Short-segment Transpedicular Fixation Research Articles

Efficacy Of Short-Segment Transpedicular Fixation for Thoracolumbar Fractures in Terms of Improvement in Neurological Status

Objective: To determine the efficacy of short-segment transpedicular fixation for thoracolumbar fractures in terms of improvement in neurological status. Materials and Methods: A prospective observational research was conducted at Bacha Khan Medical Complex, Swabi, Section of Neurosurgery. Patients having traumatic thoracolumbar fractures with neurological deficits were subjected to short-segment transpedicular fixation and evaluated for post-operative improvement in neurological status at a 6-month follow-up. Results: 48 patients participated in the study. Mean age was 35.69±8.22 years and 60.4% were males. History of falls was the most common mechanism responsible for spinal injury i.e. 56.3%. D12 vertebra was fractured in 43.8% of patients. The leading type of fracture was, AO type B in 37.5% of patients. 23 (47.9%) of the patients showed one or more grade improvements in their neurological status on the ASIA scale at 6-month follow-up. Surgical site infection was the common postoperative complication (8.3%). Conclusion: Short-segment transpedicular fixation is an effective procedure for traumatic thoracolumbar fractures in terms of improvement in neurological status.

Evaluation of the Outcome of Transpedicular Fixation for Thoracic and Lumbar Tuberculous Spine Disease

Objective: Pakistan stands sixth in countries, contributing 60% of new TB cases worldwide. TB can involve a wide variety of organs including the spine which at times need neurosurgical intervention. This study aims to determine the overall clinical and radiological outcomes in patients with dorsolumbar spine TB managed by posterior transpedicular screw fixation. The study focused to evaluate the outcome of transpedicular screws fixation for the thoracic and lumbar tuberculous spine. Materials and Methods: The study included a total of 60 patients were observed. A complete history and systemic physical examination was done. Pre-operative anteroposterior and lateral view radiographs were taken to measure the height of the vertebral body, kyphotic angulation, and sagittal plane index. Short-segment transpedicular fixation was done under general anesthesia by consultant neurosurgeons. All patients were asked for follow-up after one month. Post-operative anteroposterior plus lateral view radiographs were done to measure the height of the vertebral body, kyphotic angulation, and sagittal index. Results: In our study mean age was 47 years. 58%patients were males and 42% of patients were female. The mean postoperative vertebral height was 18.93 mm ± 1.17 and the mean postoperative Kyphotic angle was 9.68 degree ± 4.03º. The mean postoperative Sagittal index was 5.83 ± 4.55. Conclusion: The outcome of transpedicular fixation of vertebral height was 18.93 mm ± 1.17, Kyphotic angle was 9.68 degree ± 4.03º) and Sagittal index was (5.83 ± 4.55) for thoracic & lumbar tuberculous spine.

A comparative study between functional and radiological outcome of short and long segment transpedicular fixation for unstable thoracolumbar vertebral fractures

: Management of unstable thoracolumbar fracture remains controversial between short segment and long segment pedicle screw fixation. Surgical stabilization is indicated to adequately decompress the spinal canal, maximizing neurological recovery and creating spinal stability. : A comparative study in unstable thoracolumbar fractures fixed with short and long segment transpedicular screw fixation was done and followed up for 6 months. For functional assessment Modified MACNAB criteria, Oswestry disability index and Visual analogue scale scoring system used. Neurological status, radiological kyphotic angle correction were analyzed.: A total of 30 cases were included in the study of which 23 were male and 7 females. The mean age was 36.77 years. Younger individuals were more susceptible to road traffic accident. L1 was the most common vertebral level involved. Cases with a higher ASIA grade had a better improvement post operatively compared to one with a lesser ASIA grade preoperatively (P Value 0.003). Cases with lesser number of transfers had a better outcome at final followup. (P value 0.018). At all months of followup both short and long segment fixation groups have statistically significant kyphotic deformity correction, but long segment have better correction with 19.86 degrees pre-operative to 8.8 degrees at the end of 6 month of followup. : Short segment transpedicular fixation gives better functional outcome than long segment transpedicular fixation, but long segment transpedicular stabilization gives better radiological results in the form of kyphotic deformity correction.

