Posterior Short-segment Fixation Research Articles

Outcome of posterior short segment fixation with implanting pedicle screw at the fractured level for treatment of thoracolumbar fracture

IntroductionThoracolumbar fractures make up majority of the spinal fractures. Various techniques including long, short, mono and short segment screw fixation have been used to achieve stability. There are still few studies describing the results of short segment fixation with intermediate screw fixation in fractured vertebrae, despite the fact that all have adequate efficacy and stability. Materials and methods41 patients were studied and evaluated preoperatively, at discharge and at 2, 6, 12, 24 weeks and 1 year follow-up clinically using Greenough and Fraser Low Back Pain Score, the American Spinal Injury Association (ASIA) grading, four-point scale questionnaire for patient's satisfaction, sagittal index (SI) of injured vertebra and Cobb's angle. ResultsThe patient's mean age was 36.9 ± 11.7 years, majority (90.2 %) with lumbar (L1-L3) segment involvement. All the patients significantly improved neurologically immediately after surgery (p < 0.001) however the improvement was not significant at final follow up (p = 0.3) as compared to the preoperative ASIA grade (Kendall's tau-b test). Low back pain decreased significantly on subsequent follow-up as measured by Visual Analogue Scale (VAS) score (p < 0.001). The Low Back Pain Scale of Greenough and Fraser calculated at immediate post-operation and at 1 year follow up in comparison to pre-operation status showed a statistically significant improvement (p < 0.001). Sagittal index (SI) estimated at 6, 12, 24 weeks and 1 year follow-up in comparison to preoperative SI was higher and statistically significant (p < 0.001). Mean Cobb's angle significantly decreased during follow-up at 6, 12, 24 weeks and 1 year compared to preoperative angle (p < 0.001). Four Point Scale Questionnaire assessed at 1 year follow-up showed majority (82.9 %) were very satisfied with the outcome. ConclusionPosterior short segment with intermediate screw fixation in fractured vertebra is a feasible and stable treatment method for traumatic single thoracolumbar fracture with respect to the functional outcome, patient satisfaction and preservation of motion segment.

Computational study of a dorsolumbar complete burst fracture and its fixation methods

PurposeDuring a fall, a significant part of the major forces is absorbed by the dorsolumbar column area. When the applied stresses exceed the yield strength of the bone tissue, fractures can occur in the vertebrae. Vertebral fractures constitute one of the leading causes of trauma-related hospitalizations, accounting for 15% of all admissions. Posterior pedicle screw fixation has become a common method for treating burst fractures. However, physicians remain divided on the number of fixed segments that are needed to improve clinical outcomes. The present work aims to understand the biomechanical impact of different fixation methods, improving surgical treatments.Design/methodology/approachA finite element model of the dorsolumbar spine (T11–L3) section, including cartilages, discs and ligaments, was created. The dorsolumbar stability was tested by comparing two different surgical orthopedic treatments for a fractured first lumbar vertebra on the L1 vertebra: the posterior short segment fixation with intermediate screws (PSS) and the posterior long segment fixation (PL). Distinct loads were applied to represent daily activities.FindingsResults show that both procedures provide acceptable segment fixation, with the PL offering less freedom of movement, making it more stable than the PSS. The PL approach can be the best choice for an unstable fracture as it leads to a stiffer spine segment.Originality/valueThis study introduces a novel computational model designed for the biomechanical analysis of dorsolumbar injuries, aiming to identify the optimal treatment approaches within both clinical and surgical contexts.

The efficacy of machine learning models in forecasting treatment failure in thoracolumbar burst fractures treated with short-segment posterior spinal fixation

BackgroundAlthough short-segment posterior spinal fixation (SSPSF) has shown promising clinical outcomes in thoracolumbar burst fractures, the treatment may be prone to a relatively high failure rate. This study aimed to assess the effectiveness of machine learning models (MLMs) in predicting factors associated with treatment failure in thoracolumbar burst fractures treated with SSPSF.MethodsA retrospective review of 332 consecutive patients with traumatic thoracolumbar burst fractures who underwent SSPSF at our institution between May 2016 and May 2023 was conducted. Patients were categorized into two groups based on treatment outcome (failure or non-failure). Potential risk factors for treatment failure were compared between the groups. Four MLMs, including random forest (RF), logistic regression (LR), support vector machine (SVM), and k-nearest neighborhood (k-NN), were employed to predict treatment failure. Additionally, LR and RF models were used to assess factors associated with treatment failure.ResultsOf the 332 included patients, 61.4% were male (n = 204), and treatment failure was observed in 44 patients (13.3%). Logistic regression analysis identified Load Sharing Classification (LSC) score, lack of index level instrumentation, and interpedicular distance (IPD) as factors associated with treatment failure (P < 0.05). All models demonstrated satisfactory performance. RF exhibited the highest accuracy in predicting treatment failure (accuracy = 0.948), followed by SVM (0.933), k-NN (0.927), and LR (0.917). Moreover, the RF model outperformed other models in terms of sensitivity and specificity (sensitivity = 0.863, specificity = 0.959). The area under the curve (AUC) for RF, LR, SVM, and k-NN was 0.911, 0.823, 0.844, and 0.877, respectively.ConclusionsThis study demonstrated the utility of machine learning models in predicting treatment failure in thoracolumbar burst fractures treated with SSPSF. The findings support the potential of MLMs to predict treatment failure in this patient population, offering valuable prognostic information for early intervention and cost savings.

