Posterior short segment pedicle screw fixation and TLIF for the treatment of unstable thoracolumbar/lumbar fracture

Ling Wang,Limin Shang,Xianping Shang,Hong Wang,Jianjun Li,Yan Xu,Kai Tang,Kai Ma,Bo Wang,Decheng Lv,Xunyuan Jia,Depeng Kou,Weiguo Zhang,Qun Yang,Yang Liu,Rui Zhang,Pengrui Wang,Shijin Wang,Yilong Tang,Meng Zhang,Xianglong Yang,Jiang Chang-Ming ,Chun‐Ming Wu

doi:10.1186/1471-2474-15-40

Abstract

BackgroundCurrently, Posterior Short Segment Pedicle Screw Fixation is a popular procedure for treating unstable thoracolumbar/lumbar burst fracture. But progressive kyphosis and a high rate of hardware failure because of lack of the anterior column support remains a concern. The efficacy of different methods remains debatable and each technique has its advantages and disadvantages.MethodsA consecutive series of 20 patients with isolated thoracolumbar/lumbar burst fractures were treated by posterior short segment pedicle screw fixation and transforaminal thoracolumbar/lumbar interbody fusion (TLIF) between January 2005 and December 2007. All patients were followed up for a minimum of 2 years. Demographic data, neurologic status, anterior vertebral body heights, segmental Cobb angle and treatment-related complications were evaluated.ResultsThe mean operative time was 167 minutes (range, 150–220). Blood loss was 450 ~ 1200 ml, an average of 820 ml. All patients recovered with solid fusion of the intervertebral bone graft, without main complications like misplacement of the pedicle screw, nerve or vessel lesion or hard ware failure. The post-operative radiographs demonstrated a good fracture reduction and it was well maintained until the bone graft fusion. Neurological recovery of one to three Frankel grade was seen in 14 patients with partial neurological deficit, three grades of improvement was seen in one patient, two grades of improvement was observed in 6 patients and one grade of improvement was found in 6 patients. All the 6 patients with no paraplegia on admission remained neurological intact, and in one patient with Frankel D on admission no improvement was observed.ConclusionPosterior short-segment pedicle fixation in conjunction with TLIF seems to be a feasible option in the management of selected thoracolumbar/lumbar burst fractures, thereby addressing all the three columns through a single approach with less trauma and good results.

Highlights

Posterior Short Segment Pedicle Screw Fixation is a popular procedure for treating unstable thoracolumbar/lumbar burst fracture
Most spinal surgeons are familiar to thoracolumbar/lumbar interbody fusion (TLIF), and the technique itself allows easy detection of the anterior wall of the canal and safely repositioning of the protruding fragments, avoiding excessive spinal cord and nerve root traction, significantly reduces the risk of nerve damage
Because most of the blood supply of the fractured vertebral body is left intact, the intraoperative blood loss is decreased and the fracture union duration might be theoretically shortened to a certain degree

Summary

Introduction

Posterior Short Segment Pedicle Screw Fixation is a popular procedure for treating unstable thoracolumbar/lumbar burst fracture. The efficacy of different methods remains debatable and each technique has its advantages and disadvantages. It still remains controversial about the optimal management strategy for thoracolumbar/lumbar burst fracture [1,2,3]. Posterior short segment pedicle screw methods remain debatable and each present technique has its advantages and disadvantages. We prospectively treated a consecutive series of 20 thoracolumbar/lumbar burst fractures with posterior short-segment pedicle screw fixation (that is, pedicle screw fixation one level cephalad to and one level caudad to a fracture) in conjunction with TLIF (transforaminal lumbar/thoracolumbar interbody fusion) to evaluate the feasibility and efficacy of this new technique

Methods

Results

Discussion

Conclusion