Only posterior hemivertebrectomy with short-segment transpedicular fixation (PHSSTPF) for congenial scoliosis: At least 10-years’ results of 37 patients

Only posterior hemivertebrectomy with short-segment transpedicular fixation (PHSSTPF) for congenial scoliosis: At least 10-years’ results of 37 patients

Is the transpedicular bone grafting an effective technique for prevention of kyphosis in thoracolumbar fractures?

Study Design: This was an interventional randomized trial. Summary of Background Data: Fractures of the thoracolumbar spine represent 90% of all spine fractures, and the thoracolumbar burst fractures (Type A fractures) are the most common in the spine and important cause of posttraumatic kyphotic deformity. The cause of this problem appears to be the structural and mechanical deficiency of the anterior column following indirect fracture reduction by posterior fixation. Objective: The objective of this study was to evaluate the effects of transpedicular intracorporeal grafting associated with short-segment transpedicular fixation on kyphosis progression in patients with thoracolumbar burst fracture Type A3/A4. Materials and Methods: Fifty-nine consecutive patients with thoracolumbar burst fracture were treated with short-segment transpedicular monoaxial screw fixation. Patients were simply randomized divided into transpedicular grafting (TPG) (n = 35; A3 = 20 and A4 = 15) and non-TPG (n = 24; A3 = 19 and A4 = 5). The average follow-up was 21.1 ± 4.2 (range: 16–26) months for the entire study group: 22.1 ± 4.5 months for the TPG group and 20.2 ± 4.8 months for the non-TPG group (P = 0.49). Results: The global mean kyphosis angle before surgery was 21.93° ±3.92°, with 22.06° ±3.55° in the TPG group and 20.75° ±4.68° for non-TPG; P = 0.93. The mean kyphosis angle at the end of follow-up for the entire study was 9.21° ±8.86°, with 8.70° ±2.11° for TPG and 14.08° ±4.73° for non-TPG, (TPG vs. non-TPG, P = 0.010). No obvious clinical complications in both the groups were documented. Conclusions: Our findings demonstrate that transpedicular bone grafting associated with short-segment fixation in thoracolumbar burst fractures has caused a significant effect on the prevention of kyphosis progression after surgery.

Comparison of clinical efficacy of unilateral and bilateral short segment transpedicular fixation in treating thoracolumbar fractures combined with unilateral pedicle fractures

Objective To compare the clinical efficacy of unilateral and bilateral short segment fixation in treating thoracolumbar fractures combined with unilateral pedicle fractures. Methods A retrospective case control study was conducted on the clinical data of 43 patients with thoracolumbar fractures with unilateral pedicle fractures admitted from January 2012 to December 2016. There were 24 males and 19 females, with a mean age of 48 years (range, 19-68 years). Fractured segments included T10 in 1 patient, T11 in 6, T12 in 11, L1 in 19, and L2 in 6. According to the fixation method, the patients were divided into unilateral transpedicular fixation group (unilateral group, 15 patients) and bilateral transpedicular fixation group (bilateral group, 28 patients). All patients were treated with fixation via injured vertebrae combined with short segment fixation. The operation time, intraoperative blood loss, X-ray frequency, fracture healing time, internal fixation removal time, preoperative and postoperative anterior vertebral height ratio, sagittal Cobb angle recovery, spinal canal invasion rate, visual analogue score (VAS), Oswestry dysfunction index (ODI), Frankel classification of spinal cord injury, incidence of screw deviation, and spinal lateral angulation were compared between the two groups. Results All patients were followed up for 12-26 months, with an average of 18.5 months. The operation time in unilateral group and bilateral group were (82.3±14.7)minutes and (120.9±12.8)minutes, respectively. The intraoperative blood loss was (186.1±20.4)ml in unilateral group and (231.2±39.6)ml in bilateral group. The number of fluoroscopy was (6.6±1.2)times in unilateral group and (13.3±2.0)times in bilateral group respectively. The incidence of screw deviation was 13% (2/15) in unilateral group and 46% (26/56) in bilateral group (P 0.05). Conclusions For thoracolumbar fractures combined with unilateral pedicle fractures, unilateral and bilateral transpedicular short segment fixation has similar reduction and fixation effects. Unilateral transpedicular short segment fixation has the advantages of shorter operation time, less bleeding, fewer fluoroscopy times, and lower screw deviation rate. Key words: Spinal fractures; Thoracic vertebrae; Lumbar vertebrae; Fracture fixation, internal

