Short-segment Pedicle Screw Fixation Research Articles

Posterior short-segment fixation with transforaminal lumbar interbody fusion for the treatment of unstable lower lumbar fracture

Background: The objective of this study was to evaluate the clinical and radiographic results of posterior short-segment pedicle screw fixation and transforaminal lumbar interbody fusion (TLIF) in selected types of lower lumbar fractures. Methods: Twenty-seven patients with lower lumbar fractures were enrolled in this study. Demographic data, neurologic grade, anterior vertebral body heights, vertebral body translation, segmental Cobb angle, and management-related complications were assessed. The minimum follow-up period was 2 yr. Results: Twenty male patients and seven female patients underwent the procedure, with a mean operative time of 182 min. Mean blood loss was 588 mL. The mean preoperative local kyphotic angle was 9.5 degrees that improved to 2.5 degrees postoperatively. The loss of correction was insignificant at the final follow-up. The preoperative percentage of height lost improved from a mean of 52.5% to a mean of 89.05% postoperatively, and at last follow-up no loss of correction in height was noted compared to the postoperative results. No pseudarthrosis or metal failure was detected. All patients who were Frankle E on admission remained neurologically intact. Conclusions: Posterior short-segment fixation with pedicle screw fixation augmented with TLIF might be a possible choice for selected patients with unstable lower lumbar fractures, particularly in split fractures, burst fractures with a reversed cortex sign, and traumatic spondylolisthesis.

Short term functional and neurological outcome of short segment pedicle screw fixation in unstable thoracolumbar burst fractures

Short term functional and neurological outcome of short segment pedicle screw fixation in unstable thoracolumbar burst fractures

Using the cortical bone trajectory screw technique with vertebral column resection to treat an osteoporotic compression fracture in progressive thoracolumbar hyperkyphosis: A case report

Abstract Progressive thoracolumbar hyperkyphosis (aka hunchbacked) with a sagittal imbalance in an osteoporotic compression fracture might warrant surgical correction when conservative treatment fails. A 70-year-old woman presented with an L1 osteoporotic compression fracture after an L1 vertebroplasty and a short-segment (T12-L2) pedicle screw fixation. Because of the osteoporosis, the pedicle screws had loosened and a new L4 compression fracture occurred after the surgery. The author used the cortical bone trajectory screw technique for a long-segment posterior fixation after an anterior vertebral column resection. The outcome was good at the one-year follow-up. This technique provided a thoracolumbar Cobb angle correction of 20° and a sagittal vertical axis correction from 8.3 cm to 2.5 cm. This was the first reported case using the long-segment cortical bone trajectory screw technique to treat an osteoporotic compression fracture in progressive thoracolumbar hyperkyphosis.

Case-control study of pedicle screw fixation combined with vertebroplasty and injured vertebra pedicle fixation in treatment of osteoporotic thoracolumbar burst fractures

To compare the curative effect of short-segment pedicle screw fixation combined with vertebroplasty and injured vertebra pedicle fixation in treating osteoporotic thoracolumbar burst fractures. A retrospective study was performed for 52 patients with thoracolumbar burst fractures from August 2010 to August 2015. Among them, 27 patients(group A) were treated with short-segment pedicle screw fixation combined with vertebroplasty, including 17 males and 10 females, aged from 54 to 68 years old with an average of(61.01±5.41) years, 16 cases were type A3 and 11 cases were type A4 according the new AO typing. Other 25 patients (group B) were treated with short-segment pedicle screw fixation combined with injured vertebra pedicle fixation, including 12 males and 13 females, aged from 55 to 66 years old with an average of (59.28±6.12) years, 18 cases were type A3 and 7 cases were type A4 according the new AO typing. Operation time, intraoperative bleeding volume, complication, image data and clinical effect were compared between two groups. All the patients were followed up for 12 to 15 months with an average of (12.4±2.1)months. There was no significant difference in general data(including gender, age, injured site, preoperative VAS score, Cobb angle, injured vertebral anterior border height) between two groups. There was no significant differences in operation time, intraoperative bleeding volume between two groups. Preoperative, one week after operation and final follow-up, VAS scores were 5.2±0.5, 1.2±0.2, 0.8±0.1 respectively in group A and 5.0±0.6, 2.5±0.4, 1.3±0.2 in group B; injured vertebral anterior border height were (49.4±6.8)%, ( 94.5±1.2)%, ( 94.1±3.7)% respectively in group A and (48.2±7.0)%, ( 94.3±4.1)%, ( 90.0±2.3)% in group B;Cobb angles were (20.4±5.2) °, (2.5±1.8) °, (4.4±1.7)° respectively in group A and (19.8±6.8)°, (2.4±1.7)°, (7.0±1.2)° in group B. At final follow-up, VAS, Cobb angle, injured vertebral anterior border height in two groups were obviously improved(P<0.05). Postoperative at 1 week and final follow-up, VAS score of group A was lower than that of group B(P<0.05);and there was no significant difference in Cobb angle between two groups(P>0.05); there was significant difference in injured vertebral anterior border height between two groups(P<0.05). The complication of internal fixation failure had 1 case in group A and 4 cases in group B. For the treatment of single osteoporotic thoracolumbar burst fractures, short-segment pedicle screw fixation combined with vertebroplasty is better than combined with injured vertebra pedicle fixation in clinical effect, it can relieve pain, maintain injured vertebral height and sagittal alinement, reduce the complications associated with internal fixation, and be worth spread in clinic.