Short segment posterior fixation of unstable thoracolumbar vertebral fractures with fractured vertebra augmentation with intermediate pedicle screw - a clinicoradiological analysis.

Unstable thoracolumbar burst fractures are routinely encountered in orthopedic practice. Recently, short-segment fixation with pedicle screw augmentation of the fractured vertebra for unstable thoracolumbar burst fractures has gained popularity. Nonetheless, the maintenance of the kyphotic correction during the follow-up period remains controversial. This study aimed to examine the clinical-radiological outcomes, complications, and functional outcomes of fractured vertebrae augmentation with intermediate pedicle screws in short-segment instrumentation in acute thoracolumbar spine fractures. This retrospective study was conducted in the Department of Orthopedics, All India Institute of Medical Sciences, Jodhpur, using medical records from January 2021 to October 2022. Parameters such as local kyphosis correction, loss of kyphotic correction at final follow-up, anterior body height correction (%), and loss of correction (%) at final follow-up were measured as primary outcomes. Various other parameters such as operative time, blood loss, length of hospital stay, and visual analog scale were measured as secondary outcomes. The mean correction obtained via surgery in the immediate postoperative period was 13.7±2.3 degrees. The mean loss of correction at the final follow-up was 4.1±2.0 degrees, and the mean final local kyphotic angle was 7.2±2.4 degrees (P<0.05). The mean correction obtained via surgery in the immediate postoperative period was 37.2%±9.0%. The mean loss of correction at the final follow-up was 10.5%±5.3%, and the mean final anterior vertebral body height maintained was 72%±11.0% (P<0.05). Short-segment posterior fixation with pedicle screw augmentation achieves good correction of local kyphotic angle and anterior vertebral height in the immediate postoperative period, but some loss of correction at final follow-up is common. In our study, the loss of correction corresponded directly to the load-sharing score.

Analysis of factors associated with the failure of treatment in thoracolumbar burst fractures treated with short-segment posterior spinal fixation

BackgroundThe treatment of thoracolumbar burst fractures continues to pose challenges. Although short-segment posterior spinal fixation (SSPSF) has shown satisfactory clinical outcomes, it is accompanied by a relatively high rate of treatment failure. This study aimed to assess factors associated with treatment failure in thoracolumbar burst fractures treated with SSPSF.MethodsThe clinical data of 241 consecutive patients with a traumatic thoracolumbar burst fracture who underwent SSPSF at our center between Apr 2016 and Apr 2021 were retrospectively reviewed. Patients were divided into two groups (failure of the treatment group and non-failure of the treatment group). We compared potential risk factors for the failure of treatment including age, gender, body mass index, smoking, diabetes, vertebral body compression rate, use of crosslinks, percentage of anterior height compression, presence of index level instrumentation, Cobb angle, interpedicular distance (IPD), canal compromise, Load Sharing Classification (LSC) score, use of posterolateral fusion, and pain intensity between the two groups.ResultsA sum of 137 (56.8%) males and 104 (43.2%) females were enrolled where the mean age and follow-up of the participants were 48.34 ± 10.23 years and 18.67 ± 5.23 months, respectively. Treatment failure was observed in 34 cases (14.1%). The results of the binary logistic regression analysis revealed that the lack of index level instrumentation (OR 2.21; 95% CI 1.78–3.04; P = 0.014), LSC score (odds ratio [OR] 2.64; 95% confidence interval [95% CI], 1.34–3.77; P = 0.007), and IPD (OR 1.77; 95% CI 1.51–2.67; P = 0.023) were independently associated with a higher rate of failure of treatment.ConclusionsThe findings of this study revealed that increased rates of treatment failure in thoracolumbar burst fractures treated with SSPSF were associated with factors such as the absence of index level instrumentation, higher LSC scores, and larger IPD. These findings could be helpful in the proper management of patients with unstable thoracolumbar burst fractures.