SURGICAL TREATMENT OF THORACIC AND LUMBAR SPINE FRACTURES USING TRANSPEDICULAR VERTEBROPLASTY AND FIXATION

Objective. To analyze treatment results in patients with fractures of thoracic and lumbar vertebal bodies after transpedicular vertebroplasty and fixation through minimally invasive percutaneous and open approaches. Material and Methods . A total of 154 patients with uncomplicated type A2, A3 fractures of the thoracic and lumbar vertebral bodies were operated on. All patients were examined with X-ray densitometry, spondylography, and CT. Group 1 included 53 patients who underwent vertebroplasty with deproteinized bone graft and percutaneous transpedicular fixation. Patients of Group 2 (n = 41), Group 3 (n = 43) and Group 4 (n = 17) underwent open transpedicular fixation and vertebroplasty with deproteinized bone graft (Group 2) and titanium nikilide granules (Groups 3 and 4). Results . Intraoperative blood loss during open vertebroplasty combined with short-segment transpedicular fixation exceeded that during percutaneous vertebroplasty. Parameters of kyphotic deformity, the wedge index and the loss of correction did not differ significantly except for Group 4. Significant improvement in ODI and VAS scores was noted after percutaneous vertebroplasty as compared with control groups. Conclusion . Transpedicular verteboplasty and transpedicular fixation, both open and percutaneous, performed for the treatment of type A2 and A3 spinal fractures provide reliable stabilization of the injured spinal segments, allow vertebral body height restoration to a greater extent and correction of the kyphotic deformity.

THORACOLUMBER VERTEBRAL FRACTURES

For spinal injuries, thoracolumbar junction is common site in our population.Surgical management of unstable fractures and fracture dislocations of thoracolumbar spineis still controversial. This study was conducted to document efficacy of short segment fixationof thoracolumbar verterbral fractures. Objectives: To determine the outcome of short segmenttranspedicular fixation of thoracolumbar fractures. Study design: Descriptive cross-sectionalstudy. Sampling technique: Non-probability purposive sampling. Material and Methods: Atotal of 103 study cases with thoracolumbar vertebral fractures were taken in this descriptivecase series study which was conducted at department of Neurosurgery, Nishtar HospitalMultan from February 2014 to June 2015. Informed verbal consent was taken from eachpatient before participation in this study ensuring them confidentiality of the information andexplaining them objectives and procedure of our study. Once registered, detailed history andclinical examination was done by a Neurosurgeon, investigations like X-ray dorsolumbar spine,CT scan and Magnetic resonance imaging (MRI) dorsolumbar spine were also done. Shortsegment transpedicular fixation was done and outcome of surgical management was assessedin terms of improvement in power, hardware failure and infection by consultant neurosurgeon.All the study cases were called for follow up visits after every month till 6 months to record finaloutcome of management. All the information were recorded in the study proforma. Data wereentered and analyzed by SPSS version 22. Results: Out of these 103 study cases, 66 (64.1 %)were male patients and 37 (35.9 %) were female patients and male to female ratio was 1.85:1.Mean age of our study cases 33.92 ± 9.72 years ranging from 20 years to 54 years. Meanages of male patients was 36.68 ± 10.37 years while in female patients it was 29.00 ± 5.89years (p=0.000).Post-surgical management improvement in power was seen in 55 (53.4%)of our study cases, hardware failure in 11 (10.7%) and infection was observed in 20 (19.4%).Conclusion: According to our study short segment transpedicular fixation is safe & effectiveprocedure providing efficient spinal stability. Short segment fixation is associated with minimumblood loss and trauma and leads to early mobilization of the patient and ease in physiotherapy.Transpedicular screw fixation is a useful choice for achieving better neurological recovery andgood pain control in post-traumatic thoracolumbar fractures.

