scholarly journals Biomechanical comparison of short-segment posterior fixation including the fractured level and circumferential fixation for unstable burst fractures of the lumbar spine in a calf spine model

2016 ◽  
Vol 25 (5) ◽  
pp. 602-609 ◽  
Author(s):  
Azad Sait ◽  
Nadipi Reddy Prabhav ◽  
Vijay Sekharappa ◽  
Reshma Rajan ◽  
N. Arunai Nambi Raj ◽  
...  
Keyword(s):  
Burst Fracture ◽  
Thoracolumbar Spine ◽  
Axial Rotation ◽  
Posterior Fixation ◽  
Lateral Flexion ◽  
Short Segment ◽  
Burst Fractures ◽  
Flexion Extension ◽  
Group A ◽  
Group B

OBJECTIVE There has been a transition from long- to short-segment instrumentation for unstable burst fractures to preserve motion segments. Circumferential fixation allows a stable short-segment construct, but the associated morbidity and complications are high. Posterior short-segment fixation spanning one level above and below the fractured vertebra has led to clinical failures. Augmentation of this method by including the fractured level in the posterior instrumentation has given promising clinical results. The purpose of this study is to compare the biomechanical stability of short-segment posterior fixation including the fractured level (SSPI) to circumferential fixation in thoracolumbar burst fractures. METHODS An unstable burst fracture was created in 10 fresh-frozen bovine thoracolumbar spine specimens, which were grouped into a Group A and a Group B. Group A specimens were instrumented with SSPI and Group B with circumferential fixation. Biomechanical characteristics including range of motion (ROM) and load-displacement curves were recorded for the intact and instrumented specimens using Universal Testing Device and stereophotogrammetry. RESULTS In Group A, ROM in flexion, extension, lateral flexion, and axial rotation was reduced by 46.9%, 52%, 49.3%, and 45.5%, respectively, compared with 58.1%, 46.5%, 66.6%, and 32.6% in Group B. Stiffness of the construct was increased by 77.8%, 59.8%, 67.8%, and 258.9% in flexion, extension, lateral flexion, and axial rotation, respectively, in Group A compared with 80.6%, 56.1%, 82.6%, and 121.2% in Group B; no statistical difference between the two groups was observed. CONCLUSIONS SSPI has comparable stiffness to that of circumferential fixation.

scholarly journals Short Segment versus Long Segment Posterior Pedicle Screws Fixation for Treatment of Thoracolumbar Burst Fracture: A Comparative Prospective Study

2020 ◽  
Vol 9 (2) ◽  
pp. 1-6
Author(s):  
Arvind Singh ◽  
Shiv Kumar Bali ◽  
Subhajit Maji ◽  
Kaustubh Ahuja ◽  
Nagaraj Manju Moger ◽  
...  
Keyword(s):  
Blood Loss ◽  
Burst Fracture ◽  
Thoracolumbar Spine ◽  
Posterior Fixation ◽  
Short Segment ◽  
Kyphosis Correction ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B ◽  
Anterior Column Reconstruction

Background: The surgical treatment of unstable burst fracture (TLICS >4) of the thoracolumbar vertebrae remain controversial. This study is aimed to compare the short segment versus long-segment posterior fixation for thoracolumbar burst fracture.The objective of the study is to study comparison of outcome of the Short-Segment Posterior Fixation (SSPF) versus Long-Segment Posterior Fixation (LSPF) for treatment of thoracolumbar burst fracture in term of surgical, radiological, neurological and functional outcome. Subjects & Methods: In this prospective study, we included 32 patients with Burst fracture AO type A3, A4 of Thoracolumbar spine (T10-L2), who underwent posterior pedicle screw fixation for Burst fracture Thoracolumbar spine. A total of 18 of the patients underwent Short-Segment Posterior Fixation (SSPF) (Group A); group A is further divided into three subgroups A1: short-segment only(n=10), A2: short-segment with index screw(n=4) and A3: short-segment with anterior column reconstruction(n=4) with cage, Whereas 14 patients had Long-Segment Posterior Fixation (LSPF) (Group B). Surgical (duration of surgery, blood loss, complication), Clinical (Oswestry questionnaire, spinal cord independent measuring scale), radiological (percentage of anterior body height compression, kyphosis correction loss, Mc Cormack classification) and Neurological (Frankel grading) outcomes were analyzed. Results:  The operative time Group A (159.85 min  22.5) was significantly shorter than Group B (198.7  31.5).  Blood loss was significantly less in Group A (478 ml   259.3) than Group B (865ml   275.7). Kyphosis Correction loss at 6th month follow up in Group A (subgroup A1: 10.7deg  6.2, subgroup A2: 7.1deg  7.4 and subgroup A3: Subgroup A3: 6.1deg  5.2) was higher than that of group B (6.2deg 6.3). Complication (surgical site infection) occurred in Two patients in group B. There was no significant difference in terms of improvement in functional and neurological outcomes among both groups. The functional outcomes as per the SCIM and ODI score at 6th month follow up in group A: 74.7 +-22.29, 31.5+-13.73 respectively, and group B: 73.8+-26.07, 26.7+-17.9, respectively. Conclusion: Short-Segment Posterior Fixation (SSPF) is a significantly decreased duration of surgery and blood loss compare with Long-Segment Posterior Fixation (LSPF). Loss of kyphosis correction in Short-Segment Posterior Fixation (SSPF) may be decreased with index screws or anterior column reconstruction.

