Short-Segment Fixation for Osteoporotic Vertebral Fracture: Reinforcing Pedicle Screws with Universal Clamps

This study was designed to compare the biomechanical effects of three posterior fixations for thoracolumbar burst fractures using the finite element (FE) method. Five T11-L1 FE models, including the intact, the fractured at T12, the monosegment fixated at the level of the fracture, the short-segment fixated with four pedicle screws and the short-segment fixated with five pedicle screws, were created. And four loading conditions (flexion, extension, lateral bending and torsion) were imposed on these models and deformations in these models under different loading conditions were calculated by finite element method. The biomechanical effects of the three different pedicle screw fixations for thoracolumbar burst fractures were compared and analyzed. The results showed that the displacement level in monosegment fixation model was close to that in the intact one. The extension motion was more limited in short-segment fixation models than that in monosegment fixation model. Under the lateral bending condition, the level of the displacements in these models were similar and the peak rotation angles in the three fixation models were close to that in the intact one. The displacements in fractured T12 were increased in monosegment fixation model under all loading conditions. These indicated that the monosegment fixation couldn’t provide desirable stability for the fractured T11-L1 and the short-segment fixation with five pedicle screws was the best selection because of ideal stability and movability.

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A finite element study on posterior short segment fixation combined with unilateral fixation using pedicle screws for stable thoracolumbar fracture

Medicine ◽

10.1097/md.0000000000012046 ◽

2018 ◽

Vol 97 (34) ◽

pp. e12046 ◽

Cited By ~ 3

Author(s):

Yunshan Su ◽

Xiongfei Wang ◽

Dong Ren ◽

Yueju Liu ◽

Shaoming Liu ◽

...

Keyword(s):

Finite Element ◽

Pedicle Screws ◽

Thoracolumbar Fracture ◽

Short Segment ◽

Finite Element Study ◽

Short Segment Fixation ◽

Element Study

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

10.17727/jmsr.2021/9-12 ◽

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.

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Short-Segment Fixation With Percutaneous Pedicle Screws in the Treatment of Unstable Thoracolumbar Vertebral Body Fractures

Orthopedics ◽

10.3928/01477447-20180912-05 ◽

2018 ◽

Vol 41 (6) ◽

pp. e802-e806 ◽

Cited By ~ 1

Author(s):

Nikhil Sahai ◽

Michael J. Faloon ◽

Conor J. Dunn ◽

Kimona Issa ◽

Kumar Sinha ◽

...

Keyword(s):

Vertebral Body ◽

Pedicle Screws ◽

Short Segment ◽

Vertebral Body Fractures ◽

Short Segment Fixation

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Short Segment Fixation of Unstable Thoracolumbar Vertebral Body Fractures with Percutaneous Pedicle Screws

The Spine Journal ◽

10.1016/j.spinee.2016.07.172 ◽

2016 ◽

Vol 16 (10) ◽

pp. S256

Author(s):

Nikhil K. Sahai ◽

Michael J. Faloon ◽

Jeff Moore ◽

Kumar G. Sinha ◽

Ki S. Hwang ◽

...

Keyword(s):

Vertebral Body ◽

Pedicle Screws ◽

Short Segment ◽

Vertebral Body Fractures ◽

Short Segment Fixation

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Screw Cutting Vertebrae After Short-Segment Fixation of Pedicle Screw Combined with Kyphoplasty for Kummell Disease ： A Case Report and Literature Review

10.21203/rs.3.rs-1039160/v1 ◽

2021 ◽

Author(s):

Xianfu Han ◽

Xingwen Xie ◽

Dengyan Bai ◽

Lijun Chai ◽

Juxian Ding

Keyword(s):

Pedicle Screw ◽

Spinal Injury ◽

Pedicle Screws ◽

Lumbar Vertebra ◽

Short Segment ◽

Relieve Pain ◽

Fracture Nonunion ◽

The Subject ◽

Magnetic Resonance Imaging Mri ◽

Short Segment Fixation

Abstract Introduction: Kummell disease is also known as vertebral fracture nonunion, delayed vertebral collapse and vertebral ischemic necrosis. It often occurs in a delayed manner after spinal injury, and is a complex and rare spinal disease. This study, aimed to report a case of stage 3 Kummell disease, diagnosed using magnetic resonance imaging (MRI) of the lumbar spine.Methods: The subject underwent a short-segment fixation of the pedicle screw combined with kyphoplasty.Results: The patient was satisfied with the relief of back pain after the surgery, but the surgery was found to cause screw cutting vertebrae in the second lumbar vertebra (L2).Conclusion: Short-segment fixation of the pedicle screw combined with kyphoplasty can reconstruct spinal stability, maintain stability of bone cement mass in vertebrae, correct kyphosis deformity, and relieve pain. However, Kummell disease in elderly patients is always accompanied by severe osteoporosis. The common fixation of the pedicle screw is prone to cause screw cutting, loosening, and pulling out. Therefore, we advocate using cement-augmented pedicle screws.

