Abstract
Background. One of the reasons for the lack of standardized approaches for treatment of lumbar and thoracolumbar spine traumatic injuries is inconclusive information on relative contribution of various factors to pedicle screw fixation stability.Objective. To determine risk factors that influence pedicle screw fixation stability in patients with unstable traumatic injuries of a lumbar spine and thoracolumbar junction.Material and methods. This was a retrospective evaluation of 192 spinal instrumentations. Patients with type А3, A4, B1, B2 and C injuries of lumbar and thoracolumbar spine were enrolled. Pedicle screw fixation was used either as a stand-alone technique or in combination with anterior column reconstruction. If required, decompression of nerve roots and spinal cord was performed. Cases with pedicle screw fixation failure were registered. Logistic regression analysis was used to assess predictive significance of potential risk factors. Results. Complication rate growth was associated with a decrease in bone radiodensity, posterior decompression extensiveness, lumbosacral fixation and residual kyphotic deformity. Anterior column reconstruction and additional pedicle screw installation led to a decline in complication rate while anterior decompression and fixation length did not influence fixation stability. Conclusion. In most cases, pedicle screw fixation system failure is associated with altered bone quality; however, surgical approach may also impact complication rate and should be taken into account planning surgical intervention. Anterior column reconstruction and additional pedicle screw installation are associated with the decline in complication rate; the influence of those options is comparable. Anterior decompression does not influence pedicle screw fixation stability; consequently, it is preferable in cases with considerable risk of pedicle screw fixation failure.
Highlights
Material and methodsOne of the reasons for the lack of standardized approaches for treatment of lumbar and thoracolumbar spine traumatic injuries is inconclusive information on relative contribution of various factors to pedicle screw fixation stability
To determine risk factors that influence pedicle screw fixation stability in patients with unstable traumatic injuries of a lumbar spine and thoracolumbar junction. This was a retrospective evaluation of 192 spinal instrumentations
Anterior column reconstruction and additional pedicle screw installation led to a decline in complication rate while anterior decompression and fixation length did not influence fixation stability
Summary
Ключевые слова: Цитировать: Одной из причин отсутствия унифицированных подходов к лечению травматических повреждений позвоночника на уровне поясничного отдела и переходной грудопоясничной зоны является недостаток информации о вкладе различных факторов в стабильность транспедикулярной фиксации. Влияющие на стабильность транспедикулярной фиксации у пациентов с нестабильными травматическими повреждениями поясничного отдела позвоночника и грудопоясничного перехода. Исследование является ретроспективным, изучены результаты хирургического лечения 192 пациентов с травматическими повреждениями типа А3, А4, В1, В2 и С на уровне поясничного отдела позвоночника и грудопоясничного перехода. При реконструкции передней колонны и промежуточной фиксации частота осложнения уменьшалась, в то время как передняя декомпрессия и протяженность фиксации не влияли на частоту осложнения. Транспедикулярная фиксация, реконструкция передней колонны, передняя декомпрессия, ламинэктомия, радиоденсивность, травма поясничного отдела позвоночника и грудопоясничного перехода. Влияющие на стабильность транспедикулярной фиксации у пациентов с нестабильными повреждениями поясничного отдела позвоночника и переходной грудопоясничной области.
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