Abstract
ABSTRACT Objective: There is still no consensus as to the treatment options for thoracolumbar burst fractures, although these fractures are widely described in the literature. The aim of this study was to evaluate the clinical and radiological outcomes of percutaneous instrumentation without arthrodesis as a method of fixation of these lesions. Methods: This retrospective, cross-sectional study evaluated 16 patients by measuring regional kyphosis using the Cobb method and the scores for quality of life and return to work (Oswestry Disability Index, VAS, SF-36 and Denis). Results: Six months after surgical treatment, 62.5% of all patients showed minimal disability according to the Oswestry Disability Index, maintenance of regional kyphosis correction and no synthesis failure. Conclusions: The clinical and radiological outcomes of the study suggest that minimally invasive fixation is indicated for the treatment of thoracolumbar burst fractures. Level of evidence IV; Observational study: retrospective cohort.
Highlights
Thoracolumbar burst fractures account for approximately 45% of all major injuries in this region, with at least half of patients maintaining intact neurological function
Six months after surgical treatment, 62.5% of all patients showed minimal disability according to the Oswestry Disability Index, maintenance of regional kyphosis correction and no synthesis failure
Patients were subdivided according to the AOSpine Classification,[23,24] with L1/A4 (25%) having the highest incidence. (Table 2) The McCormack[4] (Load Sharing) classification was used, yielding 3 and 6 points as the most common scores, assigned to 4 patients each (25%). (Table 3)
Summary
Thoracolumbar burst fractures account for approximately 45% of all major injuries in this region, with at least half of patients maintaining intact neurological function. Short-segment pedicle screw instrumentation for the treatment of thoracolumbar fractures gained popularity in the 1980s. Several studies have provided evidence that short-segment posterior fixation with screw fixation at the level of the fracture is sufficient to achieve stability in some injury patterns, such as burst fractures, avoiding the need for circumferential reconstruction and long segment instrumented thoracolumbar fusion.[2,4,5,6,7] Over this period, biomechanical analyses have yielded basic knowledge, which led to the development of synthetic materials with greater rigidity and better preparation for load sharing across the three columns described by Denis.4.8
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