Modified Posterior Short-Segment Pedicle Screw Instrumentation for Lumbar Burst Fractures with Incomplete Neurological Deficit

We have introduced a method of modified posterior short-segment pedicle screw fixation and evaluated its clinical effects in treating lumbar burst fractures with incomplete neurological deficits. The data from 22 patients with lumbar burst fracture and incomplete neurological deficits who had undergone modified posterior short-segment instrumentation with Schanz screw fixation from January 2012 to February 2018 in our clinic were evaluated in the present retrospective study. All Schanz screws were implanted in an oblique downward direction into the vertebrae above and below the injured vertebra (insertion depth, 90%-100%). The implants were removed ∼1 year after surgery. Neurological function, back pain, anterior and posterior body height ratio, kyphosis angle, percentage of canal compromise, fracture severity, and treatment-related complications were evaluated. Technical success was achieved in all 22 patients. No infection, instrument loosening or failure, or breakage was observed. Statistically significant improvements with regard to the anterior body height (P < 0.05) and posterior body height (P < 0.05) ratios, kyphosis angle, and percentage of canal compromise (P < 0.05) were observed at 1 week postoperatively or the final follow-up visit. No correction loss had occurred at the final follow-up examination. Postoperatively, all patients with neurological deficits had functional improvement equivalent to ≥1 grade on the American Spinal Injury Association impairment scale and fracture union. Back pain was greatly improved postoperatively. Short-segment Schanz screw fixation implanted in an oblique downward direction seems to be a promising method for lumbar burst fractures with incomplete neurological deficits because it provided good clinical and radiographic outcomes.

Extent and location of fixation affects the biomechanical stability of short- or long-segment pedicle screw technique with screwing of fractured vertebra for the treatment of thoracolumbar burst fractures: An observational study using finite element analysis.

Intermediate screw fixation at the fracture level has been widely accepted to treat thoracolumbar burst fractures, but no study has shown the effect of the extent and location of fixation. The effect of the extent and location of fixation on short- or long-segment pedicle screw fixation through intermediate screw fixation at the fracture level in the treatment of thoracolumbar burst fractures is discussed.Posterior intermediate screw fixation techniques in treating T12 vertebral fracture models were simulated and compared using finite element methods; the fixation techniques included M3-L1 (bilateral 3 monoaxial pedicle screw fixation from L1 to T11), M3-L2, M4-L1 (bilateral 4 monoaxial pedicle screw fixation from L1 to T10), M4-L2, M4-L3, and M5-L2 (bilateral 5 monoaxial pedicle screw fixation from L2 to T10). Range of motion (ROM) and largest von Mises stress (LVMS) of the instrumentations were recorded and analyzed.No significant differences were observed in the mean ROM of all states of motion between the M3-L1 model and the other fixation models except for M5-L2. The LVMS of the pedicle screws and rods all occurred during flexion. The LVMS values of the pedicle screws were larger in the M3-L2 fixation model and M4-L3 fixation model than in the other fixation models. The M3-L1 model presented a significantly smaller mean LVMS of the pedicle screws in all states of motion than the M3-L2 model (P = .026). The LVMS values of the rods were larger in the M3-L2 fixation model, M4-L3 fixation model, and M4-L2 fixation model than in the other fixation models. No significant differences were observed in the mean LVMS of the rods in all states of motion among all the fixation models.When choosing short-segment pedicle screw fixation with the screwing of fractured vertebrae to treat thoracolumbar fractures, we suggest M3-L1 over M3-L2. More severe injuries can be considered to identify an alternative treatment to long-segment monoaxial pedicle fixation constructs such as the M4-L1 and M5-L2 techniques.