Comparative finite element analysis of posterior short segment fixation constructs with or without intermediate screws in the fractured vertebrae for the treatment of type a thoracolumbar fracture

Six-screw short-segment posterior fixation for thoracolumbar fractures, which involves intermediate screws at the fractured vertebrae has been proposed to reduce the rates of kyphosis recurrence and implant failure. Yet, little is known about the mechanisms and biomechanical responses by which intermediate screws at the fracture vertebrae enhance fixation strength. The objective of this study was to investigate the biomechanical properties that are associated with the augmentation of intermediate screws in relation to the severity of type A thoracolumbar fracture using finite element analysis. Short-segment stabilization models with or without augmentation screws at fractured vertebrae were established based on finite element model of moderate compressive fractures, severe compressive fractures and burst fractures. The spinal stiffness, stresses at the implanted hardware, and axial displacement of the bony defect were measured and compared under mechanical loading conditions. All six-screw stabilization showed a decreased range of motion in extension, lateral bending, and axial rotation compared to the traditional four-screw fixation models. Burst thoracolumbar fracture benefited more from augmentation of intermediate screws at the fracture vertebrae. The stress of the rod in six-screw models increased while decreased that of pedicle screws. Our results suggested that patients with more unstable fractures might achieve greater benefits from augmentation of intermediate screws at the fracture vertebrae. Augmentation of intermediate screws at the fracture vertebrae is recommended for patients with higher wedge-shaped or burst fractures to reduce the risk of hardware failure and postoperative re-collapse of injured vertebrae.

Erratum. Biomechanical comparison of short-segment posterior fixation including the fractured level and circumferential fixation for unstable burst fractures of the lumbar spine in a calf spine model.

"Erratum. Biomechanical comparison of short-segment posterior fixation including the fractured level and circumferential fixation for unstable burst fractures of the lumbar spine in a calf spine model" published on 05 May 2023 by American Association of Neurological Surgeons.

Biomechanical analysis of the effect of ‘intermediate screws’ in short segment posterior fixation of unstable burst fractures of thoracolumbar spine in calf spine model

Background: Efforts in preserving motion levels in unstable thoracolumbar burst fractures steered to short segment fixation. However, short segment spanning fixation in clinical scenario reported high failure rates. Augmentation of spanning fixation by inserting intermediate screws into the fracture level is proposed to enhance stability. An experimental comparative study was performed to assess the biomechanical role of the ‘intermediate screws.’ Methods: Five calf spine specimens were freshly prepared to record the biomechanical characteristics, range of motion (ROM), and stiffness. CT scan confirmed an unstable burst fracture in each specimen. Each specimen was instrumented with short-segment posterior fixation with an intermediate screw. The same test protocols were repeated with and without intermediate screws. Results: Intermediate screws contribute to 20.2%, 16.5%, 14.5% and 23% decrease in ROM and 15.4%, 25.6%, 48.3%, and 160.2% increase in construct stiffness. Conclusions: Intermediate screws significantly increase the construct stiffness and decrease the ROM.

Effectiveness of the Endplate Reduction Technique Combined With Bone Grafting for the Treatment of Thoracolumbar Fractures by Using Posterior Short-Segment Fixation.

This study aimed to examine the effect of the endplate reduction (EPR) technique combined with bone grafting for treating thoracolumbar burst fractures using posterior short-segmental fixation. Patients with thoracolumbar fractures admitted between January 2018 and October 2021 were retrospectively analyzed, and those meeting the criteria were assigned to the EPR group and the intermediate screws (IS) group. The vertebral wedge angle (VWA), Cobb angle (CA), anterior vertebral body height (AVBH), middle vertebral body height (MVBH), upper endplate line (UEPL), upper intervertebral angle (UIVA), and upper intervertebral disc height (UIDH) indices were examined and compared preoperatively, first day postoperatively, as well as at 12 months postoperatively. The result indicated that the EPR group achieved better MVBH reduction (p < 0.001), UEPL reduction (p < 0.001), vertebral body fracture healing (p = 0.006), as well as implant breakage (p = 0.04) than the IS group; VWA (p < 0.001), CA (p = 0.005), AVBH (p < 0.001), MVBH (p < 0.001), UEPL (p < 0.001), and UIDH (p < 0.001) were lost after reduction less than those in the IS group. There was no significant difference in operative time (p = 0.315) and intraoperative bleeding (p = 0.274) between the 2 groups. The EPR group achieved better results in repositioning and maintaining MVBH and endplate morphology, with less correction loss after the reduction of the VWA, CA, AVBH, and endplate morphology. The EPR group exhibited a better healing pattern after vertebral fracture and disc degeneration was better relieved.

