Rotational stability of thoracolumbar junction fixation systems

Objective To compare the rotational stability of fusion constructs using bisegmental fixation of Th12-L2 vertebrae with anterior stabilization or pedicle screw fixation.Material and Methods The strength, rigidity and limit of elasticity in the “injured vertebral motion segments (VMS) – bisegmental anterior stabilization” system under dislocating rotational loads were estimated. The data obtained were compared with the similar characteristics of the “injured VMS – bisegmental 4-screw transpedicular metal construction” system and intact spine segments.Results Under rotational loads the limits of elasticity of injured spine segments of Th12-L2 with anterior stabilization and transpedicular screw fixation (TSF) is 45.5 and 41.7%, respectively, and the general strength is 66.4% and 80%, respectively, as compared with those intact VMS. Rigidity parameters of anterior-stabilized and pedicle screw fixated VMS with unstable damage of L1 are 60.2 and 93.9%, accordingly, in comparison with those intact VMS.Conclusion No significant differences were observed between bisegmental anterior stabilization and bisegmental pedicle screw fixation of thoracolumbar junction in terms of the key mechanical properties. When treating patients with unstable thoracolumbar spine injuries using bisegmental anterior stabilization or transpedicular fixation with 4-screw spinal system possible rotation motion amplitude of operated segments must not exceed 50% of maximum physiological limits.

Download Full-text

Clinical effect of a novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation for thoracolumbar burst fractures

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04423-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Menghan Cai ◽

Zhijun Xin ◽

Weijun Kong ◽

Qian Du ◽

Wenjun Ji ◽

...

Keyword(s):

Pedicle Screw ◽

Vertebral Body ◽

Bone Grafting ◽

Screw Fixation ◽

Pedicle Screw Fixation ◽

Control Group ◽

Observation Group ◽

Thoracolumbar Burst Fractures ◽

Transpedicular Screw ◽

Transpedicular Screw Fixation

Abstract Background Short-segment transpedicular screw fixation is a common method for the treatment of thoracolumbar burst fractures (TBFs),but this technique has many problems. Therefore,the purpose of this article is to observe and evaluate the clinical efficacy of a novel transpedicular reducer that we designed for fractured vertebral body reduction and bone grafting in the treatment of TBFs. Methods From July 2018 to November 2020, 70 cases of TBFs were included. Thirty-five patients were treated with the novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation (observation group), and 35 patients were treated with short-segment transpedicular screw fixation (control group). Before the operation, after reduction, and 3 days, 3 months,and 12 months after the operation, the two groups were assessed, and compared with respect to the anterior and middle heights of the injured vertebrae, the ratios of the anterior and middle heights of the injured vertebral body to the respective heights of the adjacent uninjured vertebral bodies (AVBHr and MVBHr, respectively), and the Cobb angle of the patients. We compared the pain VAS score and quality of life GQOL-74 score at the last follow-up. Finally,we evaluated the distribution of bone grafts and bone healing 12 months after the operation. Results The anterior height, middle height, AVBHr, MVBHr, and Cobb angle of the injured vertebral body in the observation after reduction, and 3 days, 3 months and 12 months post-operatively were compared with those of the injured vertebral body before operation. All of these parameters were improved, and the difference was statistically significant (p < 0.05). These parameters in the observation group at the above time points were significantly better than thoes in the control group at the corresponding time points (p < 0.05). The VAS scores at the last follow-up were significantly better than those of the control group (p < 0.05), but the GQOL-74 score differences were not statistically significant (p > 0.05). The observation group showed no obvious defects on CT at 12 months after the operation, and the bone healing was good. Conclusion The novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation for TBFs has good clinical efficacy.

Download Full-text

Clinical effect of a new type of transpedicular reducer for fracture reduction via pedicle and bone grafting combined with pedicle screw fixation for thoracolumbar burst fractures

10.21203/rs.3.rs-245481/v1 ◽

2021 ◽

Author(s):

Menghan Cai ◽

Zhijun Xin ◽

Weijun Kong ◽

Qian Du ◽

Wenjun Ji ◽

...

Keyword(s):

Pedicle Screw ◽

Bone Grafting ◽

Screw Fixation ◽

Pedicle Screw Fixation ◽

Fracture Reduction ◽

Control Group ◽

Thoracolumbar Burst Fractures ◽

Transpedicular Screw ◽

New Type ◽

Transpedicular Screw Fixation

Abstract Background: Short-segment transpedicular screw fixation is a common method for the treatment of thoracolumbar burst fractures (TBFs),but this technique has many problems.Therefore,the purpose of this article is to observe and evaluate the clinical efficacy of a new type of transpedicular reducer that we designed for fractured vertebral body reduction and bone grafting in the treatment of TBFs.Methods:From July 2018 to November 2020, 70 cases of TBFs were included. 35 cases were treated with the new transpedicular reducer for fracture reduction via pedicle and bone grafting combined with pedicle screw fixation (observation group), 35 cases were treated with short-segment transpedicular screw fixation (control group).Before operation, after application of the transpedicular reducer(not needed in the control group),3 days after operation, 3 months after operation, 6 months after operation, and 12 months after operation, the two groups were recorded and compared respectively: the anterior and middle heights of the injured vertebrae, the ratios of the anterior and middle heights of the injured vertebral body to the respective heights of the adjacent uninjured vertebral bodies (AVBHr and MVBHr, respectively), and the Cobb angle of patients.And we compared the pain VAS score and quality of life GQOL-74 score at the last follow-up.At last,we evaluated the distribution of bone grafts and bone healing 12 months after the operation.Results:All 70 cases were followed up for at least 12 months.The observation group's anterior and middle heights of the injured vertebral, AVBHr and MVBHr were higher than those of the control group at 3 days,3 months,6 months and 12 months after operation, the cobb angle was smaller than that in control group, the pain VAS score and the quality of life GQOL-74 score at the last follow-up were better than those of the control group, and these difference were statistically significant (P <0.05). The observation group showed no obvious defects on CT at 12 months after operation, and the bone healing was good. Conclusion: The new type of transpedicular reducer for fracture reduction via pedicle and bone grafting combined with pedicle screw fixation for TBFs has a good clinical efficacy.