Spine Trauma as a Component of Essential Neurosurgery: An Outcomes Analysis from Cambodia.

In recent years, delivery of cost-effective "essential neurosurgery" in resource-limited communities has been recognized as an indispensable part of health care and a global health priority. The aim of this study was to review outcomes from operative management of spine trauma at a resource-limited government hospital in Phnom Penh, Cambodia, and to provide an epidemiologic report to guide prevention programs. A retrospective review of a prospective neurosurgical database was performed to identify risk factors for spine trauma and severe spinal cord injury (American Spinal Injury Association A or American Spinal Injury Association B) and to evaluate the cost-effectiveness of surgery for patients treated at Preah Kossamak Hospital for subaxial and thoracolumbar spine trauma from 2013 to2016. Surgical treatment was provided to 277 patients with cervical or thoracolumbar spine trauma, including 36 facet dislocations and 135 thoracolumbar burst fractures at a cost of $100-$280 per surgery. Six patients (2.2%) required treatment for postoperative wound infection. Reoperation was performed in 8 patients (2.9%) for wrong-level surgery. Failure of short-segment pedicle screw fixation was discovered in 4 patients (7.0%). Neurologic improvement was reported by 64 patients (65.3%) with incomplete spinal cord injury and available long-term follow-up. Affordable neurosurgical care can beprovided in a safe and sustainable manner to patientswith traumatic spine and spinal cord injuries in resource-limited communities. This supports the call for essential neurosurgery to be made available around the world to individuals from all socioeconomic strata.

Comparison of Wiltse\u2019s paraspinal approach and open book laminectomy for thoracolumbar burst fractures with greenstick lamina fractures: a randomized controlled trial

BackgroundPosterior short-segment pedicle screw fixation is used to treat thoracolumbar burst fractures. However, no randomized controlled studies have compared the efficacy of the two approaches––the Wiltse’s paraspinal approach and open book laminectomy in the treatment of thoracolumbar burst fractures with greenstick lamina fractures.Materials and methodsPatients with burst fractures of the thoracolumbar spine without neurological deficit were randomized to receive either the Wiltse’s paraspinal approach (group A, 24 patients) or open book laminectomy (group B, 23 patients). Patients were followed postoperatively for average of 27.4 months. Clinical and radiographic data of the two approaches were collected and compared.ResultsOur results showed the anterior segmental height, kyphotic angle, visual analog scale (VAS) score, and Smiley-Webster Scale (SWS) score significantly improved postoperatively in both groups, indicating that both the Wiltse’s paraspinal approach and open book laminectomy can effectively treat thoracolumbar burst fractures with greenstick lamina fractures. The Wiltse’s paraspinal approach was found to have significantly shorter operating time, less blood loss, and shorter length of hospital stay compared to open book laminectomy. However, there were two (2/24) patients in group A that had neurological deficits postoperatively and required a second exploratory operation. Dural tears and/or cauda equina entrapment were subsequently found in four patients in group B and all two patients of neurological deficits in group A during operation. No screw loosening, plate breakage, or other internal fixation failures were found at final follow-up.ConclusionsThe results demonstrated that either of the two surgical approaches can achieve satisfactory results in treating thoracolumbar burst fractures in patients with greenstick lamina fractures. However, if there is any clinical or radiographic suspicion of a dural tear and/or cauda equina entrapment pre-operation, patients should receive an open book laminectomy to avoid a second exploratory operation. More research is still needed to optimize clinical decision-making regarding surgical approach.