English

For spinal injuries, thoracolumbar junction is common site in our population.Surgical management of unstable fractures and fracture dislocations of thoracolumbar spineis still controversial. This study was conducted to document efficacy of short segment fixationof thoracolumbar verterbral fractures. Objectives: To determine the outcome of short segmenttranspedicular fixation of thoracolumbar fractures. Study design: Descriptive cross-sectionalstudy. Sampling technique: Non-probability purposive sampling. Material and Methods: Atotal of 103 study cases with thoracolumbar vertebral fractures were taken in this descriptivecase series study which was conducted at department of Neurosurgery, Nishtar HospitalMultan from February 2014 to June 2015. Informed verbal consent was taken from eachpatient before participation in this study ensuring them confidentiality of the information andexplaining them objectives and procedure of our study. Once registered, detailed history andclinical examination was done by a Neurosurgeon, investigations like X-ray dorsolumbar spine,CT scan and Magnetic resonance imaging (MRI) dorsolumbar spine were also done. Shortsegment transpedicular fixation was done and outcome of surgical management was assessedin terms of improvement in power, hardware failure and infection by consultant neurosurgeon.All the study cases were called for follow up visits after every month till 6 months to record finaloutcome of management. All the information were recorded in the study proforma. Data wereentered and analyzed by SPSS version 22. Results: Out of these 103 study cases, 66 (64.1 %)were male patients and 37 (35.9 %) were female patients and male to female ratio was 1.85:1.Mean age of our study cases 33.92 ± 9.72 years ranging from 20 years to 54 years. Meanages of male patients was 36.68 ± 10.37 years while in female patients it was 29.00 ± 5.89years (p=0.000).Post-surgical management improvement in power was seen in 55 (53.4%)of our study cases, hardware failure in 11 (10.7%) and infection was observed in 20 (19.4%).Conclusion: According to our study short segment transpedicular fixation is safe & effectiveprocedure providing efficient spinal stability. Short segment fixation is associated with minimumblood loss and trauma and leads to early mobilization of the patient and ease in physiotherapy.Transpedicular screw fixation is a useful choice for achieving better neurological recovery andgood pain control in post-traumatic thoracolumbar fractures.

Short-segment fixation of thoracolumbar burst fractures using pedicle fixation at the level of fracture in patients with osteoporosis

To evaluate the curative effect of short-segment transpedicular fixation plus vertebra fracture fixation for thoracolumbar burst fractures in patients with osteoporosis. The clinical data of thoracolumbar burst fractures in 46 patients with osteoporosis, single segment fracture and neurological intactness were analyzed retrospectively from January 2008 to January 2012. There were 20 males and 26 females with a mean age of 64.5 (56-78) years. The mechanisms of injury were fall (n = 20), traffic accident (n = 12), high falling injury (n = 8) and heavy pound injury (n = 4). The involved vertebrae included T11 (n = 5); T12 (n = 17); L1 (n = 21); L2 (n = 3). Pedicle screw was inserted into injured vertebra and the height of collapsed vertebra fractures reduced with position and instrument. Visual analogue scale (VAS) and short form-36 scoring systems were used to evaluate pain level and quality of life. The height restoration and kyphotic correction rates of fracture level were measured radiologically. All patients underwent surgery safely without severe complications. The average follow-up period was 20.5 (9-48) months. There was significant difference (t = 20.057, P = 0.000; t = 24.287, P = 0.000) in VAS score between last follow-up (3.09 ± 1.01) and post-operation (2.35 ± 1.02) versus pre-operation (7.22 ± 1.05) respectively. And also there was significant difference (P < 0.05) in SF-36 score between last follow-up (126.5 ± 22.3) and post-operation (96.7 ± 17.5). The Cobb angle was corrected to (5.6 ± 1.9)° of post-operation and (7.8 ± 3.3)° of last follow-up. The loss rate of vertebral was (4.8 ± 5.2)% of post-operation and (7.6 ± 2.9) % of last follow-up. There was no loosening or breakage of internal fixations. The approach of short-segment transpedicular fixation plus vertebra fracture fixation is both safe and effective to maintain reduction and reduce the rate of correction loss and instrument failure.