Download Full-text

The role of fusion in the management of burst fractures of the thoracolumbar spine treated by short segment pedicle screw fixation

Journal of Bone and Joint Surgery - British Volume ◽

10.1302/0301-620x.94b8.28311 ◽

2012 ◽

Vol 94-B (8) ◽

pp. 1101-1106 ◽

Cited By ~ 42

Author(s):

N. Jindal ◽

S. S. Sankhala ◽

V. Bachhal

Keyword(s):

Pedicle Screw ◽

Screw Fixation ◽

Thoracolumbar Spine ◽

Pedicle Screw Fixation ◽

Short Segment ◽

Burst Fractures

Download Full-text

Does Tranexamic Acid Reduce Perioperative Bleeding in Short Segment Pedicle Screw Fixation in Thoracolumbar Spine Fractures?

Journal of Nepal Medical Association ◽

10.31729/jnma.2785 ◽

2015 ◽

Vol 53 (199) ◽

pp. 169-173 ◽

Cited By ~ 3

Author(s):

Rabindra Lal Pradhan ◽

Bimal Kumar Pandey

Keyword(s):

Tranexamic Acid ◽

Pedicle Screw ◽

Screw Fixation ◽

Thoracolumbar Spine ◽

Pedicle Screw Fixation ◽

Control Group ◽

Thoracolumbar Fractures ◽

Short Segment ◽

Perioperative Bleeding ◽

Thoracolumbar Spine Fractures

Introduction: Blood loss with spinal surgery is common potential cause of morbidity and often requires blood transfusion. Tranexamic acid (TXA), is effective in reducing bleeding in patients undergoing knee arthroplasty. TXA used in spine surgery studies have included different cases leading to inconsistence of surgical procedures. Purpose of this prospective observational study was to examine effect of TXA decreasing bleeding in short segment pedicle screw fixation for thoracolumbar fractures. Methods: 38 patients' undergoing short segment pedicle screw for thoracolumbar fractures were enrolled in study from July to August 2013. There were 28 male and 10 female patients, with an average age of 36.5 years. Patients received 10 mg/kg of TXA or a control 30 minutes intravenously before skin incision and 3 hours post-operative and oral medication for three days. Intraoperative bleeding was estimated by weighing surgical sponges, blood collected by suction container and by subtracting all irrigation fluid. Postoperative bleeding was measured from volume in vacuum drainage bag. Results: Twenty (20) patients were in control group and eighteen(18) to TXA group. There were no statistical differences between groups in terms of age, gender, co-morbidities, and operating time, preoperative Hemoglobin, PT and INR. Intra-operative bleeding in TXA group was significant than in control group. Post-operative drainage and Hemoglobin in first 48 h was reduced compared with placebo in TXA group. Need for post-operative transfusion was nil in TXA group. Conclusions: Administration of TXA before surgery significantly reduces perioperative bleeding in patients undergoing short segment pedicle screw fixation for thoracolumbar spine fractures. Keywords: bleeding; spinal surgery; tranexamic acid.

Download Full-text

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

Download Full-text

Outcome analysis for adults with spondylolisthesis treated with posterolateral fusion and transpedicular screw fixation

Journal of Neurosurgery ◽

10.3171/jns.1997.86.1.0056 ◽

1997 ◽

Vol 86 (1) ◽

pp. 56-63 ◽

Cited By ~ 76

Author(s):

Charles L. Schnee ◽

Andrew Freese ◽

Lee V. Ansell

Keyword(s):

Pedicle Screw ◽

Screw Fixation ◽

Fusion Rate ◽

Pedicle Screw Fixation ◽

Outcome Analysis ◽

Low Grade ◽

Content Type ◽

Poor Outcomes ◽

Transpedicular Screw Fixation ◽

Fine Print

✓ The outcomes of 52 adult patients with symptomatic low-grade spondylolisthesis treated with autologous posterolateral arthrodesis and pedicle screw fixation were retrospectively reviewed. Although a 90% rate of successful fusion was obtained using this technique, only 60% of patients were considered to have good outcomes. Treatment failures consisted mostly of back pain and were not predicted by preoperative symptoms. Compensation claims and smoking had very significant adverse impacts on both employment and pain results despite high fusion rates, particularly in patients under the age of 55 years. Overall, patients who required more than one operation demonstrated poor outcomes compared to those who only needed one. However, patients with at least two prior operations or preoperative pseudoarthrosis fared particularly poorly, whereas those who had undergone only one prior surgery and had no attendant compensation issue reported good results. A trend toward poor outcome was observed in patients with postlaminectomy spondylolisthesis, versus those with isthmic or degenerative etiologies. Gender did not exert an impact on outcome. The authors conclude that autologous posterolateral arthrodesis combined with pedicle screw fixation resulted in a high fusion rate, and contributed to successful outcomes in the treatment of certain subgroups of adults with spondylolisthesis. In the absence of other risk factors, patients may obtain significant benefit from surgery despite older age and a single failed operation. Careful patient selection appears critical in predicting the maximum benefit from this technique.

Download Full-text