Bone Cement-Augmented Short-Segment Pedicle Screw Fixation for Kümmell Disease with Spinal Canal Stenosis.

BackgroundThis study aimed to explore the feasibility and efficacy of bone cement-augmented short-segmental pedicle screw fixation in treating Kümmell disease.Material/MethodsFrom June 2012 to June 2015, 18 patients with Kümmell disease with spinal canal stenosis were enrolled in this study. Each patient was treated with bone cement-augmented short-segment fixation and posterolateral bone grafting, and posterior decompression was performed when needed. All patients were followed up for 12–36 months. We retrospectively reviewed outcomes, including the Oswestry disability index (ODI), visual analog scale (VAS) score, anterior and posterior heights of fractured vertebrae, kyphotic Cobb angle, and neurological function by Frankel classification.ResultsThe VAS grades, ODI scores, anterior heights of affected vertebrae, and kyphotic Cobb angles showed statistically significant differences between pre- and postoperative and between preoperative and final follow-up values (P<0.05), whereas the differences between postoperative and final follow-up values were not statistically significant (P>0.05). The differences between posterior vertebral heights at each time point were not statistically significant (P>0.05). Improved neurological function was observed in 12 cases at final follow-up. Three cases had complications, including asymptomatic cement leakage in 2 patients and delayed wound infection in 1 patient.ConclusionsBone cement-augmented short-segment pedicle screw fixation is safe and effective for treating Kümmell disease, and can achieve satisfactory correction of kyphosis and vertebral height, with pain relief and improvement in neurological function, with few complications.

Thoracolumbar Vertebral Injuries with Neurological Deficit Treated with Posterior Decompression, Short Segment Pedicle Screw Fixation, and Interlaminar Fusion.

Study DesignProspective clinical study.PurposeThe purpose of this study was to evaluate the effect of interlaminar fusion and short segment pedicle screw fixation on thoracolumbar vertebral injuries for preventing pain and post-traumatic kyphosis.Overview of LiteratureThe treatment of thoracolumbar injuries continues to be one of the most controversial areas in spine care. The main aim of surgical treatment is to decompress the spinal cord or nerve roots, realign the spine, and correct or prevent post-traumatic kyphosis. We evaluated the outcome of interlaminar fusion along with posterior decompression and short segment pedicle screw fixation in patients with thoracolumbar fractures with neurological deficit.MethodsTwenty-two patients with traumatic thoracolumbar vertebral injuries and neurological deficit underwent short segment pedicle screw fixation above and below the fractured vertebrae, posterior decompression, and interlaminar fusion using a bone graft.ResultsAll patients were followed up for 12 months postoperatively. The average operative time and blood loss was 142 minutes and 214 mL, respectively. Of the 22 patients, 14 recovered completely. Of the nine patients with American Spinal Injury Association (ASIA) grade A disease, two improved by 1 grade, whereas one each improved by grades 2, 3, and 4, and four did not recover. Radiologically, vertebral kyphosis angle improved from 20.91 preoperatively to 15.73 postoperatively, sagittal index improved from 24.77 to 18.73, the sagittal plane kyphosis angle improved from 17.45 to 11.41, regional angle kyphosis improved from 14.73 to 10.14, the superior inferior end plate angle from 16.14 to 13.00, and mean anterior body compression improved from 36.26 to 27.64 postoperatively. No implant failed and no patient had neurological deterioration.ConclusionsShort segment pedicle screw fixation with posterior decompression and interlaminar fusion provided considerable reduction in kyphosis, restored the vertebral height of patients with thoracolumbar vertebral injuries and neurological deficit, and prevented development of delayed kyphotic deformity.

