scholarly journals Posterior Instrumentation for Unstable Thoracolumbar Fractures

2018 ◽  
Vol 6 (4) ◽  
pp. 150-155
Author(s):  
Bimal Kumar Pandey ◽  
Anjana Rajbhandari
Keyword(s):  
Posterior Instrumentation ◽  
Thoracolumbar Fractures ◽  
Type B ◽  
Vertebral Height ◽  
Kyphotic Angle ◽  
Short Segment ◽  
Medical College ◽  
Loss Of Correction ◽  
Type C

Background: About 90 percent of all spinal injuries involve the thoracolumbar region. Unstable fractures need surgical treatment to achieve a painless, balanced and stable spine preserving or recovering neurological function, highest degree of spinal motion and to allow early patient mobilization.Objective: This study was carried out to evaluate radiological outcome of posterior instrumentation in thoracolumbar fractures.Methodology: A total of 110 patients with thoracolumbar fracture were included in the study, which was carried out at Kathmandu Medical College Teaching Hospital from December 2011 to December 2016. Unstable Arbeitsgemeinschaft fur Osteosynthesefragen type A and type B fractures were treated with short segment instrumentation and type C with long segment instrumentation. Radiological evaluation of postoperative correction of kyphotic angle and vertebral height was measured and was compared with immediate postoperative correction and loss of correction in two years final follow up.Results: Mean postoperative correction of vertebral kyphotic angle was 25° and loss of correction in final follow up was 5°. Mean postoperative vertebral height correction was 24% and its loss in final follow up was 2%. There was no significant difference in loss of correction of vertebral kyphosis and vertebral height in short segment and long segment fi xation in final follow up.Conclusion: Long segment posterior instrumentation results in good reduction and its maintenance for Arbeitsgemeinschaft fur Osteosynthesefragen type C thoracolumbar fractures whereas similar results can be achieved with short segment posterior instrumentation in type A and type B fractures. Journal of Kathmandu Medical College,Vol. 6, No. 4, Issue 22, Oct.-Dec., 2017, Page: 150-155  

scholarly journals Comparative study of long segment versus short segment posterior fixation of thoracolumbar fractures with pedicle screws

2021 ◽  
Vol 9 (2) ◽  
pp. 77-84
Author(s):  
Vihar SJ ◽  
Naveen DS ◽  
Agrawal NK
Keyword(s):  
Pedicle Screws ◽  
Posterior Fixation ◽  
Rigid Fixation ◽  
Thoracolumbar Fractures ◽  
Kyphotic Angle ◽  
Short Segment ◽  
Duration Of Surgery ◽  
One Year ◽  
Short Segment Fixation

Choice of long or short segment fixation for thoracolumbar fractures, benefits of either of these techniques has been a topic for analysis and assessment. Kyphotic angles in twenty patients diagnosed to have thoracolumbar vertebral fractures between December 2019 to December 2020 in Bapuji hospital and Chigateri general hospital, Davanagere, Karnataka, India were measured pre operatively, post operatively and at one year follow up and assessed. No statistical difference between the degrees of correction of initial kyphotic angle between long segment fixation and short segment posterior fixation in our study was found (p<0.6). Method of fixation of the thoracolumbar vertebral fracture did not correlate with initial degree of kyphosis (p=0.4). Amount of correction loss at one year follow up was found to be statistically significant in short segment fixation (p<0.05). Loss of kyphotic angle at one year follow up was higher in case of short segment fixation than long segment fixation and found to be statistically significant (p<0.005). Our study showed that long segment fixation helps in better correction of the kyphosis angle with lesser chance of loss of correction and can be opted when pedicles aren’t intact at the fracture level, as in cases of burst fractures. Short segment fixation provides better rigid fixation at the site of fracture with increased range of motion at the thoracolumbar segment and can be treatment of choice when the pedicles at the fractured level are intact, as in cases of compression fractures, having benefits of shorter duration of surgery and reduced risks.