Correction loss following short-segment posterior fixation for traumatic thoracolumbar burst fractures related to endplate and intervertebral disc destruction

BackgroundThere has been widespread use of short-segment posterior fixation (SSPF) for traumatic thoracolumbar burst fractures. The relationship between the destruction of the vertebral endplate and adjacent disc and postoperative correction loss has been studied in only a few studies. This study investigated the risk factors for correction loss following SSPF.MethodsForty-eight patients (mean age 35.0 years) who underwent SSPF for thoracolumbar burst fractures were enrolled. The mean follow-up period was 25.7 months (12–98 months). The neurological status and postoperative back pain were assessed by the medical records. Segmental kyphotic angle (SKA) and anterior vertebral body height ratio (AVBHR) were measured radiographically to assess indirect vertebral body reduction and local kyphosis. Preoperative Sander’s traumatic intervertebral disc lesion (TIDL) classification and AO classification were used to evaluate the severity of disc and vertebral endplate injury. The corrective loss was considered present if ΔSKA was ≥10°. A multivariate logistic regression analysis was performed to identify the risk factors associated with postoperative loss of correction.ResultsThe fracture distribution was as follows: 10 at T12, 17 at L1, 10 at L2, 9 at L3, and 2 at L4. Vertebral fractures were classified in the following way: A3 in 13 patients, A4 in 11, B1 in 11, and B2 in 13. In 47 patients (98%), a union of the fractured vertebrae was achieved. SKA and AVBHR improved significantly after surgery from 11.6° to 3.5° and from 67.2 to 90.0%, respectively. However, the correction loss at follow-up was 10.4° and 9.7%, respectively. Twenty patients (42%) had severe TIDL (grade 3). Postoperative ΔSKA and ΔAVBHR were significantly higher in patients with TIDL grade 3 than with TIDL grade 0–2. The presence of cranial TIDL grade 3 and older age were significant risk factors for ΔSKA ≥10° on multivariate logistic regression analysis. All patients could walk at follow-up. TIDL grade 3 and ΔSKA ≥10° were associated with severe postoperative back pain.ConclusionsRisk factors for loss of correction after SSPF for thoracolumbar burst fractures were severe disc and endplate destruction at the time of injury and older age.

Short-segment fixation and transpedicular bone grafting for the treatment of thoracolumbar spine fracture.

Thoracolumbar fracture is one of the most common fractures of spine. And short-segment posterior fixation including the fractured vertebra (SSPFI) is usually used for the surgical treatment of it. However, the outcomes of SSPFI for different types of thoracolumbar fractures are not clear, and whether it is necessary to perform transpedicular bone grafting is still controversial. This study was conducted to determine the clinical efficacy of SSPFI for the treatment of different types of single-level thoracolumbar fracture, and make clear what kind of fractures need transpedicular bone grafting during the surgery. Patients with single-level thoracolumbar fracture undergoing SSPFI surgery between January 2013 and June 2020 were included in this study. The operative duration, intraoperative blood loss, anterior vertebral height ratio (AVHR) and anterior vertebral height compressive ratio (AVHC) of the fractured vertebra, local kyphotic Cobb angle (LKA), vertebral wedge angle (VWA) and correction loss during follow up period were recorded. Outcomes between unilateral and bilateral pedicle screw fixation for fractured vertebra, between SSPFI with and without transpedicular bone grafting (TBG), and among different compressive degrees of fractured vertebrae were compared, respectively. A total of 161 patients were included in this study. All the patients were followed up, and the mean follow-upped duration was 25.2 ± 3.1 months (6-52 months). At the final follow-up, the AVHR was greater, and the LKA and VWA were smaller in patients with bilateral fixation (6-screw fixation) than those with unilateral fixation (5-screw fixation) of AO type A3/A4 fractures (P < 0.001). The correction loss of AVHR, LKA and VWA in fractured vertebra were significantly great when preoperative AVHC was >50% (P < 0.05). For patients with AVHC >50%, the correction loss in patients with TBG were less than those without TBG at the final follow-up (P < 0.05). SSPFI using bilateral fixation was more effective than unilateral fixation in maintaining the fractured vertebral height for AO type A3/A4 fractures. For patients with AVHC >50%, the loss of correction was more obvious and it can be decreased by transpedicular bone grafting.