Biomechanical comparison of three fixation techniques for unstable thoracolumbar burst fractures

2008 ◽  
Vol 8 (4) ◽  
pp. 341-346 ◽  
Author(s):  
Frank L. Acosta ◽  
Jenni M. Buckley ◽  
Zheng Xu ◽  
Jeffrey C. Lotz ◽  
Christopher P. Ames
Keyword(s):  
Burst Fracture ◽  
Axial Rotation ◽  
Short Segment ◽  
Thoracolumbar Burst Fractures ◽  
Spinal Reconstruction ◽  
Burst Fractures ◽  
Flexion Extension ◽  
Circumferential Fusion ◽  
Fixation Techniques ◽  
Biomechanical Comparison

Object Increased structural stability is considered sufficient justification for higher-risk surgical procedures, such as circumferential fixation after severe spinal destabilization. However, there is little biomechanical evidence to support such claims, particularly after traumatic lumbar burst fracture. The authors sought out to compare the biomechanical performance of the following 3 fixation strategies for spinal reconstruction after decompression for an unstable thoracolumbar burst fracture: 1) short-segment anterolateral fixation; 2) circumferential fixation; and 3) extended anterolateral fixation. Methods Thoracolumbar spines (T10–L4) from 7 donors (mean age at death 64 ± 6 years; 1 female and 6 males) were tested in pure moment loading in flexion–extension, lateral bending, and axial rotation. Thoracolumbar burst fractures were surgically induced at L-1, and testing was repeated sequentially for each of the following fixation techniques: short-segment anterolateral, circumferential, and extended anterolateral. Primary and coupled 3D motions were measured across the instrumented site (T12–L2) and compared across treatment groups. Results Circumferential and extended anterolateral fixations were statistically equivalent for primary and off-axis range-of-motions in all loading directions, and short-segment anterolateral fixation offered significantly less rigidity than the other 2 methods. Conclusions The results of this study strongly suggest that extended anterolateral fixation is biomechanically comparable to circumferential fusion in the treatment of unstable thoracolumbar burst fractures with posterior column and posterior ligamentous injury. In cases in which an anterior procedure may be favored for load sharing or canal decompression, extension of the anterior instrumentation and fusion one level above and below the unstable segment can result in near equivalent stability to a 2-stage circumferential procedure.

A comparison of single and incremental impact approaches for producing experimental thoracolumbar burst fractures

2007 ◽  
Vol 7 (2) ◽  
pp. 199-204 ◽  
Author(s):  
Xiang-Yang Wang ◽  
Li-Yang Dai ◽  
Hua-Zi Xu ◽  
Yong-Long Chi
Keyword(s):  
Burst Fracture ◽  
Axial Rotation ◽  
Similar Degree ◽  
Thoracolumbar Burst Fractures ◽  
Single Impact ◽  
Burst Fractures ◽  
Flexion Extension ◽  
The Impact ◽  
Flexibility Parameters

Object. Experimental burst fracture models are often developed by using either single or incremental impacts. In both protocols, the weight-drop technique produces the impact. However, to the authors' knowledge in no study have researchers attempted to compare the equivalence of the spine burst fracture produced using the different impact protocols. This study was performed to investigate whether the single and incremental trauma approaches produce equivalent degrees of severity in thoracolumbar burst fractures. Methods. Twenty bovine thoracolumbar spines comprising three vertebrae were divided evenly into the single impact and incremental impact groups. The specimens in the incremental impact group were subjected to three axial compressive impacts of increasing energy (78.4, 107.8, and 137.2 J), whereas specimens in the other group were subjected to a single impact (137.2 J). Before and after the final trauma, multidirectional flexibility of each specimen was measured under flexion/extension, right/left lateral bending, and right/left axial rotation, thus quantifying the instability of the fracture. The flexibility parameters were then compared between the two groups. Results. A significant increase in flexibility parameters was found after the final trauma in both groups, indicating the instability of the spine (p < 0.01). No significant differences in flexibility parameters were observed in either intact status or injured status between the two groups (p > 0.05). Conclusions. In this study the authors have confirmed that the single and incremental impact protocols produced a similar degree of severity in producing an in vitro bovine burst fracture. The results of this study support the use of the incremental impact protocol in future experimental biomechanical studies.