Role of Including the Index level in Short Segment Pedicular Fixation in Traumatic Thoraco-Lumbar Fractures

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ayman Abd-El-Ra’ouf EL-Shazly ◽  
Salah Mostafa Hamada ◽  
Ahmed Maged Nagaty ◽  
Ahmed Adel Nabih
Keyword(s):  
Pedicle Screw ◽  
Thoracolumbar Fractures ◽  
Spine Trauma ◽  
Kyphosis Angle ◽  
Short Segment ◽  
Loss Of Correction ◽  
Significant Difference ◽  
Index Level ◽  
Short Segment Fixation ◽  
Fracture Level

Abstract Background It is generally acknowledged that short-segment pedicle screw instrumentation is the preferred surgical method for thoracolumbar fractures. However, the use of short-segment instrumentation with or without intermediate screws at the fracture level remains controversial. This review will evaluate the evidence available to date regarding the efficacy of including the fracture level in trans-pedicular screw short segment fixation, to assess clinical and radiological outcome. Objectives Our primary objective is evaluating the efficacy and outcome of including the fractured level vertebra in short segment fixation. And concerns regarding the use of pedicle screws into the fractured vertebra as to whether it is safe to insert a screw through a broken bone. Our secondary objective analyzing the importance of posterior pedicle screw fixation in unstable thoracolumbar fractures. Methods The following electronic databases will be searched from 1992 to 2018: PubMed, Google scholar search engine. Cochrane database of systematic reviews, EMBASE and science Direct, using the keywords “TLICS”, "index screw", “short segment fixation”, "Thoracolumbar spine trauma", "traumatic spine injury", "spinal cord injury", "spine trauma", "role", “reliability”.Studies will be eligible if they contain the target keywords in title or abstract, addressing our age group. Afterwards the full text of the articles will be reviewed to exclude full texts not fulfilling the criteria or deviating from the initial impression taken from the title/abstract reviewing. References/bibliography of the selected articles will be examined to evaluate potential for further research and possible inclusion in the analysis. Any differences will be sorted by discussion between study team (student, director, and co-directors). Results A total of 3010 studies were screened for eligibility , 8 studies were included in our systematic review for comparing the short segment fixation “including” the fracture level with “conventional” methods whether short or long segment fixation. Overall study population reached 512 patients. Analysis showed comparable results regarding clinical picture and radiography, showing highly statistically significant difference in favor of “including” index level in fixation in post operative kyphosis angle correction, loss of correction of kyphosis angle through follow up until 2 years and loss of correction of AVH, also statistically significant difference in rate of implant failure in favor for “including” group, and with no significant difference in operative time , blood loss and VAS for post-operative pain. Conclusion We conclude that Short segment fixation including the fracture level is a promising surgical option when it comes to thoraco-lumbar unstable fractures. In conclusion, inclusion of the fracture level into the construct offers a better kyphosis correction, in addition to fewer instrument failures, without additional complications, and with a comparable-if not better-clinical outcome, the radiologic correction achieved is maintained even at the end of 2 years and reflected in good functional outcomes. We recommend insertion of screws into pedicles of the fractured thoracolumbar vertebra when considering a short segment posterior fixation, especially in Magerl type C fractures. Large population prospective randomized controlled studies and clinical trials are recommended for more high level evidence data.

Feasibility, safety, and changes in systolic blood pressure associated with endovascular revascularization of symptomatic and chronically occluded cervical internal carotid artery using a newly suggested radiographic classification of chronically occluded cervical internal carotid artery: pilot study

2019 ◽  
Vol 130 (5) ◽  
pp. 1468-1477 ◽  
Author(s):  
David Hasan ◽  
Mario Zanaty ◽  
Robert M. Starke ◽  
Elias Atallah ◽  
Nohra Chalouhi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Type B ◽  
Type D ◽  
Type C ◽  
Radiographic Classification

