽  
pp. 681
Author(s):  
Naushad Hussain ◽  
Nirmal Dhananjay Patil ◽  
Hiren Patel ◽  
Akash Shakya
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Wedge Angle ◽  
Body Height ◽  
Pedicle Screw Fixation ◽  
Thoracolumbar Fracture ◽  
Vertebral Body Height ◽  
Short Segment ◽  
Screw Insertion

<p class="abstract"><strong>Background:</strong> Pedicle screw instrumentation in case of fracture spine provides stable fixation. However in absence of experience and proper technique of pedicle screw insertion, it is associated with many complications. We aim to study the results of patients with thoracolumbar fracture stabilized with short segment pedicle screw instrumentation.</p><p class="abstract"><strong>Methods:</strong> 33 cases of thoracolumbar wedge compression fracture spine presenting to Nair Hospital were included in the study. All patients were operated by the senior author via a posterior approach and short segment pedicle screw fixation. Patients were followed up for one year.<strong></strong></p><p class="abstract"><strong>Results:</strong> 33 patients with a mean age were 37.6 years of which 3 were females and 30 were males in our study. Fall from height (93.93%) was the most common mode of injury followed by road traffic accident (6.07%). D12 and L1 were the most common vertebrae involved. Statistically significant (p=0.01) correction in the vertebral body height occurred in the immediate postop period and there was 4.1% loss of correction at final follow-up. There was statistically significant improvements in the Regional angle (p=0.03) and anterior wedge angle (p=0.03). Residual regional angle at final follow-up was found to be &gt;5° in 3 patients. Neurological improvement was seen in 23 (74.19%) patients (p=0.01). No improvements were seen in 8 (25.81%) patients. None of our patients had postoperative worsening of the neurological status. None of the patients had pedicle wall breach on final follow up CT scan.</p><p class="abstract"><strong>Conclusions:</strong> Short segment fixation in case of wedge fracture can restore the vertebral body height, mean regional angle and mean anterior wedge angle and provide good outcome. There are poor chances of recovery of patient with Frankel grade A. Meticulous dissection and careful technique of pedicle screw insertion, adequate decompression, good contouring of the rod with correction of kyphosis can provide excellent results.</p>

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