Short Versus Long Segment Fixation for Thoracolumbar Burst Fractures: A Randomized Controlled Trial

Background Data: Selection of stabilization procedures for treating thoracolumbar burst fractures remains controversial. Both long-segment and short-segment pedicle screw fixation including the fractured vertebral body have been used widely with no consensus on the better method.Purpose: To compare between the long segment and short-segment with intermediate screw (s) fixation of thoracolumbar junction burst fractures in terms of radiological and clinical outcomes.Study Design: Prospective randomized controlled trial.Patients and Methods: Fifty consecutive patients (32 males and 18 females, mean age 33.6±14.6 years) with thoracolumbar burst fractures presenting during the period between October 2015 and December 2016 to Assiut University hospital were randomized into one of two groups. Group A (25 patients) was treated by long segment pedicle screw fixation, i.e., fixation of 2 levels above and below the fractured vertebra. Group B (25 patients) was treated by short segment fixation, i.e., 1 level above and 1 level below the fractured vertebra, with one or 2 intermediate screws in the fractured vertebra itself. The study protocol was approved by our institution review board and all patients signed an informed consent. The inclusion criteria were single level Type A3 and A4 fracture at thoracolumbar junction, regardless of their neurological status. All patients were treated within 48 hours from the injury. Monoaxial screws were used in all patients. Assessment of kyphosis correction by using the Cobb method and restoration of the anterior vertebral body height was performed radiologically postoperatively and at 3 and 6 months follow up. The clinical outcomes were evaluated using the modified Macnab criteria in the last follow-up. Radiological and clinical assessment was made by an independent observer.Results: Demographic data of both groups were quite comparable. The mean operative time in Group B was significantly shorter than in group A (85±28 min. and 110±0.59 min. respectively). The mean operative blood loss was also significantly lower in Group B than in Group A (476±133.2cc and 656±195.9cc respectively). There was no significant difference between both groups as regards the degree of local kyphosis angle correction and anterior vertebral body height restoration or the correction loss observed during the follow up. Neurological recovery was observed in all patients. Clinically, 14 (56%) patients in Group A and 21 (84%) patients in group B were within the Excellent/Good categories according to Macnab Criteria, whereas 11 (44%) patients in group A and 4 (16%) patients in Group B (16%) were in Fair/poor Group (P=0.064). No perioperative complications were recorded in either group. Conclusion: Short-segment fixation using monoaxial pedicle screws and including the fractured vertebral body is as effective as long-segment pedicle screw fixation for treating A3 and A4 thoracolumbar burst fractures. It preserves motion segments and reduces the costs of surgery and seems to result in a better clinical outcome. (2017ESJ131)

Short segment pedicle screw fixation of thoracolumbar fracture: a case series of 33 patients

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Pedicle screw instrumentation in case of fracture spine provides stable fixation. However in absence of experience and proper technique of pedicle screw insertion, it is associated with many complications. We aim to study the results of patients with thoracolumbar fracture stabilized with short segment pedicle screw instrumentation.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 33 cases of thoracolumbar wedge compression fracture spine presenting to Nair Hospital were included in the study. All patients were operated by the senior author via a posterior approach and short segment pedicle screw fixation. Patients were followed up for one year.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 33 patients with a mean age were 37.6 years of which 3 were females and 30 were males in our study. Fall from height (93.93%) was the most common mode of injury followed by road traffic accident (6.07%). D12 and L1 were the most common vertebrae involved. Statistically significant (p=0.01) correction in the vertebral body height occurred in the immediate postop period and there was 4.1% loss of correction at final follow-up. There was statistically significant improvements in the Regional angle (p=0.03) and anterior wedge angle (p=0.03). Residual regional angle at final follow-up was found to be &amp;gt;5° in 3 patients. Neurological improvement was seen in 23 (74.19%) patients (p=0.01). No improvements were seen in 8 (25.81%) patients. None of our patients had postoperative worsening of the neurological status. None of the patients had pedicle wall breach on final follow up CT scan.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Short segment fixation in case of wedge fracture can restore the vertebral body height, mean regional angle and mean anterior wedge angle and provide good outcome. There are poor chances of recovery of patient with Frankel grade A. Meticulous dissection and careful technique of pedicle screw insertion, adequate decompression, good contouring of the rod with correction of kyphosis can provide excellent results.&lt;/p&gt;

Treatment of thoracolumbar burst fractures by short-segment pedicle screw fixation using a combination of two additional pedicle screws and vertebroplasty at the level of the fracture: a finite element analysis