OBJECTIVEThe overall risk of ischemic stroke from a chronically occluded internal carotid artery (COICA) is around 5%–7% per year despite receiving the best available medical therapy. Here, authors propose a radiographic classification of COICA that can be used as a guide to determine the technical success and safety of endovascular recanalization for symptomatic COICA and to assess the changes in systemic blood pressure following successful revascularization.METHODSThe radiographic images of 100 consecutive subjects with COICA were analyzed. A new classification of COICA was proposed based on the morphology, location of occlusion, and presence or absence of reconstitution of the distal ICA. The classification was used to predict successful revascularization in 32 symptomatic COICAs in 31 patients, five of whom were female (5/31 [16.13%]). Patients were included in the study if they had a COICA with ischemic symptoms refractory to medical therapy. Carotid artery occlusion was defined as 100% cross-sectional occlusion of the vessel lumen as documented on CTA or MRA and confirmed by digital subtraction angiography.RESULTSFour types (A–D) of radiographic COICA were identified. Types A and B were more amenable to safe revascularization than types C and D. Recanalization was successful at a rate of 68.75% (22/32 COICAs; type A: 8/8; type B: 8/8; type C: 4/8; type D: 2/8). The perioperative complication rate was 18.75% (6/32; type A: 0/8 [0%]; type B: 1/8 [12.50%]; type C: 3/8 [37.50%], type D: 2/8 [25.00%]). None of these complications led to permanent morbidity or death. Twenty (64.52%) of 31 subjects had improvement in their symptoms at the 2–6 months’ follow-up. A statistically significant decrease in systolic blood pressure (SBP) was noted in 17/21 (80.95%) patients who had successful revascularization, which persisted on follow-up (p = 0.0001). The remaining 10 subjects in whom revascularization failed had no significant changes in SBP (p = 0.73).CONCLUSIONSThe pilot study suggested that our proposed classification of COICA may be useful as an adjunctive guide to determine the technical feasibility and safety of revascularization for symptomatic COICA using endovascular techniques. Additionally, successful revascularization may lead to a significant decrease in SBP postprocedure. A Phase 2b trial in larger cohorts to assess the efficacy of endovascular revascularization using our COICA classification is warranted.

scholarly journals The Loss of Correction in Thoracolumbar Burst Fracture Treated by Surgery. Can We Predict It?

2014 ◽  
Vol 60 (3) ◽  
pp. 99-101
Author(s):  
S. Anghel ◽  
D. Márton
Keyword(s):  
Anterior Approach ◽  
Burst Fracture ◽  
Regression Equations ◽  
Kyphosis Angle ◽  
Short Segment ◽  
Loss Of Correction ◽  
Short Segment Fixation ◽  
Lumbar Fractures ◽  
Fracture Level

Abstract Objective: This paper aims to differentially depict potential patterns of the loss of correction in surgically treated thoraco-lumbar burst fractures. These may eventually serve to foreseeing and even forestalling loss of correction. Methods: The study focused on 253 patients with surgically treated thoraco-lumbar fractures. This cohort of patients was clustered in four subgroups according to the fracture spine segment (T11-L1 or L1-L2) and surgery type (short segment fi xation or anterior approach). Relevant recorded and processed data were the fracture level, post-operative (Kpo) and last follow-up (Kf) kyphosis angle values. Correlation, regression and determination testing were performed for the last follow-up kyphosis angle and post-operative kyphosis angle, and regression equations were determined for each subgroup of patients. Results: The patterns of loss of correction were described through the following equations: Kf = 0.95*Kpo + 3.2° for the T11-L1 level fractured vertebrae treated by posterior short segment fixation; Kf = 0.98*Kpo + 3.4° for the L1-L2 level fractured vertebrae treated by posterior short segment fixation; Kf = 1.1*Kpo + 1.6° for the T11-L1 level fractured vertebrae treated by anterior approach; and Kf = 0.7*Kpo + 2.8° for the L1-L2 level fracture vertebrae treated by anterior approach. Conclusions: The loss of correction may be predicted, to a certain extent, for thoraco-lumbar fractured vertebrae treated surgically. The bestfit equations depicted for both type of surgery (short segment fixation and anterior approach) and both spinal segments (T11-L1 and L2-L3) are significantly different than the equations delineated for the collapse of non-surgically treated fractures.

scholarly journals Comparison of Unipedicular and Bipedicular Percutaneous Kyphoplasty for Kummell's Disease

2020 ◽  
Author(s):  
Dan Pan ◽  
Xiaojie Ouyang ◽  
Qinghua Huang ◽  
Dayong Chen
Keyword(s):  
Bone Cement ◽  
Operative Time ◽  
Cement Leakage ◽  
Vertebral Height ◽  
Kyphotic Angle ◽  
Injection Volume ◽  
Kummell’S Disease ◽  
Kümmell’S Disease ◽  
Better Than