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 Comparison of the Therapeutic Effects of Short-Segment Posterior Fixation With Monoaxial Pedicle Screws or Polyaxial Pedicle Screws via Injured Vertebra on Thoracolumbar Fracture

2020 ◽  
Author(s):  
Wenye Yao ◽  
Runsheng Guo ◽  
Qi Lai ◽  
Bin Zhang
Keyword(s):  
Pedicle Screw ◽  
Pedicle Screws ◽  
Thoracolumbar Fracture ◽  
Posterior Fixation ◽  
Therapeutic Effects ◽  
Vertebral Endplate ◽  
Short Segment ◽  
Group A ◽  
Group B ◽  
Fracture Level

Abstract Purpose: To evaluate the therapeutic effects of short-segment posterior fixation with monoaxial pedicle screw or polyaxial pedicle screw via injured vertebra on thoracolumbar fracture.Methods: All patients who underwent short-segment posterior fixation with monoaxial pedicle screws or polyaxial pedicle screws in the injured vertebra of a thoracolumbar fracture (T12-L2). The clinical and radiological data such as the correction of deformity, sagittal profle and record of the perioperative morbidity of the patients were analyzed.Results: There were 63 patients (21 males and 42 females) with an average age of 44.7 years and were categorised into two groups: monoaxial pedicle screws group (group A) and polyaxial pedicle screws group (group B). There were no significant differences in age, gender, fracture site, TLISS Score, ASIA Score, AO Classification, hospital stay, Injury-to-operation intereval, and associated injury between the two groups (P>0.05). Howere, compared with group B, the injury vertebral endplate centre ratio significantly increased postoperatively and at the final follow-up (P<0.05) in group A.Conclusion: Short-segment posterior fixation with monoaxial or polyaxial pedicle screws via the fracture level for thoracolumbar fracture can achieve kyphosis correction, reduce sagittal alignment correction failure, and maintain anterior vertebral height. The insertion of monoaxial pedicle screws at the fracture level after thoracolumbar vertebral fracture has a flick up ffect on the central vertebral body of the injured vertebrae, which is beneficial to the recovery of the vertebral endplate.

scholarly journals A comparison of monoaxial and polyaxial pedicle screws in thoracolumbar fracture

2020 ◽  
Author(s):  
Wenye Yao ◽  
Runsheng Guo ◽  
Qi Lai ◽  
Banglin Xie ◽  
Zhi Yi ◽  
...  
Keyword(s):  
Pedicle Screws ◽  
Thoracolumbar Fracture ◽  
Posterior Fixation ◽  
Vertebral Endplate ◽  
Short Segment ◽  
Thoracolumbar Injury ◽  
Group A ◽  
Group B ◽  
Fracture Level

Abstract Purpose: To evaluate the use of short-segment posterior fixation with monoaxial and polyaxial pedicle screws in thoracolumbar fractures Methods: All patients who underwent short-segment posterior fixation with monoaxial pedicle screws or polyaxial pedicle screws in the injured vertebra of a thoracolumbar fracture (T12-L2) in our hospital between June 2012 and December 2018 were categorised into two groups: monoaxial pedicle screws group (group A) and polyaxial pedicle screws group (group B). We compared the Thoracolumbar Injury Severity Score (TLISS), American Spinal Injury Association (ASIA) score, the fracture level, Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, hospital stay, injury-to-operation interval, and associated injuries between the two groups. In addition, the prevertebral height ratio, the injured vertebra Cobb angle, and the injured vertebral endplate centre ratio were measured preoperatively, postoperatively, and at the final follow-up. Results: There were 63 patients (21 males and 42 females) with an average age of 44.7 years. Compared with group B, the injury vertebral endplate centre ratio significantly increased postoperatively and at the final follow-up (P<0.05) in group A. Conclusion: Short-segment posterior fixation with monoaxial or polyaxial pedicle screws via the fracture level for thoracolumbar fracture can achieve kyphosis correction, reduce sagittal alignment correction failure, and maintain anterior vertebral height. The insertion of monoaxial pedicle screws at the fracture level after thoracolumbar vertebral fracture has a flick up effect on the central vertebral body of the injured vertebrae, which is beneficial to the recovery of the vertebral endplate.

