Anterior Column Reconstruction for Treatment of Failed Short Segment Pedicular Fixation in Thoracic and Lumbar Spine Fractures

Abstract

Background Data: Short segment pedicular fixation is one of the most common operative techniques to treat unstable thoracolumbar burst fracture. However, it may be associated with pseudoarthrosis, progressive kyphosis, and a high rate of hardware failure. Different surgical techniques were described to deal with this failure. Biomechanical investigations have shown that anterior fusion provides superior stability as compared to single dorsal instrumentations.Study Design: A retrospective clinical case study. Purpose: To evaluate the outcomes of anterior column reconstruction for treatment of failed short segment pedicular fixation system in thoracolumbar fractures. Patients and Methods: This study included 25 patients with failed short segment pedicular fixation after acute thoracolumbar fracture. They were treated byanterior column reconstruction with strut iliac graft and fixed with either posterior long pedicular system or anterior locked system through simultaneous combined approaches. This study was done in the period between January 2009 to December 2013. Neurological status was classified using Frankel classification. All patients had been followed up by radiographs and CT-scans. Back pain and functional outcomes were assessed by VAS andODI respectively.Results: All patients were followed up for at least 24 months. The visual analogue scale (VAS) of back pain improved significantly from 6.20±0.94 preoperatively to 1.87±0.83 at the latest follow up. The mean Cobb angle improved significantly from 28.47±10.80o preoperatively to 2.07±9.39o immediate postoperatively and was maintained at 4.13±10.21o at latest follow up. According to Brantigan criteria, fusion was considered certain in all 25 patients (100%) and no failure of internal fixation occurred at latest follow up. The functional outcomes which measured by Oswestry disability index (ODI) improved significantly from 62.60±11.17% preoperatively to 24.00±6.04% at latest follow up.Conclusion: Anterior column reconstruction of the spine achieved significant improvement in radiological,clinical, and functional outcomes with few complications for treatment of failed short segment pedicular fixation in thoracolumbar fractures. (2015ESJ091)