Loss Of Cobb Angle Research Articles

Accurate rebuilding of sagittal plane radian measure for treatment of thoracolumbar vertebrate fracture: a comparative study

Objective To conduct a comparative study on the middle-and long-term efficacies of individualized titanium stick angular designs for treating thoracolumbar vertebrate fractures.Methods A total of 96patients were divided into two groups,with 50in the treatment group and 46in the control group.The titanium stick in the treatment group was folded based on the numerical value which had been obtained by measuring and calculating the standard lateral projection of thoracolumbar vertebrate before the operation;the numerical value on sagittal plane was the sum of the average angle of its upper and subtus athletic segment,the angulation of subtus athletic segment and the angle of subtus vertebral body.The titanium stick in the control group was folded based on experience during the operation,with other treatments being the same.The patients were followed-up for at least 6months,with an average of(18±5)months.All the patients received radiography examination pre-and post-operatively.And 42patients received CT examination before and at the last follow-up;another 30patients received MRI examination at last follow-up.Results At the final follow-up,the anterior,posterior vertebral heights were(1.06±0.46)mm and(0.42±0.26)mm for the treatment group and(2.37±0.86)mm(P0.05)and(0.79±0.46)mm for the control group,respectively.The average loss of Cobb angle was(1.57±0.51)°in the treatment group and(2.49±0.89)°in the control group at final follow-up(P0.05).The treatment group had 21cases with fish tail and the control group had 25.The failure rate of internal fixation was 6%in the treatment group and 13%in the control group.The eggshell phenomenon on CT findings was found in 10of the 22patients in the treatment group and in 9of the 20cases in the control group at final follow-up.The neurological status was improved at least by 1Frankel grade in the patients who had preoperative incomplete paraplegia.The scores of Oswestry Disability Questionnaire for the treatment group were:0in 17cases,2in 15cases,4in11cases,6in 2cases,8in 2cases,56in 1case,80in 1case,and 88in 1case;for the control group were 0in 10cases,4in 15cases,6in 11cases,8in 2cases,10in 2cases,18in 2cases,50in 2cases,and 80in 2cases.There were significant differente between the two groups(34%vs 21.74%,P0.05).Conclusion When transpedicle vertebral arch internal fixation system is used for treatment of thoracolumbar vertebrae fractures via posterior approach,individualized titanium stick angular design can accurately regain the physiologic curve of the fixed thoracolumbar segment,reducing operational time,loss of vertebral height correction,failure rate of internal fixation,incidence of backache,and degeneration of adjacent segment.

Efficacy analysis of pedicle screw internal fixation of fractured vertebrae in the treatment of thoracolumbar fractures

The present study aimed to discuss the method and effect of posterior internal fixation of thoracolumbar fractures strengthened by the vertical stress pedicle screw fixation of fractured vertebrae. Patients with single thoracolumbar fractures were examined retrospectively. Fourteen patients (group A) had been treated with vertical stress pedicle screw fixation of a fractured vertebra and sixteen patients (group B) received traditional double-plate fixation, as a control. All patients were diagnosed with fresh fractures with a complete unilateral or bilateral pedicle and no explosion of the inferior half of the vertebral body or inferior endplate. In group A, patients received conventional posterior distraction and lumbar lordosis restoration, as well as pedicle screws in the fractured vertebra in a vertical direction to relieve stress to achieve a local stress balance. All patients were followed up postoperatively for 4–18 months (average, 12.6 months). The vertical stress pedicle screw fixation assisted in the reduction of vertebrae fracture, which reduced the postoperative Cobb’s angle loss. There was a significant difference in the change of Cobb’s angle between the two groups one year after surgery (P<0.01). Conditional application of pedicle screws in a single thoracolumbar fracture enhances the stability of the internal fixation system and is conducive to the correction of kyphosis and maintenance of the corrective effects.

Navigation-guided posterior fixation plus transpedicular vertebroplasty for thoracolumbar fractures

ObjectiveTo assess the outcomes of navigation-guided posterior fixation plus transpedicular vertebroplasty for thoracolumbar fractures.MethodsFrom June, 2005 through March,2009, 30 patients with thoracolumbar fracture underwent navigation-guided posterior fixation with transpedicular vertebroplasty in our department. They were 18 men and 12 women, aged from 21 to 57 years (mean,35.5 years). Three fractures occurred on T11, 11 on T12, 14 on L1, and 2 on L2.Results The follow-ups averaged 18 months ( 12 to 36 months). Of the 120 pedicle screws inserted, 110 were of degree 0, 8of degree I, 2 of degree Ⅱ, 0 of degree Ⅲ. The total good to excellent rate was 98.3％ for the screw insertion. Before operation, the average canal compromise was 37.5％ (5％ to 70％ ), the average vertebrae compression was 54. 5％ (40％ to 70％ ), and the average Cobb angle was 29. 5° ( 15.5° to 41.5°). Postoperatively the average canal compromise was 14. 3％ (0 to 20％ ), the average height of vertebrae was 91.3％ (80％ to 100％ ) and the average Cobb angle was 4. 9° ( 1. 3° to 9. 1°). The long-term follow-ups showed an average Cobb angle loss of ＜ 1° and an average vertebral height loss of ＜ 2 mm.Conclusions The navigation-guided posterior fixation plus transpedicular vertebroplasty is an effective treatment for thoracolumbar fractures. Computer-assisted navigation system enhances accuracy and further improves the safety of spine surgery, compared with just the anterior or posterior fixation. Key words: Su rgery, computer-assisted; Spil al fracture; Fracture fixation, internal; Bone graft