BackgroundTraditional one-above and one-below four-screw posterior short-segment instrumentation is used for unstable thoracolumbar burst fractures. However, this method has a high rate of implant failure and early loss of reduction. The purpose of this study was to use finite element (FE) analysis to determine the effect of treating thoracolumbar burst fractures by short-segment pedicle screw fixation using a combination of two additional pedicle screws and vertebroplasty at the level of the fracture.MethodsAn intact T11-L1 spine FE model was created from the computed tomography images of a male subject. Four fixation models with posterior fusion devices (pedicle screws, rods, cross-link) were established to simulate an unstable thoracolumbar fracture with different fusion surgeries: short-segment fixation with: 1) a link (S-L); 2) intermediate bilateral screws (S-I); 3) a link and calcium sulfate cement (S-L-C); 4) intermediate bilateral screws and calcium sulfate cement (S-I-C). Different loading conditions (flexion, extension, lateral bending, and axial rotation) were applied on the models and analyzed with a FE package. The range of motion (ROM), and the maximum value and distribution of the implant stress, and the stress in the facet joint, were compared between the intact and fixation models.ResultsThe ROM in flexion, extension, axial rotation, and lateral bending was the smallest in the S-I-C model, followed by the S-I, S-L-C, and S-L models. Maximum von Mises stress values were larger under lateral bending and axial rotation loadings than under flexion and extension loading. High stress was concentrated at the crosslink and rod junctions. Maximal von Mises stress on the superior vertebral body for all loading conditions was larger than that on the inferior vertebral body. The maximal von Mises stress of the pedicle screws during all states of motion were 265.3 MPa in S-L fixation, 192.9 MPa in S-I fixation, 258.4 MPa in S-L-C fixation, and 162.3 MPa in S-I-C fixation.ConclusionsShort-segment fixation with two intermediate pedicle screws together with calcium sulfate cement at the fractured vertebrae may provide a stiffer construct and less von Mises stress of the pedicle screws and rods as compared to other types of short-segment fixation.

Transpedicular screw fixation for the treatment of thoracolumbar spine fracture

One of the most popular procedures for treating the unstable thoracolumbar fracture is the short segment pedicle screw fixation. Due to lack of adequate neurological improvement, progressive kyphosis and hardware failure, the efficacy of different methods remain debatable. One hundred patients of thoracolumbar burst fractures were managed from January 2010 to December 2014 by transforaminal thoracolumbar interbody fusion and short-segment pedicle screw stabilization. Each patient was followed-up for a minimum of 2 years. Bony fusion was done in each patient in between two vertebra along with transpedicular fixation. Follow-up radiological images showed good reduction and the fusion of the vertebral body was good. Excellent neurological improvement of the Frankel grade C and D was seen in 81 patients. Eight patients had grade B, improvement which was not satisfactory. Fifteen patients with no paraplegia/hemiplegia on admission remained neurologically intact. For the management of thoracolumbar burst fractures short segment posterior transpedicular fixation with bone graft is very economic and safe procedure with good neurological improvement.

Temporary short-segment pedicle screw fixation for thoracolumbar burst fractures: comparative study with or without vertebroplasty

Background ContextShort-segment posterior spinal instrumentation for thoracolumbar burst fracture provides superior correction of kyphosis by an indirect reduction technique, but it has a high failure rate. PurposeThe purpose of the study we report here was to compare outcomes for temporary short-segment pedicle screw fixation with vertebroplasty and for such fixation without vertebroplasty. Study DesignThis is a prospective multicenter comparative study. Patient SampleWe studied 62 consecutive patients with thoracolumbar burst fracture who underwent short-segment posterior instrumentation using ligamentotaxis with Schanz screws with or without vertebroplasty. Outcome MeasuresRadiological parameters (Cobb angle on standing lateral radiographs) were used. MethodsImplants were removed approximately 1 year after surgery. Neurologic function, kyphotic deformity, canal compromise, and fracture severity were evaluated prospectively. ResultsAfter surgery, all patients with neurologic deficit had improvement equivalent to at least one grade on the American Spinal Injury Association impairment scale and had fracture union. Kyphotic deformity was reduced significantly, and reduction of the vertebrae was maintained with and without vertebroplasty, regardless of load-sharing classification. Although no patient required additional anterior reconstruction, kyphotic change was observed at disc level mainly after implant removal with or without vertebroplasty. ConclusionsTemporary short-segment fixation yielded satisfactory results in the reduction and maintenance of fractured vertebrae with or without vertebroplasty. Kyphosis recurrence may be inevitable because adjacent discs can be injured during the original trauma.