Short-segment transpedicular fixation combined with augmentation vertebroplasty in treatment of thoracolumbar burst fractures

Objective To evaluate the efficacy of short-segment transpedicular fixation combined with augmentation vertebroplasty in treatment of thoracolumbar burst fractures. Methods From November 2006 to September 2009, 37 patients with thoracolumbar burst fracture were admitted and received transpedicular fixation combined with calcium sulfate cement augmentation vertebroplasty, and the clinical data including fracture types, complications and following-up results were collected for analysis. The multimethod evaluation strategies involved the anterior vertebral body height, the sagittal Cobb's angle, the restoration of nervous function, internal fixation failure, visual analogue scale (VAS) and Oswestry disability index (ODI) were retrospective analyzed. Results All patients were followed up for average 19 months (range, 14-37). There were no internal fixation failure, loss of reduction, neurological complications in all the patients. In 16 patients with partial neurologic deficits, 14 initially improved at the final follow-up, with no deterioration of neurologic functions. The mean time of calcium sulfate cement obvious absorption and union was 3 months and 5 months postoperatively, respectively. The anterior vertebral body height was 55.40％before surgery and 85.46％ after surgery on average, ended up with 82.35％. The sagittai Cobb's angle was improved from 22.45° to 6.86°, ended up with 9.66° on average. The mean VAS and ODI at the final followup were respectively 1.2 and 20.4 on average. Conclusion Short-segment transpedicular fixation combined with augmentation vertebroplasty appears to be effective in achieving stable biomechanics with high security,which seems to be a feasible option in the management of thoracolumbar burst fractures. Key words: Thoracic vertebrae; Lumbar vertebrae; Fractures, bone; Fracture fixation, internal

Application of Osteoplasty for Complex treatmrnt of the Thoracic and Lumbar Vertebrae Fractures

Objective. To assess the efficacy of short-segment transpedicular fixation and grafting with deproteinized bone material for injury of thoracic and lumbar vertebrae. Material and Methods. The study included 101 patients aged 37 to 65 years with uncomplicated osteoporotic fractures of thoracic and lumbar vertebrae. Split fractures (type A2) were identified in 42.6 % of patients, burst fractures (type A3) – in 57.4 %. All patients were treated by short-segment transpedicular fixation and transpedicular osteoplasty with deproteinized bone graft (n = 82) or autograft (n = 19). Results. Results of surgical treatment were evaluated at 6 to 40 months after operation. Good results were achieved in 79.8 % of cases, satisfactory results – in 20.2 %. The better long-term outcomes of deformity component correction at the injured spinal segment was observed in patients with deproteinized bone grafts. Conclusion. The use of short-segment transpedicular fixation for acute osteoporotic fracture of the thoracic and lumbar vertebrae provides correction of deformity components at the injured spinal segment, and when combined with deproteinized bone grafting – maintenance of this correction and improvement of long-term results.

Combined Anterior Plus Posterior Stabilization Versus Posterior Short-Segment Instrumentation and Fusion for Mid-Lumbar (L2–L4) Burst Fractures

Prospective randomized study. OBJECTIVES.: To compare the results of the combined anterior-posterior surgery (Group A) with posterior "short-segment" transpedicular fixation (SSTF) (Group B) in mid-lumbar burst fractures. There are no comparative randomized clinical studies on the outcome following operative treatment of mid-lumbar fractures. Forty consecutive patients with L2-L4 fresh single A3-type/AO burst fractures and load sharing score up to 6 were randomly selected to underwent either combined one-stage anterior stabilization with mesh cage and SSTF (Group A) or solely SSTF with intermediate screws in the fractured vertebra (Group B). Kyphotic Gardner angle, anterior and posterior vertebral body height (PVBHr, AVBHr), spinal canal encroachment (SCE), SF-36, VAS, and Frankel classification were used. The follow-up observation averaged 46 and 48 months for Group A and B, respectively. Operative time, blood loss, and hospital stay were significant more in Group A. More surgical complications were observed in the Group A. After surgery, VAS was reduced to 4.3 and 3.6 for Group A and Group B, respectively. The SF-36 domains Role physical and Bodily pain improved significantly only in Group B (P = 0.05) and (P = 0.06), respectively. Correction of AVBHr, PVBHr, and spinal canal clearance was similar in both groups. Spinal canal clearance did not differ between the two groups, but it was continuous until the last evaluation in Group B. The final Gardner angle loss of correction averaged 2 degrees and 5 degrees for Group A and Group B, respectively. The posttraumatic Gardner deformity did not significantly improve by SSTF at the final evaluation in the spines of Group B. Gardner angle correlated significantly with SCE in Group B and Group A in all three periods and in the last evaluation, respectively. Frankel grade did not correlate with loss of correction of AVBHr and PVBHr in Group A, while it significantly correlated with loss of PVBHr correction and SCE in the patients of Group B. There was no neurologic deterioration after surgery in any patient. VAS and SF-36 scores did not significantly correlate with the loss of kyphotic angle correction and AVBHr, PVBHr at the final observation in any patient of both groups. SSTF offered similar significant short-term correction of posttraumatic deformities associated with mid-lumbar A3-burst fractures, but better clinical results as compared to combined surgery. However, SSTF did not significantly maintain the after surgery achieved correction of local posttraumatic kyphosis at the final evaluation. Thus, SSTF is not recommended for operative stabilization of fractures with this severity.

