scholarly journals Finite Element Analysis of the Indirect Reduction of Posterior Pedicle Screw Fixation for a Thoracolumbar Burst Fracture

2020 ◽  
Author(s):  
Yuanzheng Song ◽  
Wei Li ◽  
Fahao Zhu
Keyword(s):  
Intervertebral Disc ◽  
Vertebral Body ◽  
Spinal Canal ◽  
Burst Fracture ◽  
Posterior Longitudinal Ligament ◽  
Neurological Dysfunction ◽  
Indirect Reduction ◽  
Thoracolumbar Burst Fracture ◽  
Maximum Displacement ◽  
Burst Fractures

Abstract Background: Because burst fractures often involve damage to the column and posterior structures of the spine, the fracture block may invade the spinal canal and compress the spinal cord or the cauda equina, causing corresponding neurological dysfunction. When a thoracolumbar burst fracture is accompanied by the presence of bone in the spinal canal, whether posterior surgery requires spinal canal incision decompression remains controversial.Methods: Computed tomography (CT) images of the thoracolumbar spine of a 31-year-old male with an L1 burst fracture and Mimics 10.0 were used to establish a three-dimensional fracture model for simulating the indirect reduction process. The model was imported into Ansys 10.0, and a 1-10 mm displacement was loaded 10° behind the Z-axis on the upper endplate of the L1 vertebral body to simulate position reduction and open reduction. The displacement and stress changes in the intervertebral disc, fractured vertebral body and posterior longitudinal ligament were observed during reduction.Results: Under a displacement loaded 10° behind the Z-axis, the maximum stress in the vertebral body was concentrated on the upper disc of the injured vertebrae. The maximum displacement corresponded to the anterior edge of the vertebral body of the injured vertebrae, and the vertebral body height and the anterior lobes were essentially restored. When the displacement load was applied in the positive Z-axis direction, the maximum displacement corresponded to the posterior longitudinal ligament behind the injured vertebrae. Under a 6 mm load, the posterior longitudinal ligament displacement was 11.3 mm. Under an 8 mm load, this displacement significantly increased to 15.0 mm, and the vertebral stress was not concentrated on the intervertebral disc.Conclusions: The reduction of thoracolumbar burst fractures by positioning and distraction allowed the injured vertebrae to be restored to the normal height and kyphotic angle. The reduction of the posterior longitudinal ligament can move the bone block in the spinal canal into the reset space and yield good reset results.

scholarly journals Outcome and Predictive Factors in Rapid Progressive Cervical Spondylotic Myelopathy: A Retrospective Case-Control Study

2020 ◽  
Author(s):  
Haimiti Abuduaini ◽  
Hao Liu ◽  
Beiyu Wang ◽  
Yang Meng ◽  
Yi Yang ◽  
...  
Keyword(s):  
Intervertebral Disc ◽  
Compression Ratio ◽  
Spinal Canal ◽  
Signal Intensity ◽  
Cervical Spondylotic Myelopathy ◽  
Neurological Deterioration ◽  
Neurological Dysfunction ◽  
Canal Diameter ◽  
History Of ◽  
Disc Level

Abstract Background: To evaluate epidemiological, clinical and radiographic features in the development and prognosis of rapid progressive cervical spondylotic myelopathy (rp-CSM).Methods: A retrospective study of 175 patient records was performed between March 2011 and January 2017. Patients were divided into rp-CSM group and chronic CSM (c-CSM) group according to the deterioration time and severity of preoperative neurological dysfunction. After selection, 25 rp-CSM patients were matched to a control group of 75 patients with c-CSM. The clinical outcomes were assessed by the Modified Japanese Orthopaedic Association (mJOA) score at six different follow-up time points. The imaging parameters including Torg-Pavlov Ratio (TPR) on conventional lateral x-ray and magnetic resonance images (MRI), intervertebral disc level compression ratio and increased signal intensity (ISI) on T2W1 were analyzed between the two groups, and predictors for rapid neurological dysfunction in CSM patients were evaluated using multivariate analysis.Results: Twenty-five patients experienced rp-CSM (18 males; median age 59.04 ± 12.81 years) and were matched with Seventy-five control subjects that with CSM without rapid progression (54 males; median age 56.88 ± 12.31 years). The average time to develop severe neurological deterioration was 0.8 month in rp-CSM group and 24 month in c-CSM group (p=0.001), preoperative mJOA were 6 in rp-CSM patients and 12 in c-CSM patients (p=0.014) and rp-CSM patients demonstrated worse outcomes than the controls in one year after surgery (mJOA improvement rate 54.5% and 80%, p=0.021). There were no differences between the two groups except the history of diabetes and the long-term smoking in basic condition, radiographic measurements signified that TPR MRI, intervertebral disc level compression ratio and increased signal intensity (ISI) on T2W1 were inferior in patients with rp-CSM than patients with c-CSM. Regression analysis verified that the history of diabetes, TPR MRI < 0.4, compression ratio ≥50%, the sagittal diameter of ISI ≥50% of spinal canal diameter on T2W1 have significant correlations with the rapid progressive neurological dysfunction in patients with CSM. Conclusion: The prognosis of rapid progressive CSM is worse than that of common chronic CSM. The rapid neurological deterioration can be identified by TPR MRI (< 0.4), compression ratio (≥50%), sagittal diameter of ISI (≥50% of spinal canal diameter). Besides, a history of diabetes was also a negative factor for these patients.

Reduction of Bone Retropulsed Into the Spinal Canal in Thoracolumbar Vertebral Body Compression Burst Fractures

Spine ◽  
1995 ◽  
Vol 20 (15) ◽  
pp. 1699-1703 ◽  
Author(s):  
Markku J. Vornanen ◽  
Ole M. Böstman ◽  
Pertti J. Myllynen
Keyword(s):  
Vertebral Body ◽  
Spinal Canal ◽  
Burst Fractures

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).

scholarly journals Biomechanical study of a semi-rigid stabilization system combined with transpedicular intracorporeal bone grafting for thoracolumbar burst fractures

2020 ◽  
Author(s):  
xiaoyong zheng ◽  
qingwen yu ◽  
zhi zhang
Keyword(s):  
Bone Grafting ◽  
Burst Fracture ◽  
Axial Rotation ◽  
Biomechanical Study ◽  
Stabilization System ◽  
Thoracolumbar Burst Fracture ◽  
Lateral Bending ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Flexion Extension

Abstract Background: For fresh thoracolumbar burst fracture, a new method which can not only promote the fracture healing, but also retain the movement segment, and restore the spinal movement function to the maximum extent is needed. The purpose of this study is to determine the performance of stabilization of a semi-rigid stabilization system combined with transpedicular intracorporeal bone grafting for thoracolumbar burst fractures.Methods Six thoracolumbar cadaver spines were used for testing. A controlled L2 burst fracture was created. The L1-3 motions were determined.Results In extension, flexion and lateral bending, the semi-rigid fixator stabilized the segment to a range of motion(ROM) and neutral zone(NZ) below the magnitude of the intact spine, but showed increased ROM and NZ of axial rotation (P < 0.05) compared with the intact spine.Conclusions Restoration of stability with the semi-rigid dynamic system combined with transpedicular intracorporeal bone grafting is possible in flexion, extension, right and left lateral bending for thoracolumbar burst fracture but for axial rotation.

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.

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