Risk factors for insufficient reduction after short-segment posterior fixation for thoracolumbar burst fractures: Does the interval from injury onset to surgery affect reduction of fractured vertebrae?

BackgroundMany surgeons have encountered patients who could not immediately undergo surgery to treat spinal fractures because they had associated injuries and/or because a complete diagnosis was delayed. For such patients, practitioners might assume that delays could mean that the eventual reduction would be insufficient. However, no report covered risk factors for insufficient reduction of fractured vertebra including duration from injury onset to surgery. The purpose of this study is to investigate the risk factors for insufficient reduction after short-segment fixation of thoracolumbar burst fractures.MethodsOur multicenter study included 253 patients who sustained a single thoracolumbar burst fracture and underwent short-segment fixation. We measured the local vertebral body angle (VBA) on roentgenograms, before and after surgery, and then calculated the reduction angle and reduction rate of the fractured vertebra by using the following formula: left[ {left( {{text{Preoperative}};{text{VBA }}{-}{text{ Postoperative}};{text{VBA}}} right)/{text{Preoperative}};{text{VBA}}} right] , times , 100. A multiple logistical regression analysis was performed to identify risk factors for insufficient reduction. The factors that we evaluated were age, gender, affected spine level, time elapsed from injury to surgery, inclusion of vertebroplasty with surgery, load-sharing score (LSS), AO classification (type A or B), preoperative VBA, and the ratio of canal compromise before surgery.ResultsThere were 140 male and 113 female patients, with an average age of 43 years, and the mean time elapsed between injury and surgery was 3.8 days. The mean reduction angle was 12°, and the mean reduction rate was 76%. The mean LSS was 6.4 points. Multiple linear regression analysis revealed that a higher LSS, a larger preoperative VBA, a younger age, and being female disposed patients to having a larger reduction angle and reduction rate. The time elapsed from injury to surgery had no relation to the quality of fracture reduction in the acute period.ConclusionsOur findings indicate that if there is no neurologic deficit, we might not need to hurry surgical reduction of fractured vertebrae in the acute phase.

Outcome of Long-Segment Fixation versus Inclusion of the Fractured Level in Short-Segment Fixation for Thoracolumbar Junction Fractures.

Objective The aim of this study was to compare the radiological outcomes of long-segment fixation and short-segment fixation, including the fracture level in patients treated for thoracolumbar junction fractures. Methods Data collected from records of patients with thoracolumbar junction fractures who were operated at our department. Neurological evaluation was done using American Spinal Injury Association classification score. Radiological parameters used were the Cobb's angle, vertebral body compression ratio, the anteroposterior spinal canal diameter, and the anterior and the posterior vertebral body heights. Patients were divided into two groups: group A included patients who underwent long-segment fixation and group B included patients who underwent short-segment fixation with inclusion of the fracture level. Results The mean preoperative Cobb angle was 22.51 degrees in group A and 19.37 degrees in group B. Both groups showed improvement in the postoperative Cobb angle as the mean in group A was 14.17 degrees and in group B was 11.77 degrees. The mean preoperative compression ratio in group A was 82.8%, while in group B it was 76%. The postoperative mean in group A was 89.2%, while in group B, it was 84%. The mean preoperative anterior vertebral body height of the fractured vertebra in group A was 16.7 mm, while in group B, it was 15.18 mm. The mean preoperative posterior vertebral body height in group A was 16.33 mm and that of group B was 19.41 mm. The mean postoperative anterior vertebral body height in group A was 17.66 mm and that of group B was 17.10 mm. The mean postoperative posterior vertebral body height in group A was 17.11 mm and that of group B was 20.79 mm. Conclusion Posterior short-segment fixation with additional screws at the fracture level provides similar-if not better-clinical and radiological outcomes to long-segment fixation in the treatment of thoracolumbar junction fractures.

