Two levels above and one level below pedicle screw fixation for the treatment of unstable thoracolumbar fracture with partial or intact neurology

Hitesh N Modi,Hoi Soo Yoon,Ji Hyo Hwang,Kook Jin Chung,Kyu Cheol Noh,Hong Kyun Kim,Il Woo Seo,Jung Han Yoo

doi:10.1186/1749-799x-4-28

Abstract

BackgroundTreatment of unstable thoracolumbar fractures is controversial regarding short or long segment pedicle screw fixation. Although long level fixation is better, it can decrease one motion segment distally, thus increasing load to lower discs.MethodsWe retrospectively analyzed 31 unstable thoracolumbar fractures with partial or intact neurology. All patients were operated with posterior approach using pedicle screws fixed two levels above and one level below the fracture vertebra. No laminectomy, discectomy or decompression procedure was done. Posterior fusion was achieved in all. Post operative and at final follow-up radiological evaluation was done by measuring the correction and maintenance of kyphotic angle at thoracolumbar junction. Complications were also reported including implant failure.ResultsAverage follow-up was 34 months. All patients had full recovery at final follow-up. Average kyphosis was improved from 26.7° to 4.1° postoperatively and to 6.3° at final follow-up. And mean pain scale was improved from 7.5 to 3.9 postoperatively and to 1.6 at final follow-up, All patients resumed their activity within six months. Only 4 (12%) complications were noted including only one hardware failure.ConclusionTwo levels above and one level below pedicle screw fixation in unstable thoracolumbar burst fracture is useful to prevent progressive kyphosis and preserves one motion segment distally.

Highlights

Treatment of unstable thoracolumbar fractures is controversial regarding short or long segment pedicle screw fixation
Carl et al [4] reported that segmental transpedicular fixation two levels above the kyphosis should be used at the thoracolumbar junction where compressive forces act more anteriorly, whereas in the more lordotic middle and lower lumbar spine where the compressive forces act more posteriorly, no implant failure occurred with use of the one above-one below construct
We retrospectively reviewed the results of unstable thoracolumbar fractures with partial or intact neurology in consecutive 31 patients who were operated between June 2004 and June 2006 at our institute by a single spine surgeon (Table 1)

Summary

Introduction

Treatment of unstable thoracolumbar fractures is controversial regarding short or long segment pedicle screw fixation. The goals of treatment in thoracolumbar fractures are restoring vertebral column stability and obtaining spinal canal decompression, leading to early mobilization of the patient. Posterior approach is less extensive, and most spine surgeons advocate posterior fusion as the treatment of choice for unstable thoracolumbar injuries [4,5]. Krag [11] has suggested segmental pedicle fixation two levels above the kyphosis to prevent implant failure. Carl et al [4] reported that segmental transpedicular fixation two levels above the kyphosis should be used at the thoracolumbar junction where compressive forces act more anteriorly, whereas in the more lordotic middle and lower lumbar spine where the compressive forces act more posteriorly, no implant failure occurred with use of the one above-one below construct

Methods

Results

Discussion

Conclusion