Abstract Background: Percutaneous kyphoplasty (PKP) is effective for the treatment of Kummell's disease. However, controversy remains regarding whether a unipedicular or bipedicular PKP is superior.Methods: A retrospective study was performed to review 40 patients with stage I and II Kummell's disease who underwent PKP in our hospital from January 2015 to June 2018. Based on the transpedicular approach of PKP, those patients were randomly divided into unipedicular group (n = 19) and bipedicular group (n = 21) . Operative time, bone cement injection volume and cement leakage rate were compared in the two groups. Pre- and post-operative visual analogue score (VAS), local kyphotic angle and average vertebral height were also evaluated.Results: All patients underwent surgery successfully. Compared with preoperative condition, VAS was significantly decreased at 1 day after operation and the last follow-up in both groups (P < 0.05) , and local kyphotic angle and average vertebral height were restored markedly (P < 0.05). Operative time of both groups had no significant difference (P > 0.05). Bone cement injection volume was larger in bipedicular group (P < 0.05). At 1 day after operation and the last follow-up , the local kyphotic angle and average vertebral height in bipedicular group were restored better than those in unipedicular group (P < 0.05). There were 4 cases of cement leakage in both groups, with leakage rates of 21.1% and 19.0%, respectively, and the difference was not significant (P > 0.05).Conclusion: Both unipedicular and bipedicular PKP are effective for treating patients with stage I and II Kummell's disease, while postoperative pain relief and imaging results in bipedicular group were better than those in unipedicular group.

The influence of correction loss in thoracolumbar fractures treated by posterior instrumentation: A minimum 7-year follow-up

2011 ◽  
Vol 18 (4) ◽  
pp. 500-503 ◽  
Author(s):  
Jinhui Shi ◽  
Xin Mei ◽  
Jiayong Liu ◽  
Weimin Jiang ◽  
Muhammad Z Moral ◽  
...  
Keyword(s):  
Posterior Instrumentation ◽  
Thoracolumbar Fractures ◽  
Correction Loss

scholarly journals Posterior Vertebrectomy and Circumferential Fusion for the Treatment of Advanced Thoracolumbar Kümmell Disease with Neurologic Deficit

2017 ◽  
Vol 11 (4) ◽  
pp. 634-640 ◽  
Author(s):  
Yongjae Cho
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Neurologic Deficit ◽  
Vertebral Height ◽  
Kyphotic Angle ◽  
Vas Score ◽  
Circumferential Fusion ◽  
Mesh Cage

<sec><title>Study Design</title><p>Single-center, retrospective case series.</p></sec><sec><title>Purpose</title><p>To investigate the effectiveness of posterior vertebrectomy and circumferential fusion in patients with advanced Kümmell disease with neurologic deficit.</p></sec><sec><title>Overview of Literature</title><p>Various surgical options exist for the treatment of Kümmell disease, and determination of the appropriate treatment is based on the clinical and radiologic status of the patient. However, surgical intervention is required for patients with advanced Kümmell disease accompanied by neurologic deficit.</p></sec><sec><title>Methods</title><p>We retrospectively analyzed 22 neurologically compromised patients with advanced Kümmell disease who were treated surgically at Ewha Womans Hospital between January 2011 and January 2014. The surgical approach used by us was a posterior vertebrectomy with mesh cage insertion and segmental cement-augmented pedicle screw fixation. The tissue from the corpectomy was histopathologically examined. Anterior vertebral height, kyphotic angle, visual analog scale (VAS) score, and the Frankel classification were used to evaluate the efficacy of the procedure.</p></sec><sec><title>Results</title><p>The mean follow-up period was 26 months (range, 13–40 months). VAS score, anterior vertebral height, kyphotic angle, and neurologic state were significantly improved immediately postoperatively and at the last follow-up compared with preoperatively (<italic>p</italic>&lt;0.05). Most patients exhibited intravertebral clefts on imaging, and postoperative pathology revealed bone necrosis.</p></sec><sec><title>Conclusions</title><p>Posterior vertebrectomy with mesh cage insertion and segmental cement-augmented pedicle screw fixation is an effective approach for treating patients with advanced Kümmell disease with neurologic deficit.</p></sec>

Sign in / Sign up

Export Citation Format

Share Document