Treatment of Thoracolumbar Burst Fractures with Polymethyl Methacrylate Vertebroplasty and Short-segment Pedicle Screw Fixation

Neurosurgery ◽  
2003 ◽  
Vol 53 (6) ◽  
pp. 1354-1361 ◽  
Author(s):  
Der-Yang Cho ◽  
Wuen-Yen Lee ◽  
Pon-Chun Sheu
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Vertebral Height ◽  
Short Segment ◽  
Thoracolumbar Burst Fractures ◽  
Kyphosis Correction ◽  
Burst Fractures ◽  
Group A ◽  
Group B

Abstract OBJECTIVES We aimed to evaluate the efficacy of reinforcing short-segment pedicle screw fixation with polymethyl methacrylate (PMMA) vertebroplasty in patients with thoracolumbar burst fractures. METHODS We enrolled 70 patients with thoracolumbar burst fractures for treatment with short-segment pedicle screw fixation. Fractures in Group A (n = 20) were reinforced with PMMA vertebroplasty during surgery. Group B patients (n = 50) were not treated with PMMA vertebroplasty. Kyphotic deformity, anterior vertebral height, instrument failure rates, and neurological function outcomes were compared between the two groups. RESULTS Kyphosis correction was achieved in Group A (PMMA vertebroplasty) and Group B (Group A, 6.4 degrees; Group B, 5.4 degrees). At the end of the follow-up period, kyphosis correction was maintained in Group A but lost in Group B (Group A, 0.33-degree loss; Group B, 6.20-degree loss) (P = 0.0001). After surgery, greater anterior vertebral height was achieved in Group A than in Group B (Group A, 12.9%; Group B, 2.3%) (P &lt; 0.001). During follow-up, anterior vertebral height was maintained only in Group A (Group A, 0.13 ± 4.06%; Group B, −6.17 ± 1.21%) (P &lt; 0.001). Patients in both Groups A and B demonstrated good postoperative Denis Pain Scale grades (P1 and P2), but Group A had better results than Group B in terms of the control of severe and constant pain (P4 and P5) (P &lt; 0.001). The Frankel Performance Scale scores increased by nearly 1 in both Groups A and B. Group B was subdivided into Group B1 and B2. Group B1 consisted of patients who experienced instrument failure, including screw pullout, breakage, disconnection, and dislodgement (n = 11). Group B2 comprised patients from Group B who did not experience instrument failure (n = 39). There were no instrument failures among patients in Group A. Preoperative kyphotic deformity was greater in Group B1 (23.5 ± 7.9 degrees) than in Group B2 (16.8 ± 8.40 degrees), P &lt; 0.05. Severe and constant pain (P4 and P5) was noted in 36% of Group B1 patients (P &lt; 0.001), and three of these patients required removal of their implants. CONCLUSION Reinforcement of short-segment pedicle fixation with PMMA vertebroplasty for the treatment of patients with thoracolumbar burst fracture may achieve and maintain kyphosis correction, and it may also increase and maintain anterior vertebral height. Good Denis Pain Scale grades and improvement in Frankel Performance Scale scores were found in patients without instrument failure (Groups A and B2). Patients with greater preoperative kyphotic deformity had a higher risk of instrument failure if they did not undergo reinforcement with vertebroplasty. PMMA vertebroplasty offers immediate spinal stability in patients with thoracolumbar burst fractures, decreases the instrument failure rate, and provides better postoperative pain control than without vertebroplasty.

Management of fresh odontoid fractures using posterior C1–2 fixation without fusion: a long-term clinical follow-up study

2021 ◽  
pp. 1-11
Keyword(s):  
Scale Score ◽  
Neck Disability Index ◽  
Implant Removal ◽  
Odontoid Fractures ◽  
Significant Difference ◽  
Flexion Extension ◽  
Group A ◽  
Group B