Short same segment fixation versus short segment fixation in postoperative correction of kyphosis and pain reduction in thoracolumbar spine fractures

Abstract Introduction: Posterior short segment pedicle screw fixation is considered the most common way for management of unstable thoracolumbar spine fracture. This study is aiming to evaluate the efficacy of both posterior short same segment and posterior short segment pedicle screw fixation on postoperative kyphotic angle and pain dense score in thoracolumbar fractures. Methods: This is a Prospective study of 32 patients with single level thoracolumbar spine fracture between June 2011 and May 2014. Patients were divided randomly into 2 groups, one of them was submitted to short same segment posterior pedicle screw fixation with mean age 31.25+9.25ys, while the other group submitted to short segment posterior pedicle screw fixation with mean age 29.18+9.65ys. Cobb method and Denis work scale were used to assess kyphotic angle and pain score respectively on admission, during follow up period and after one year postoperatively. Results: The short same segment type of operation showed improvement in correction in kyphotic angle deformity at the end of follow up period although this improvement was not statistically significant compared to short segment type. The short same segment patients showed statistically significant improvement as regard pain Denis score among those patients treated by short segment fixation. Conclusion: In this study short same segment posterior pedicle screw fixation is more efficient in postoperative pain reduction than short segment posterior pedicle screw fixation.

Balloon vertebroplasty reinforced by injectable calcium sulfate cement versus posterolateral fusion for treatment of thoracolumbar burst fractures

Objective To compare the clinical curative effects of balloon vertebroplasty reinforced by injectable calcium sulfate cement(CSC) and posterolateral fusion after short-segment pedicle screw fixation through the fractured vertebra in treatment of thoracolumbar bumt fractures. Methods From February 2012 to May 2015, 68 cases patients with single thoracolumbar burst fracture were admitted in Orthopaedics and Traumatology Department of Traditional Chinese Medicine Hospital of Gaozhou, and were randomly divided into two observation group and control group, each group with 34 cases.Observation group were treated by short-segment pedicle screw fixation through the fractured vertebra followed by transpedicular balloon reduction of the endplate and CSC injection, the control group were underwent posterolateral fusion in addition to short-segment pedicle screw fixation through the fractured vertebra.The 2 groups were compared at preoperation, and the last follow-up in terms of visual analog pain score(VAS), Oswestry disability index(ODI), anterior height ratio of the injured vertebra, middle height ratio of the injured vertebra, the vertebral wedge angle and the sagittal Cobb angle. Results The patients were followed up from 12 to 54 months.All the measure indexes at the last follow-up were significantly improved than those at preoperation in all the patients(P 0.05). At the last follow-up, the observation group showed a significantly less loss than the control group regarding the corrections of anterior height ratio of the injured vertebra((93.6±3.4) vs.(81.8±4.8)), middle height ratio of the injured vertebra((90.7±3.8) vs.(78.9±5.1)), the veaebral wedge angle((5.7±1.9) ° vs.(8.8±3.0) °) and the sagittal Cobb angle((5.2±2.1) ° vs.(7.9±2.4) °)(t=4.143, 5.786, 4.819, 4.465, P<0.05). Conclusion In treatment of thoracolumbar burst fractures, compared with posterolateral fusion, balloon vertebroplasty reinforced by injectable CSC can better restore the shape of injured vertebral body and stability of the anterior and middle columns in the early period, can also reduce losses of corrections, and keep the function of the spinal motion segment. Key words: Spinal Fractures; Fracture fixation; Calcium sulfate; Bone cement

Effectiveness comparison between two operations in treatment of unstable type Kümmell's disease