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A short-segment fusion strategy using a wide-foot-plate expandable cage for vertebral pseudarthrosis after an osteoporotic vertebral fracture

Journal of Neurosurgery Spine ◽

10.3171/2020.5.spine2062 ◽

2020 ◽

Vol 33 (6) ◽

pp. 862-869

Author(s):

Ryo Taiji ◽

Masanari Takami ◽

Yasutsugu Yukawa ◽

Hiroshi Hashizume ◽

Akihito Minamide ◽

...

Keyword(s):

Vertebral Fracture ◽

Adverse Events ◽

Spinal Fusion ◽

Visual Analog Scale ◽

Osteoporotic Vertebral Fracture ◽

Analog Scale ◽

Kyphotic Angle ◽

Short Segment ◽

Final Observation ◽

The Mean

OBJECTIVEVarious surgical treatments have been reported for vertebral pseudarthrosis after osteoporotic vertebral fracture (OVF). However, the outcomes are not always good. The authors now have some experience with combined anterior-posterior short-segment spinal fusion (1 level above and 1 level below the fracture) using a wide-foot-plate expandable cage. Here, they report their surgical outcomes with this procedure.METHODSBetween June 2016 and August 2018, 16 consecutive patients (4 male and 12 female; mean age 75.1 years) underwent short-segment spinal fusion for vertebral pseudarthrosis or delayed collapse after OVF. The mean observation period was 20.1 months. The level of the fractured vertebra was T12 in 4 patients, L1 in 3, L2 in 4, L3 in 3, and L4 in 2. Clinical outcomes were assessed using the lumbar Japanese Orthopaedic Association (JOA) scale and 100-mm visual analog scale for low-back pain. Local kyphotic angle, intervertebral height, bone union rate, and instrumentation-related adverse events were investigated as imaging outcomes. The data were analyzed using the Wilcoxon signed-rank test.RESULTSThe mean operating time was 334.3 minutes (range 256–517 minutes), and the mean blood loss was 424.9 ml (range 30–1320 ml). The only perioperative complication was a superficial infection of the posterior wound that was cured by irrigation. The lumbar JOA score and visual analog scale value improved from 11.2 and 58.8 mm preoperatively to 20.6 and 18.6 mm postoperatively, respectively. The mean local kyphotic angle and mean intervertebral height were 22.6° and 28.0 mm, respectively, before surgery, −1.5° and 40.5 mm immediately after surgery, and 7.0° and 37.1 mm at the final observation. Significant improvement was observed in both parameters immediately after surgery and at the final observation when compared with the preoperative values. Intraoperative endplate injury occurred in 8 cases, and progression of cage subsidence of 5 mm or more was observed in 2 of these cases. Proximal junctional kyphosis was observed in 2 cases. There were no cases of screw loosening. No cases required reoperation due to instrument-related adverse events. Bone union was observed in all 14 cases that had CT evaluation.CONCLUSIONSThis short-segment fusion procedure is relatively minimally invasive, and local reconstruction and bone fusion have been achieved. This procedure is considered to be attempted for the surgical treatment of osteoporotic vertebral pseudarthrosis after OVF.

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Short Segment Fixation Versus Short Segment Fixation With Pedicle Screws at the Fracture Level for Thoracolumbar Burst Fracture

Acta Medica Marisiensis ◽

10.2478/amma-2014-0011 ◽

2014 ◽

Vol 60 (2) ◽

pp. 49-52

Author(s):

S Anghel ◽

D Márton

Keyword(s):

Blood Loss ◽

Traditional Approach ◽

Burst Fracture ◽

Pedicle Screws ◽

Operation Time ◽

Short Segment ◽

Hardware Failure ◽

Loss Of Correction ◽

Short Segment Fixation

Abstract Objective: The most prevailing surgical procedure in the treatment of thoracolumbar burst fractures, Short Segment Fixation (SSF), is often followed by loss of correction or hardware failure which may be significant enough to require another surgical intervention. In order to take advantage of its benefits but to avoid or diminish the risk and impact of associated drawbacks, some other alternatives have been lately developed among which we refer to short segment fixation with intermediate screws (SSF+IS). This article provides a comparative picture over the effectiveness of the two above-mentioned surgical treatments, focusing on their potential to prevent the loss of correction. Methods: After a systematic literature review over research papers published between 2000 and 2012, 14 articles which met the criteria were included in the meta-analysis. The relevant data extracted and compared for each subgroup of patients treated either with SSF or SSF+IS, were the weighted averages for the pre-operative, post-operative and last follow up kyphosis angles. We also considered common associated complications, operation time, and blood loss values for each surgical subgroups. Results: The values for the loss of correction at the last follow-up were: 5.5° for SS and 7.4° for SSF+IS, which didn’t prove to be statistically different. With reference to other parameters, such as operation time, blood loss and correction attainment, the values did not present statistically significant differences, either. Regarding complications, we noticed that both SSF and SSF+IS display a similar incidence for hardware failure, screw breakages, superficial infections, deep venous thrombosis. Conclusions: This paper concludes that, adding one or two screws at the fractured vertebra level (SSF+IS) does not bring forth a significant improvement compared to the traditional approach (SSF). Apparently, the blood loss depends mostly on the approach type (open or percutaneous) and less on the surgery type.

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