Short segment versus long segment pedicle screws fixation in management of thoracolumbar burst fractures

Background: Selection of stabilization procedures for treating thoracolumbar burst fractures remains controversial. Both long-segment and short-segment pedicle screw fixation have been used widely with no consensus on the better method. Aim of study: To compare the outcome of long segment and short segment posterior fixation as amanagement of thoracolumbar burst fractures. Patients and Methods: 60 patients fulfilling the inclusion criteria who underwent posterior pedicle screw fixation for burst fracture of thoracolumbar spine in Neurosurgery Department of Al-Azhar University Hospitals and El-Ahrar General Hospital, Zagazig between August 2019 and Febrauray 2022. Patients were randomized into one of two groups. Short segment group (30 patients) was treated by short segment fixation, i.e., 1 level above and 1 level below the fractured vertebra. Long segment group (30 patients) was treated by long segment pedicle screw fixation, i.e., fixation of 2 levels above and below the fractured vertebra. 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. Results: Demographic data of both groups were quite comparable. thoracolumbar burst fracture

Comparison of Short Segment Percutaneous Transpedicular Fixation With and Without Inclusion of Fractured Vertebrae in Thoracolumbar Fractures

Objective: To compare the outcome of SSPF (Short Segment Posterior Fixation) with and without the inclusion of fractured vertebrae in thoracolumbar fractures in terms of visual analog score and vertebral column stability.&#x0D; Materials and Methods: The study enrolled 96 patients who were divided into two groups. Group A treated by SSPF (four screws: one level above and below the fracture), and Group B was treated by PSFFV (six screws: including fractured vertebrae). Assessment of parameters related to clinical and radiological aspects was recorded at 3 – 6 months.&#x0D; Results: Mean ages of patients were 36.96 and 37.41 years with an M:F ratio of 1.8:1 and 1.4:1 in groups A (SSPF) and B (PSFFV), respectively. Mean VAS preoperatively, and postoperatively, at 3 and 6 months were 8.78 vs. 9.01, 4.98 vs. 5.01, 2.08 vs. 2.11, and 0.47 vs. 0.67 in groups A and B, respectively. Mean Kyphotic angle preoperatively, postoperatively, at 3 and 6 months were 21.76 vs. 22.91, 11.13 vs. 10.16, 13.59vs. 11.16 and 14.88 vs. 12.87 in groups A and B respectively. Mean AVH preoperatively, and postoperatively, at 3 and 6 months were 19.11 vs. 18.72, 20.01 vs. 22.71, 20.61 vs. 22.87, and 20.02 vs. 22.67 in groups A and B, respectively.&#x0D; Conclusion: The results of this study favor PSFFV (Group B) over SSPF (Group A) in terms of vertebral column stability which was better achieved in PSFFV. PSFFV was also found superior with no implant failure which declares it safer and more effective than SSPF. None of the techniques was found superior in terms of pain. Radiologically, PSFFV, showed significant improvement in achieving anterior vertebral height, while there was no important distinction in kyphotic angle between the two.

Efficacy and Safety of Posterior Long-Segment Fixation Versus Posterior Short-Segment Fixation for Kummell Disease: A Meta-Analysis.

PurposePosterior short-segment fixation (SSF) and long-segment fixation (LSF) are two methods for the treatment of Kummell disease, but the safety and effectiveness of these two surgical methods still lack adequate medical evidence. This study aimed to evaluate the two methods.MethodsDatabase searches for randomized controlled trials, case-control studies, and cohort studies of posterior SSF and posterior LSF in the treatment of Kummell disease were performed. After the document quality was evaluated with the Newcastle-Ottawa Quality Assessment Scale, a meta-analysis was carried out.ResultsMeta-analysis revealed that the operation time and intraoperative blood loss in the LSF group were higher than those in the SSF group [MD = −18.17, 95% CI (−30.31, −6.03), z = 2.93, P = .003; MD = −82.07, 95% CI (−106.91, −57.24], z = 6.48, P < .00001). The postoperative last follow-up local kyphosis angle in the SSF group was greater than that in the LSF group (MD = 3.18, 95% CI [.56, 5.81], z = 2.38, P = .02), and there were no significant differences in perioperative complications, bone cement leakage rate, incidence of adverse events during follow-up, postoperative follow-up visual analog scale, postoperative Oswestry dysfunction index, and postoperative immediate local kyphosis angle between the two groups (P > .05).ConclusionSSF and LSF are effective and safe for the treatment of Kummell disease. SSF can reduce the operation time and intraoperative bleeding; LSF can better maintain the long-term stability of kyphosis. The methods should be evaluated by clinicians according to the individual situation of the patients.

