Thoracolumbar Burst Fracture Treatment Using Posterior Pedicle Screw Fixation and Autogenous Bulk Iliac Bone Graft Fusion

Abstract

Background: Thoracolumbar vertebral fracture is the most common type of thoracolumbar vertebral fracture. For the patients with severe thoracolumbar vertebral burst fracture and neurological impairment, surgical decompression and reconstruction of spinal stability is an important intervention method, however, there is still controversy on the way of postoperative stability reconstruction. Objective: This study was to investigate the efffcacy of posterior open reduction, pedicle screw ffxation, and autogenous iliac bone graft fusion in the treatment of thoracolumbar burst fractures with neurological impairment. Methods: The clinical data of 43 patients with thoracolumbar single vertebral burst fracture with neurological function injury treated in our department from January 2016 to December 2020 were retrospectively analyzed. The Visual Analog Scale (VAS) score of lumbothoracic pain, the occupying rate of spinal canal, the ratio of the anterior height of the injured vertebral body to the normal height, Cobb angle, and the American Spinal Injury Association (ASIA) classiffcation of neurological function were compared before and after operation. All patients completed the procedure successfully. Results: Bone graft fusion was achieved in all patients, and no screw or rod was broken. The VAS score of thoracolumbar pain, the ratio of the anterior height of the injured vertebral body to the normal height, and the Cobb angle were signiffcantly lower than those before operation at 1 and 12 months after operation (P < 0.001). There was no signiffcant difference in the VAS score of thoracolumbar pain, the ratio of the anterior height of the injured vertebral body to the normal height, and the Cobb angle between 1 and 12 months after operation. The occupying rate of spinal canal 6 months after operation was lower than that before operation (12.02% ±7.35% vs. 46.98% ±9.26%), and the difference was statistically signiffcant (t = 20.066, P < 0.05). There was a signiffcant difference in ASIA classiffcation of neurological function between 12 months after operation and before operation (Z = −5.372, P < 0.001). The neurological function was signiffcantly improved 12 months after operation. Conclusion: Reconstruction of vertebral lamina with iliac bone graft is an effective method for the treatment of thoracolumbar burst fractures, which can reduce the loss of vertebral height and recurrent kyphosis and avoid the neurological impairment caused by secondary spinal stenosis.