Loss of correction after dorsal stabilization of burst fractures of the thoracolumbar junction. The role of transpedicular spongiosa plasty

Abstract

Short segment pedicle instrumentation for thoracolumbar burst fracture is known to fail due to lack of anterior support. Additional transpedicular grafting and dorsolateral fusion were offered to prevent its failure. The purpose of this study was to analyse the clinical and radiological outcome in two identical groups of patients treated with short segment pedicle instrumentation and posterolateral fusion with and without inter- and intracorporal transpedicular bone grafting. The clinical and radiological results of two identical groups of patients with thoracolumbar burst fractures were analysed. 15 patients (2 f, 13 m), mean age 35 years, were treated with bisegmental fixation with the fixateur interne and unisegmental fusion. Further 15 patients (3 f, 12 m), mean age 34 years, obtained additional intra- and intercorporal bone grafting. The implants were removed 15 resp. 13 months post surgery. Latest clinical and radiological follow-up was at 61/24 months. The clinical results were identical in both groups. Radiological measurements showed a significant loss of correction for all three measured angles (vertebral kyphosis, unisegmental kyphosis and bisegmental kyphosis) in both groups. However, patients with transpedicular bone grafting showed less loss of bony, vertebral kyphosis. Neither dorsolateral fusion nor dorsolateral fusion with transpedicular bone grafting could prevent loss of angular corrections.