The effect of the sequence of intermediate instrumentation and distraction-reduction of the fractured vertebrae on the surgical treatment of mild to moderate thoracolumbar burst fractures

To investigate the effect of the sequence of intermediate instrumentation with long screws and distraction-reduction on mild to moderate thoracolumbar fractures treated by posterior open and short-segmental fixation. The clinical data of 68 patients with mild to moderate thoracolumbar burst fractures who met the selection criteria between January 2016 and June 2019 were retrospectively analyzed. The patients were divided into group ISDRF (intermediate screws then distraction-reduction fixation, 32 cases) and group DRISF (distraction-reduction then intermediate screws fixation, 36 cases) according to the different operation methods. There was no significant difference between the two groups in age, gender, body mass index, fracture segment, cause of injury, and preoperative load-sharing classification score, thoracolumbar injury classification and severity score, vertebral canal occupational rate, back pain visual analogue scale (VAS) score, anterior height of fractured vertebra, and Cobb angle ( P>0.05). The operation time, intraoperative blood loss, complications, and fracture healing time were recorded and compared between the two groups. The vertebral canal occupational rate, anterior height of fractured vertebra, kyphosis Cobb angle, and back pain VAS score before and after operation were used to evaluate the effectiveness. There was no significant difference in intraoperative blood loss and operation time between the two groups ( P>0.05). No vascular or spinal nerve injury and deep infections or skin infections occurred in both groups. At 1 week after operation, the vertebral canal occupational rate in the two groups was significantly improved when compared with that before operation ( P<0.05), no significant difference was found in the difference of vertebral canal occupational rate before and after operation and improvement between the two groups ( P>0.05). The patients in both groups were followed up 18-24 months, with an average of 22.3 months. All vertebral fractures reached bone union at 6 months postoperatively. At last follow-up, there was no internal fixation failures such as broken screws, broken rods or loose screws, but there were 2 cases of mild back pain in the ISDRF group. The intra-group comparison showed that the back pain VAS score, the anterior height of fractured vertebra, and the Cobb angle of the two groups were significantly improved at each time point postoperatively ( P<0.05); the VAS scores at 12 months postoperatively and last follow-up were also improved when compared with that at 1 week postoperatively ( P<0.05). At last follow-up, the anterior height of fractured vertebra in the ISDRF group was significantly lost when compared with that at 1 week and 12 months postoperatively ( P<0.05), the Cobb angle had a significant loss when compared with that at 1 week postoperatively ( P<0.05); the anterior height of fractured vertebra and Cobb angle in DRISF group were not significantly lost when compared with that at 1 week and 12 months postoperatively ( P>0.05). The comparison between groups showed that there was no significant difference in the remission rate of VAS score between the two groups at 1 week postoperatively ( P>0.05), the recovery value of the anterior height of fractured vertebra in ISDRF group was significantly higher than that in DRISF group ( P<0.05), the loss rate at last follow-up was also significantly higher ( P<0.05); the correction rate of Cobb angle in ISDRF group was significantly higher than that in DRISF group at 1 week postoperatively ( P<0.05), but there was no significant difference in the loss rate of Cobb angle between the two groups at last follow-up ( P>0.05). In the treatment of mild to moderate thoracolumbar burst fractures with posterior short-segment fixation, the instrumentation of long screws in the injured vertebrae does not affect the reduction of the fracture fragments in the spinal canal. DRISF can better maintain the restored anterior height of the fractured vertebra and reduce the loss of kyphosis Cobb angle during the follow-up, indicating a better long-term effectiveness.

Posterior short segment fixation including the fractured vertebra in unstable burst fractures of thoracolumbar region in Nepal

The objective of this study was to observe the outcome of short segment fixation of the unstable burst fracture in the thoracolumbar region. The study was conducted on 30 patients (age: 21-50 years) from February 2019 to August 2020 with thoracolumbar burst fracture (T10–L2). In Magerl Type A fractures, all underwent posterior pedicle screw fixation, including the fractured vertebra. The functional evaluation was done by Visual Analogue Score (VAS), Oswestry disability index (ODI), ASIA grade and radiologic parameters (Cobb angle, the kyphotic deformation and vertebral height) were recorded immediately preoperatively and at 3, 6 and 12 months then yearly. The presence of screw pullout, screw breakage, rod breakage and peri-implant loosening were evaluated as implant failure. Most of the fractures resulted from falls (21 cases), and the remaining from the road traffic accidents (9 cases). The fractured level was L1 in 13 patients, T12 in 9 patients, L2 in 6 patients and T11 and T10 in 2 patients. The modified Mcnab criteria were excellent in 18 cases, good in 11 cases and poor in 1. All patients showed improvement in mean kyphotic angle. Their pre-operative, post-operative and final follow-up mean kyphotic angle were 13.5±6.3, 13.4±4.3, 8.5±6 degrees, respectively. The average loss of kyphosis correction was 6.4±5.2° at the final follow-up. The pre- and post-operative kyphotic deformity of the vertebral body were 5.1±3.2, 4.8±2.3 and at final follow-up was 4.5±4.0 (p>0.05). Both posterior and anterior vertebral height improved significantly post-operatively with no significant loss of height at final follow-up. Functional outcomes mean ODI was 17.4% and VAS score was 1.7 at the end of one year. No complications were seen postoperatively and at final follow-up. In conclusion, short-segment pedicle screw fixation, including fractured vertebra was capable of reducing and maintain the reduction of unstable burst fractures of the thoracolumbar region.