OBJECTIVE Posterior C1–2 fixation without fusion makes it possible to restore atlantoaxial motion after removing the implant, and it has been used as an alternative technique for odontoid fractures; however, the long-term efficacy of this technique remains uncertain. The purpose of the present study was to explore the long-term follow-up outcomes of patients with odontoid fractures who underwent posterior C1–2 fixation without fusion. METHODS A retrospective study was performed on 62 patients with type II/III fresh odontoid fractures who underwent posterior C1–2 fixation without fusion and were followed up for more than 5 years. The patients were divided into group A (23 patients with implant removal) and group B (39 patients without implant removal) based on whether they underwent a second surgery to remove the implant. The clinical outcomes were recorded and compared between the two groups. In group A, the range of motion (ROM) of C1–2 was calculated, and correlation analysis was performed to explore the factors that influence the ROM of C1–2. RESULTS A solid fracture fusion was found in all patients. At the final follow-up, no significant difference was found in visual analog scale score or American Spinal Injury Association Impairment Scale score between the two groups (p > 0.05), but patients in group A had a lower Neck Disability Index score and milder neck stiffness than did patients in group B (p < 0.05). In group A, 87.0% (20/23) of the patients had atlantoodontoid joint osteoarthritis at the final follow-up. In group A, the C1–2 ROM in rotation was 6.1° ± 4.5° at the final follow-up, whereas the C1–2 ROM in flexion-extension was 1.8° ± 1.2°. A negative correlation was found between the C1–2 ROM in rotation and the severity of tissue injury in the atlantoaxial region (r = –0.403, p = 0.024) and the degeneration of the atlantoodontoid joint (r = –0.586, p = 0.001). CONCLUSIONS Posterior C1–2 fixation without fusion can be used effectively for the management of fresh odontoid fractures. The removal of the implant can further improve the clinical efficacy, but satisfactory atlantoaxial motion cannot be maintained for a long time after implant removal. A surgeon should reconsider the contribution of posterior C1–2 fixation without fusion and secondary implant removal in preserving atlantoaxial mobility for patients with fresh odontoid fractures.

A comparative study of laminoplasty with short segment transpedicular screw fixation versus laminoplasty with anterior fusion in treating extensional cervical spinal cord injury without radio graphic abnormality in adults

2019 ◽  
Author(s):  
Bi Zhang ◽  
Zhenhai Zhou ◽  
Honggui Yu ◽  
Zhimin Pan ◽  
Rongping Zhou ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Intraoperative Blood Loss ◽  
Short Segment ◽  
Transpedicular Screw ◽  
Cord Injury ◽  
Group A ◽  
Group B ◽  
Transpedicular Screw Fixation

Abstract Background: Cervical spinal cord injury(CSCI) without major fracture or dislocation is often described as cervical SCI without radiographic abnormality (SCIWORA). Majority of this injury could be without radiographic abnormality but with disrupted anterior longitudinal ligament or intervertebral disc unless examined by MRI. The optimal surgical management of this cervical spinal cord injury remains controversial. This study is to evaluate the clinical advantages of laminoplasty combined with short-segment transpedicular screw fixation for managing this issue. Methods: SCIWORA patients were collected into two groups according to different surgical methods. Patients in group A received laminoplasty combined with transpedicular screw fixation, and patients in group B received anterior cervical fusion combined with laminoplasty. All cervical spine were assessed by X-ray, CT, MRI preoperatively and postoperatively to evaluate the decompression range, bonegraft fusion and instruments location. ASIA grade and JOA score were recorded to assess the neurological function recovery. Complications, surgery time, intraoperative blood loss and hospital stay were compared between two groups. Mean follow-up was at least 2 years. Results: In this study, Forty eight patients were in group A and 54 ones were in group B. All cases were decompressed fully and obtained fusion 6-month postoperatively. The ASIA grade was improved postoperatively, but no significantly different between two groups (p=0.907). The JOA was 6.12±1.76 preoperatively and improved to 11.98±2.98 postoperatively with the 53.13% neurofunction recovery rate in group A, with no significantly different compared with group B(vs 6.63±2.45, p=0.235; vs 12.62±3.59, p=0.303; vs 57.76%, p=0.590)respectively. Total 18 complications occurred but the occurrence was significant lower in group A(p=0.020). The average surgery time was 2.2±0.32 hours, intraoperative blood loss was 304±56ml and hospital stay was 8.2±3.1 days, significantly decreased compared with group B(vs 3.1±0.29, p=0.000; vs 388±61ml, p=0.000; vs 12±2.8days, p=0.000)respectively. Conclusions: Cervical laminoplasty combined with short-segment transpedicular screw fixation is a reliable option to treat SCIWORA patients with CSS. The advantages include achieving sufficient cervical decompression, maintaining cervical stability and avoiding extra anterior cervical fusion which increases surgery time, intraoperative blood loss, postoperative complications and hospital stay.

Sign in / Sign up

Export Citation Format

Share Document