Postoperative Disc Wedging in Adolescent Idiopathic Thoracolumbar/Lumbar Scoliosis: a Comparison of Anterior and Posterior Approaches

To evaluate the different influences of anterior and posterior correction and fusion approaches upon disc wedging in adolescent idiopathic thoracolumbar/lumbar scoliosis. The retrospective study was conducted with the medical records and radiographs of adolescent idiopathic thoracolumbar/lumbar scoliosis patients that underwent anterior (group A) or posterior (group B) correction and fusion surgery from December 1998 to May 2008. The correction of the main curve and changes of the disc wedging were analyzed. Fifty-three patients were included, 26 in group A and 27 in group B. The mean coronal Cobb angles of the main curve in group A and group B were significantly corrected after surgery (P < 0.05), with an average correction rate of 75.2% and 88.2%, respectively. Upon final follow-up, the coronal Cobb angles of the two groups were 18.90 +/- 11.1 degrees and 7.70 +/- 5.6 degrees, respectively, with an average correction loss of 6.8 degrees +/- 6.5 degrees and 2.7 degrees +/- 3.3 degrees, respectively. The coronal Cobb angle after operation and at final follow-up, and the correction rate were significantly better in group B than those in group A (P < 0.05), while the coronal Cobb angle loss in group A was greater than that in group B (P < 0.05). The disc wedging before operation, after operation, and at final follow-up were 3.2 degrees +/- 3.0 degrees, 5.7 degrees +/- 3.0 degrees, and 8.6 degrees +/- 4.4 degrees in group A, and 2.4 degrees +/- 3.2 degrees, 3.3 degrees +/- 3.4 degrees, and 3.7 degrees +/- 3.6 degrees in group B, respectively. Postoperative disc wedging was significantly larger compared with preoperative measurements in group A (P < 0.05), but not in group B (P > 0.05). The difference between disc wedging at final follow-up and that after surgery was significant in group A (P < 0.05), but not in group B (P > 0.05). Between the two groups, group A had larger disc angles after operation and at final follow-up (P < 0.05), and a greater loss of disc angle (P < 0.05). For adolescent idiopathic thoracolumbar/lumbar scoliosis, posterior approach using all pedicle screws might produce a better result in terms of disc wedging compared with anterior approach.

Morphological features of complicated thoracolumbar fractures and fixation technology of injured vertebra

To study the morphological feature of complicated thoracolumbar fractures and the fixation technology of injured vertebra. From January 2005 to December 2007, 61 patients with type B and C thoracolumbar fractures according to AO classification were treated. There were 53 males and 8 females, with a mean age of 33.2 years (range, 9 to 65 years). Based on ASIA grading system of neurologic deficit, Grade A was found in 41 cases, grade B in 5 cases, Grade C in 5 cases, Grade D in 6 cases and Grade E in 4 cases. The injured vertebra located at thoracic region in 13, thoracolumbar in 39 and lumbar in 9 cases. The patients were divided into two groups: 32 cases with pedicle screws in the injured vertebra and 29 cases without pedicle screw in the injured vertebra. The analyses on the morphological features of injured vertebra were performed, and comparisons were carried out on the outcome regarding the reduction and correction of the injured vertebra, and the difference of Denis scale in pain domain and work status domain, between the two groups. All the patients were followed up for an average of 3 years (range, 1.5 to 4.5 years). There were significance statistical difference in the correction loss of Cobb angle, sagittal index, correction of dislocation index, and the Denis pain scale between the two groups (P < 0.05). A better outcome was observed in the injured vertebra fixation group than the injured vertebra non-fixation group. Inserting pedicle screws in the injured vertebra is effective and useful in the correction of complicated thoracolumbar fractures. It improves biomechanical stability of the spine after the operation.

The effect of post-operative immobilization on short-segment fixation without bone grafting for unstable fractures of thoracolumbar spine

Background:Controversy regarding the fixation level for the management of unstable thoracolumbar spine fractures exists. Often poor results are reported with short-segment fixation. The present study is undertaken to compare the effect of fixation level and variable duration of postoperative immobilization on the outcome of unstable thoracolumbar burst fractures treated by posterior stabilization without bone grafting.Patients and Methods:A randomized, prospective, and consecutive series was conducted at a tertiary level medical center. Thirty-six neurologically intact (Frankel type E) thoracolumbar burst fracture patients admitted at our institute between February 2003 and December 2005 were randomly divided into three groups. Group I (n = 15) and II (n = 11) patients were treated by short-segment fixation, while Group III (n = 10) patients were treated by long-segment fixation. In Group I ambulation was delayed to 10th-14th postoperative day, while group II and III patients were mobilized on third postoperative day. Anterior body height loss (ABHL) percentage and increase in kyphosis as measured by Cobb's angle were calculated preoperatively, postoperatively, and at follow-up. Denis Pain Scale and Work Scales were obtained during follow-up.Results:Mean follow-up was 13.7 months (range 3-27 months). At the final follow-up the mean ABHL was 4.73% in group I compared with 16.2% in group II and 6.20% in group III. The mean Cobb's angle loss was 1.8° in group I compared with 5.91° in group II and 2.3° in group III. The ABHL difference between groups I and II was significant (P = 0.0002), while between groups I and III was not significant (P = 0.49).Conclusion:The short-segment fixation with amenable delayed ambulation is a valid option for the management of thoracolumbar burst fractures, as radiological results are comparable to that of long-segment fixation with the advantage of preserving maximum number of motion segments.