Implant Removal after Percutaneous Short Segment Fixation for Thoracolumbar Burst Fracture : Does It Preserve Motion?

Abstract BackgroundTo compare clinical and radiological results of long-segment fixation (LF) and six-screw short-segment fixation combined with kyphoplasty (SSFK) for osteoporotic thoracolumbar burst fracture (OTBF). Methods Forty patients affected by OTBF with mean age of 61.85 were included in this study. The mean follow-up period was 13.63 months. Twenty-four patients were treated by SSFK, and 16 patients were treated by LF. Clinical outcomes, radiological parameters and complications were assessed and compared. ResultsThe mean operative time and blood loss were 89.71±7.62min and 143.75±42.51ml for SFK group, respectively; 111.69±12.25min (P<0.01) and 259.38±49.05 ml (P<0.01) for LF group, respectively. The two groups were similar in terms of preoperative radiological and clinical results. Compared with preoperative values, both groups achieved significant improvement in terms of VAS, ODI, Cobb angle and anterior vertebral body height (AVH) ratio at final follow-up. However, during the follow-up period, the loss of Cobb angle and AVH ratio were significant different between immediately postoperative and final follow-up evaluations for both groups. Five cases (20.83%) of asymptomatic cement leakage were observed in SSFK group. One case of implant failure and two cases of adjacent or non-adjacent vertebral fractures were observed in LF group. ConclusionsFor the treatment of OTBF, SSFK shows similar clinical and radiological results as LF. Comparatively, SSFK is less invasive and can preserve more motion segments, which is a more valuable surgical option in selected elderly patients.

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LONG SEGMENT VERSUS SHORT SEGMENT FIXATION WITH INDEX LEVEL IN THORACOLUMBAR BURST FRACTURE

Zagazig University Medical Journal ◽

10.21608/zumj.2018.18294 ◽

2018 ◽

Vol 24 (6) ◽

pp. 521-525

Author(s):

Mohamed Mohamed Abdeen ◽

Omar Abdel Wahab Kelany ◽

Amr El Adawy ◽

Tarek El Hewala

Keyword(s):

Burst Fracture ◽

Thoracolumbar Burst Fracture ◽

Short Segment ◽

Segment Versus ◽

Index Level ◽

Short Segment Fixation

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

Acta Medica Marisiensis ◽

10.2478/amma-2014-0020 ◽

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.

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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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Vacuum Phenomenon as a Predictor of Kyphosis After Implant Removal Following Posterior Pedicle Screw Fixation Without Fusion for Thoracolumbar Burst Fracture: a Single-center Retrospective Study

10.21203/rs.3.rs-190211/v1 ◽

2021 ◽

Author(s):

Masahiro Hirahata ◽

Tomoaki Kitagawa ◽

Youichi Yasui ◽

Hiroyuki Oka ◽

Iwao Yamamoto ◽

...

Keyword(s):

Retrospective Study ◽

Pedicle Screw ◽

Old Age ◽

Screw Fixation ◽

Burst Fracture ◽

Pedicle Screw Fixation ◽

Implant Removal ◽

Thoracolumbar Burst Fracture ◽

Loss Of Correction ◽

Vacuum Phenomenon

Abstract Background: Posterior pedicle screw fixation without fusion has been commonly applied for thoracolumbar burst fracture. Implant removal is performed secondarily after bone union. However, the occurrence of secondary kyphosis has recently attracted attention. Secondary kyphosis results in poor clinical outcomes. The purpose of this was to determine predictors of kyphosis after implant removal following posterior pedicle screw fixation without fusion for thoracolumbar burst fracture.Methods: This retrospective study reviewed 60 consecutive patients with thoracolumbar burst fracture who underwent implant removal following posterior pedicle screw fixation without fusion. Inclusion criteria were non-osteoporotic fracture and T11-L4 burst fracture. Old age, sex, initial severe wedge deformity, initial severe kyphosis, and vacuum phenomenon were examined as factors potentially associated with final kyphotic deformity (defined as kyphotic angle greater than 25°) or loss of correction. Logistic regression analysis was performed using propensity score matching.Results: Among the 31 female and 29 male patients (mean age 39 years), final kyphotic deformity was found in 17 cases (28%). Multivariate analysis showed a significant association with the vacuum phenomenon. Loss of correction was found in 35 cases (58%) and showed a significant association with the vacuum phenomenon. There were no significant associations with other factors.Conclusions: The findings of this study suggest that the vacuum phenomenon before implant removal may be a predictor of secondary kyphosis of greater than 25° after implant removal following posterior pedicle screw fixation without fusion for thoracolumbar burst fracture, but that old age, sex, initial severe kyphosis, and initial severe wedge deformity may not be predictors.

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Risk factor analysis for predicting kyphosis reoccurrence of thoracolumbar burst fracture patients treated with posterior short-segment fixation

10.21203/rs.2.14567/v3 ◽

2020 ◽

Author(s):

Xiangyao Sun ◽

Zhaoxiong Chen ◽

Siyuan Sun ◽

Tongtong Zhang ◽

Xinuo Zhang ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Burst Fracture ◽

Wedge Angle ◽

Implant Removal ◽

Thoracolumbar Burst Fracture ◽

Height Ratio ◽

Vertebral Height ◽

Thoracolumbar Injury ◽

Multi Center Study

Abstract Background: The thresholds of risk factors of kyphosis recurrence in thoracolumbar burst fracture patients were still controversial. The aim of this multi-center study was to identify these thresholds. Methods: 169 patients were included in this study. Upper intervertebral angle (UIVA), lower intervertebral angle (LIVA), Cobb angle (CA), anterior vertebral height ratio (AVH%), regional angle (RA), posterior vertebral height ratio (PVH%), vertebral wedge angle (VWA), anteroposterior ratio (A/P%), Clinical assessment included Load Sharing Classification (LSC) score, Thoracolumbar Injury Classification and Severity (TLICS) score, Visual Analogue Scale (VAS), and Body mass index (BMI) were perioperatively evaluated. Patients were divided into KR group and none KR (NKR) group according to whether the loss of CA correction was less than 5˚ or not. The risk factors of KR before or after implant removal were analyzed, respectively. Results: There were significant improvements in postoperative parameters compared with preoperative parameters, such as AVH%, A/P%, VAS, CA, VWA, PVH% ( P < 0.001, respectively), and UIVA ( P = 0.02). Age (AUC = 0.828) and BMI (AUC = 0.846) were good predictors of KR before implant removal. BMI (AUC = 0.871) was a good predictor of KR after implant removal. Conclusions: There were significant differences in risk factors of KR at different postoperative follow-up stages: age > 49 years, BMI > 24 were risk factors of KR before implant removal; BMI > 25.17 was a risk factor of KR after implant removal.

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