Burst fractures of the second through fifth lumbar vertebrae. Clinical and radiographic results.

Fifty-five patients who had sustained a burst fracture of the lumbar spine were followed for a mean of seventy-nine months (range, twenty-four to 192 months) after the injury. Thirty patients had been managed non-operatively with a short period of bed rest followed by protected mobilization. The remaining twenty-five patients had been managed operatively: eight, with posterior arthrodesis with long-segment hook-and-rod fixation; eight, with posterior arthrodesis with short-segment transpedicular fixation; six, with posterior arthrodesis and instrumentation followed by anterior decompression and arthrodesis; and three, with anterior decompression and arthrodesis. Thirty-six patients had been neurologically intact at the time of presentation and had remained so throughout the follow-up period. No neurological deterioration or symptoms of late spinal stenosis were seen. Isolated partial single-nerve-root deficits resolved regardless of the method of treatment. Patients who had had a complete single or a multiple-nerve-root paralysis seemed to have benefited from anterior decompression. Although the anatomical results as seen on the most recent radiographs were superior for the group that had been managed operatively with long posterior fixation or anterior and posterior arthrodesis, the most recent pain scores and the functional outcomes were similar for all treatment groups. At the latest follow-up evaluation, some loss of spinal alignment was noted in the patients who had been managed with short transpedicular fixation; the alignment at the most recent follow-up examination was comparable with that in the patients who had been managed non-operatively. For the patients who had had non-operative treatment, we were unable to predict the deformity at the time of follow-up on the basis of the initial diagnostic radiographs. The clinical outcome was not related to the deformity at the latest follow-up evaluation. On the basis of the results of our study, we recommend non-operative treatment for patients who do not have neurological dysfunction or who have an isolated partial nerve-root deficit at the time of presentation. For patients who have a multiple-nerve-root paralysis, anterior decompression is indicated.

Sagittal contour restoration and canal clearance in burst fractures of the thoracolumbar junction (T12-L1): the efficacy of timing of the surgery.

The efficacy of timing of surgery (short segment fixation using transpedicular screws), in burst fractures of thoracolumbar spine was evaluated between May 1993 and October 1994. The patients were divided into two groups according to time elapsed between injury and operation. Cases operated on within the first 24 h were taken as the early surgery group (n = 10) and cases operated on later than 24 h after the injury were considered as the late surgery group (n = 8). The efficacy of treatment was assessed by evaluation of the sagittal index (SI) restoration and reduction of canal compromise. The pre- and postoperative values for SI and canal narrowing (CN) for both groups are as follows: Early preoperative SI-23.40 degrees, late preoperative SI-24.50 degrees, p = 0.53; early preoperative CN-0.47, late preoperative CN 0.52, p = 0.33; early postoperative SI-4.20 degrees, late postoperative SI-13.50 degrees, p = 0.0001; early postoperative CN-0.10, late postoperative CN-0.39, p = 0.0000. There is still controversy concerning the relationship between canal narrowing and neurologic deficit, and the effect, if any, of decompression on neural recovery. Nevertheless, if the main aim of the surgical procedure is to restore the SI and decompress the neural canal, then other alternatives of decompression and realignment should be preferred to indirect reduction using short segment transpedicular fixation in cases to be operated on later than 24 h after injury.