To compare the effectiveness between short segmental fixation combined with vertebroplasty (SSF+VP) and short segmental pedicle screw fixation combined with bone graft (SSF+BG) in the treatment of unstable type Kümmell's disease so as to provide a reference for the selection of the surgical method. Between March 2013 and February 2015, 48 patients with unstable type Kümmell's disease who were in accordance with the inclusive criteria were included in the study. SSF+VP were used in 25 cases (SSF+VP group) and SSF+BG in 23 cases (SSF+BG group). There was no significant difference in gender, age, disease duration, bone mineral density, fracture segment, and preoperative visual analogue scale (VAS), Oswestry disability index (ODI), and kyphotic Cobb angle between 2 groups ( P>0.05). The operation time and complications related to operation were recorded; the effectiveness was evaluated by VAS, ODI, and kyphotic Cobb angle. The operation time was (107.7±18.8) minutes in SSF+VP group and was (113.7±22.4) minutes in SSF+BG group, showing no significant difference between 2 groups ( t=-1.045, P=0.302). Bone cement leakage occurred in 6 cases of SSF+VP group, and incision delayed healing occurred in 1 case of SSF+BG group. All patients achieved bone graft fusion on X-ray films. The bone graft fusion time was (15.1±1.3) weeks in SSF+VP group and (15.7±1.8) weeks in SSF+BG group, showing no significant difference between 2 groups ( t=-1.361, P=0.180). The VAS, ODI, and kyphotic Cobb angle at immediate after operation and at last follow-up were significantly lower than preoperative ones ( P<0.05). The VAS, ODI, and kyphotic Cobb angle had no significant difference between at immediate and at last follow-up in SSF+VP group ( P>0.05). In SSF+BG group, VAS at last follow-up was significantly lower than that at immediate after operation ( P<0.05), but no significant difference was found in kyphotic Cobb angle and ODI ( P>0.05). SSF+VP group was significantly better than SSF+BG group in VAS at immediate after operation ( P<0.05), but SSF+BG group was significantly better than SSF+VP group at last follow-up ( P<0.05). There was no significant difference in kyphotic Cobb angle and ODI between 2 groups at immediate after operation and at last follow-up ( P>0.05). SSF+BG can achieve satisfactory effectiveness in the treatment of unstable type Kümmell's disease, and it has the advantages of good bony healing, obvious improvement of pain, and low complication incidence when compared with SSF+VP.

Bi-Pedicle Fixation of Affected Vertebra in Thoracolumbar Burst Fracture.

Burst fractures of the spine account for 14% of all spinal injuries and more than 50% of all thoracolumbar trauma. However, there is ambiguity while choosing the right treatment plan. Short Segment Pedicle screw Fixation (SSPF) has become an increasingly popular method of treatment of thoracolumbar burst fractures, providing the advantage of incorporating fewer motion segments in the fixation. Various biomechanical studies showed that the use of pedicle screws could achieve stable construct within short-segment fixation. To evaluate the efficacy of SSPF using longest possible screws in both pedicles of fractured vertebra. A retrospective chart review of 25 single burst thoracolumbar fracture patients, operated between May 2009 to 2015 in a tertiary care trauma center, was conducted. Preoperative and post-operative plain radiographs were evaluated for kyphotic angulations using the traditional Cobb method. Anterior Vertebral Height (AVH), Posteriors Vertebral Height (PVH) were measured preoperatively and immediate postoperatively. Average percentage loss of AVH and mid-sagittal height were calculated on preoperative and postoperative X-rays on follow up. Fourteen men and 11 women with an average age of 42.92 years comprised the study population. Mean age at the time of operation was 34.5±14.2 years. Mean operation time was 168±72 (minutes). Average hospitalization time was 9±7 (days). Mean blood loss was 515±485 (ml). There were two cases of postoperative infection and implant failure each. A mean of 15.2° of kyphosis correction was attained from pre-operation to post-operation (p<0.0001). Although, there was a 15° average improvement of kyphosis post-fixation, loss of correction over time was nearly 8°, resulting in a 7° mean correction of kyphosis. A mean loss of AVH on postoperative radiograph was 6.12% and maintained 12.4% at the time of review (p<0.001). Similarly, there was 32.8% mid-sagittal height loss at time of injury, which was improved to only 12.6% as compare to initial height loss (p<0.0001). In this study, we propose SSPF using longest possible screws in both pedicle of fractured vertebra. Bi-pedicular fixation gives significant radiological corrections.

Short segment pedicle screw fixation by using additional screws at the fracture level -for the fixation of thoracolumbar burst fractures-

Short segment pedicle screw fixation by using additional screws at the fracture level -for the fixation of thoracolumbar burst fractures-