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

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>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.

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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

10.21203/rs.3.rs-1141848/v1 ◽

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.

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Short same segment fixation versus short segment fixation in postoperative correction of kyphosis and pain reduction in thoracolumbar spine fractures

Romanian Neurosurgery ◽

10.1515/romneu-2017-0001 ◽

2017 ◽

Vol 31 (1) ◽

pp. 3-7

Author(s):

Mohamed State ◽

Ahmed Zaher ◽

Nabil Ali

Keyword(s):

Pedicle Screw ◽

Screw Fixation ◽

Thoracolumbar Spine ◽

Pain Reduction ◽

Pedicle Screw Fixation ◽

Spine Fracture ◽

Kyphotic Angle ◽

Short Segment ◽

Short Segment Fixation

Abstract Introduction: Posterior short segment pedicle screw fixation is considered the most common way for management of unstable thoracolumbar spine fracture. This study is aiming to evaluate the efficacy of both posterior short same segment and posterior short segment pedicle screw fixation on postoperative kyphotic angle and pain dense score in thoracolumbar fractures. Methods: This is a Prospective study of 32 patients with single level thoracolumbar spine fracture between June 2011 and May 2014. Patients were divided randomly into 2 groups, one of them was submitted to short same segment posterior pedicle screw fixation with mean age 31.25+9.25ys, while the other group submitted to short segment posterior pedicle screw fixation with mean age 29.18+9.65ys. Cobb method and Denis work scale were used to assess kyphotic angle and pain score respectively on admission, during follow up period and after one year postoperatively. Results: The short same segment type of operation showed improvement in correction in kyphotic angle deformity at the end of follow up period although this improvement was not statistically significant compared to short segment type. The short same segment patients showed statistically significant improvement as regard pain Denis score among those patients treated by short segment fixation. Conclusion: In this study short same segment posterior pedicle screw fixation is more efficient in postoperative pain reduction than short segment posterior pedicle screw fixation.

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

10.21203/rs.3.rs-129857/v1 ◽

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.

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

BMC Surgery ◽

10.1186/s12893-021-01165-8 ◽

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.

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Minimally Invasive Spine Surgery for Unstable Thoracolumbar Burst Fractures: A Case Series

The Surgery Journal ◽

10.1055/s-0036-1594248 ◽

2016 ◽

Vol 02 (04) ◽

pp. e131-e138 ◽

Cited By ~ 2

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.

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Minimally Invasive Decompression and Intracorporeal Bone Grafting Combined with Temporary Percutaneous Short-Segment Pedicle Screw Fixation for Treatment of Thoracolumbar Burst Fracture with Neurological Deficits

World Neurosurgery ◽

10.1016/j.wneu.2019.11.123 ◽

2020 ◽

Vol 135 ◽

pp. e209-e220

Author(s):

Lin Chen ◽

Hao Liu ◽

Ying Hong ◽

Yi Yang ◽

Lingyun Hu

Keyword(s):

Minimally Invasive ◽

Pedicle Screw ◽

Bone Grafting ◽

Screw Fixation ◽

Burst Fracture ◽

Pedicle Screw Fixation ◽

Neurological Deficits ◽

Thoracolumbar Burst Fracture ◽

Short Segment ◽

Minimally Invasive Decompression

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Short Segment vs. Long Segment Pedicle Screw Fixation for Treating Thoracolumbar Junction Burst Fractures

The Spine Journal ◽

10.1016/j.spinee.2010.07.352 ◽

2010 ◽

Vol 10 (9) ◽

pp. S136-S137

Author(s):

Todd W. Peters ◽

Suresh R. Chinthakunta ◽

Mir Hussain ◽

Saif Khalil

Keyword(s):

Pedicle Screw ◽

Screw Fixation ◽

Pedicle Screw Fixation ◽

Thoracolumbar Junction ◽

Short Segment ◽

Burst Fractures

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Posterior monoaxial screw fixation combined with distraction-compression technology assisted endplate reduction for thoracolumbar burst fractures: a retrospective study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-3038-6 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Xuhong Xue ◽

Sheng Zhao

Keyword(s):

Retrospective Study ◽

Pedicle Screw ◽

Screw Fixation ◽

Pedicle Screws ◽

Pedicle Screw Fixation ◽

Thoracolumbar Burst Fractures ◽

Correction Rate ◽

Burst Fractures ◽

The Mean

Abstract Background The management of thoracolumbar burst fractures traditionally involves posterior pedicle screw fixation, but it has some drawbacks. The aim of this study is to evaluate the clinical and radiological outcomes of patients with thoracolumbar burst fractures. They were treated by a modified technique that monoaxial pedicle screws instrumentation and distraction-compression technology assisted end plate reduction. Methods From March 2014 to February 2016, a retrospective study including 42 consecutive patients with thoracolumbar burst fractures was performed. The patients had undergone posterior reduction and instrumentation with monoaxial pedicle screws. The fractured vertebrae were also inserted screws as a push point. The distraction -compression technology was used as assisting end plate reduction. All patients were followed up at a minimum of 2 years. These parameters including segmental kyphosis, severity of fracture, neurological function, canal compromise and back pain were evaluated in preoperatively, postoperatively and at the final follow-up. Results The average follow-up period was 28.9 ± 4.3 months (range, 24-39mo). No patients had postoperative implant failure at recent follow-up. The mean Cobb angle of the kyphosis was improved from 14.2°to 1.1° (correction rate 92.1%). At final follow-up there was 1.5% loss of correction. The mean preoperative wedge angle was improved from 17.1 ± 7.9°to 4.4 ± 3.7°(correction rate 74.3%). The mean anterior and posterior vertebral height also showed significant improvements postoperatively, which were maintained at the final follow-up(P < 0.05). The mean visual analogue scale (VAS) scores was 8 and 1.6 in preoperation and at the last follow-up, and there was significant difference (p < 0.05). Conclusion Based on our experience, distraction-compression technology can assist reduction of collapsed endplate directly. Satisfactory fracture reduction and correction of segmental kyphosis can be achieved and maintained with the use of monoaxial pedicle screw fixation including the fractured vertebra. It may be a good treatment approach for thoracolumbar burst fractures.

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

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2014.11.031 ◽

2015 ◽

Vol 22 (5) ◽

pp. 883-888 ◽

Cited By ~ 2

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

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

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20172550 ◽

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

Background: 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.Methods: 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.Results: 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 >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.Conclusions: 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.

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