Surgical outcomes of posterior short segment fixation with percutaneous pedicle screws for thoracolumbar burst fractures: comparison between side loading system and top loading system

Surgical outcomes of posterior short segment fixation with percutaneous pedicle screws for thoracolumbar burst fractures: comparison between side loading system and top loading system

SHORT SEGMENT FIXATION WITH TRANSPEDICULAR SCREWS IN TRAUMATIC THORACOLUMBAR SPINE FRACTURES

ABSTRACT Aim: The gold surgical treatment for an unstable thoracolumbar fracture is transpedicular screw fixation. Although traditional treatment supports long-segment posterior fixation (LSPF), more recent studies suggest short-segment posterior fixation (SSPF) with transpedicular screws, but incur higher failure rates. Thus, this study aimed to evaluate the effectiveness of SSPF in the management of traumatic unstable thoracolumbar injuries in terms of stability, deformation correction, neurological recovery, and pain relief. Methods: This prospective and observational hospital-based study was carried out in the Orthopedics Department of Universal College of medical Sciences-Teaching Hospital (UCMS-TH) from August 2020 to July 2021. After Ethical clearance (UCMS/IRC/047/20) from the Institutional Review Committee (IRC) and informed written consent, all patients with a traumatic thoracolumbar fracture who fulfilled the inclusion criteria were enrolled in this study and were treated with SSPF. The fracture was classified according to Thoracolumbar injury classification and severity score (TLICS) and AO classification. Functional outcome was assessed according to neurological status, patient satisfaction, and pain assessment which was assessed by Frankel grading, Macnab grading, and Denis pain scale respectively. Post-operatively patients were regularly followed at 6 weeks, 3 months, and 6 months. The data was analyzed in SPSS 20 and descriptive statistics like frequency, percentage, mean and standard deviation were used to analyze the data. Chi-Square test, Independent sample t-test, and ANOVA tests were used as inferential statistics. Results: Thirty-one patients (16 females and 15 males) with traumatic thoracolumbar fracture were surgically managed with SSPF with a mean age of 38.61 ± 11.54 years. Twenty-seven patients (87.1 %) had fall injuries. The majority of cases (14 patients: 45.2%) had L1 vertebral fracture with a majority of the cases being wedge compression type (24 patients: 77.4%) and A1 type (24 patients: 77.4%). Posterior ligamental complex (PLC) was injured in 23 patients (74.2%) and 7 cases (22.6%) had neurological involvement. The majority of cases had a TLICS score of 4 (12 patients). The mean interval between trauma and surgery was 2.13 ± 0.71 days. The average duration of hospital stay was 13.10 ± 2.95 days and intraoperative average blood loss was 460±58.2 ml. In 16 cases, an additional screw was fixed through the intact pedicle of the fractured vertebra. Screw failure was the only complication seen in 2 cases (6.5%). Preoperatively, 20 cases (64.5%) had Frankel type E injury, mean Denis pain scale was 4.16±0.93, and mean preoperative kyphotic angle was 16.77±6.82 degree which improved to 26 cases (83.9%), 1.42±0.62, and 1.35±0.48 degrees at 6 months respectively. The mean loss of kyphotic correction angle was 0.58±0.88 (range 1-4) degrees. The majority of compression fracture cases had excellent to good patient satisfaction scores where 12(50%) and 10(41.7%) cases had excellent and good scores respectively (P 0.02). Concerning patient satisfaction score, a statistically significant difference was observed in mean TLICS score (P 0.101) and AO fracture type (P 0.034) while no difference was observed in PLC status (P 0.101) and additional screws (P 0.909). There was a statistically significant difference between the fracture type and improvement of Frankel grading at the end of six months follow up (P <0.001) where compression fracture managed with SSPF showed remarkable neurological recovery than burst fracture in terms of improvement of Frankel grading. Conclusions: Short segment transpedicular screw fixation is an effective treatment procedure for achieving better neurological recovery and good pain control in traumatic unstable thoracolumbar fractures. Keywords: Short segment, thoracolumbar spine fracture, transpedicular screw