Short-segment Pedicle Screw Fixation Research Articles

Radiological and Clinical Outcome of Thoracolumbar Burst Fracture Following Short Segment and Long Segment Pedicle Screw Fixation

INTRODUCTION: The indications for operative treatment and type of stabilization procedures for the treatment of thoracolumbar fracture remains controversial. Long-segment pedicle screw fixation permits correction of kyphotic deformity while short-segment pedicle screw fixation preserves motion segments, reduces costs and time of surgery. Our aim is to study the correlation and comparison between clinical and radiological outcome of both fixations and identify factors that might contribute to the outcome. MATERIALS AND METHODS: 60 patients with thoracolumbar spine fracture from 2017 to 2022 were identified. Age, gender, mechanism of injury, classification of fracture, duration of hospital stays and one-year post-operative outcome of Visual Analogue (VAS) pain score, and Oswestry Disability Index (ODI) score were documented. Pre- and post-operative AP/Lateral radiographs measurements of local kyphotic angle, Cobb angle were measured. Signs of fixation failure were examined at follow-up. RESULTS: Subjects mean age is 42.4, male predominance (85%) and work-related. The highest incidence was at level of L1 (56.7 %) in the long-segment and 46.7 % in short-segment. Most common injury was burst fracture (AO classification A3 A4 group) due to fall from height. There is shorter hospital stay documented in the short-segment fixation. Radiological outcome measured in both groups were comparable with no signs of fixation failure. Short-segment fixation group also resulted in better clinical and functional outcome at one-year follow-up. CONCLUSION: There is no significant difference in radiologic outcome of Cobb and kyphotic angle in both fixation groups. Short-segment fixation has significantly better clinical and functional outcome post-operative and at 1-year follow up.

Early Short Segment Pedicle Screw Fixation Including Fractured Vertebra of Thoracolumbar Burst Fracture with Incomplete Spinal Cord Injury

Background: Fractures of the thoracolumbar region are the most common injuries of the vertebral column; among them burst fractures are the most frequent. Several studies were done to see the surgical outcome of thoracolumbar burst fracture hence surgery was recommended for a better outcome. So, the current study aimed to evaluate the clinical, functional, and radiological outcome of short-segment pedicle screw fixation including the fractured vertebral body. Objectives: The primary aim of this study is to comprehensively evaluate the functional and radiological outcomes of early short-segment pedicle screw fixation, particularly in cases involving fractured vertebrae in thoracolumbar burst fractures accompanied by incomplete spinal cord injuries. Materials & Method: In this prospective observational study, 31 cases were included between April 2017 and July 2018 through non-randomized purposive sampling. All patients, aged 15 to 60 years, underwent posterior decompression and short-segment pedicle screw fixation, including the fractured vertebral body, within 21 days of the fracture. Postoperative functional outcomes were clinically assessed using the Oswestry Disability Index (ODI), Visual Analog Scale (VAS), American Spinal Injury Association (ASIA) scale, Denis Work Scale, and radiologically evaluated by Cobb's kyphotic angle, kyphotic deformation, Beck index, and Bridwell criteria. Postoperative follow-ups were conducted at the 6th, 12th, and 24th weeks. Results: In this study, 31 cervical spinal injury patients underwent operative treatment with a 3 to 12-month follow-up. Most were day laborers (35.48%), experiencing falls from height (80.65%), mainly at L1 (54.84%). Initial ASIA grade D improved to E (54.58%). Postoperatively, significant improvements in kyphotic angles, Beck index, and vertebral height were noted, with some correction loss at the final follow-up. Complications occurred in 22.58% of cases, including per-operative hemorrhage, dural tear, .......

Unilateral Pediculectomy and Reduction with Short-Segment Pedicle Screw Fixation for Thoracolumbar Burst Fracture: A Case Series

This study aimed to evaluate the efficacy of unilateral pediculectomy and reduction with short-segment pedicle screw fixation for thoracolumbar burst fracture. We retrospectively reviewed patients who underwent a unilateral pediculectomy and reduction with short-segment fixation and interbody fusion for thoracolumbar burst fracture. The unilateral pediculectomy created sufficient space to approach the ventral side of the spinal cord for removing bone fragments and insertion of an interbody cage to correct kyphosis. Lumbar lordosis (LL), pelvic incidence (PI) minus LL, and segmental Cobb angle were measured at three time points: preoperatively, postoperatively, and final follow-up. Furthermore, sagittal vertical axis (SVA) was measured to assess global sagittal balance at the final follow-up. A total of 10 patients, with a mean age of 39.8 ± 21.0, underwent the surgical procedure. All patients had a thoracolumbar injury classification and severity score > 5. The mean follow-up period was 15.8 ± 13.9 months. The mean postoperative LL (46.0 ± 5.8) was significantly higher (P = 0.008) than the preoperative measurement (32.8 ± 8.2). The mean postoperative PI minus LL (2.2 ± 8.4) was not significantly lower (P = 0.051) than preoperative measurement (15.4 ± 12.6). The mean postoperative segmental Cobb angle (11.4 ± 8.4) was significantly higher (P < 0.001) than the preoperative measurement (-11.6 ± 10.9). At the final follow-up, the mean SVA was 10.0 ± 28.8 mm. Unilateral pediculectomy and reduction with short-segment fixation and interbody fusion served as an efficient surgical method for thoracolumbar burst fracture.

SHORT SEGMENT VERSUS LONG SEGMENT PEDICLE SCREW FIXATION IN MANAGEMENT OF THORACOLUMBAR BURST FRACTURES: A META-ANALYSIS

This comprehensive meta-analysis evaluates the comparative effectiveness of short-segment pedicle screw fixation (SSF) and long-segment pedicle screw fixation (LSF) in treating thoracolumbar burst fractures. Our study examines various outcomes, including fusion rates, pain relief, functional recovery, and complication rates. Data from studies conducted between January 2018 and January 2022 were reviewed, involving a collective patient cohort of 100 individuals diagnosed with thoracolumbar burst fractures. We conducted an extensive review of the literature, including six investigations, with a total sample size of 100 patients, drawn from studies by Smith et al. (2018), Johnson et al. (2019), Brown et al. (2020), White et al. (2021), Davis et al. (2022), and Wilson et al. (2022). Fusion rates were 90% for SSF and 91% for LSF. The risk difference (RD) between SSF and LSF was -1%, indicating a marginal advantage favoring LSF (RD M-H = -0.95, 95% CI: -4.02 to 2.11). Analysis of postoperative pain scores showed that SSF patients had a mean pain level of 2.4, while LSF patients reported 2.3. With low heterogeneity (T = 12%) and a Z-score of 3.42, our findings demonstrated no statistically significant difference in postoperative pain levels between SSF and LSF. Functional outcomes were assessed using the Oswestry Disability Index (ODI) and Short Form 36, revealing an RD of -1% in favor of LSF. However, this difference was insignificant (RD M-H = -0.82, 95% CI: -3.80 to 2.16). The complication rate for SSF was 12%, and for LSF, it was 11%, with an RD of 1%, suggesting a slightly higher complication rate for SSF, although this difference was not statistically significant (RD M-H = 1.05, 95% CI: -1.38 to 3.48).Our meta-analysis found no statistically significant differences in fusion rates, postoperative pain scores, or complication rates between SSF and LSF in the context of thoracolumbar burst fractures. The choice between SSF and LSF for treating thoracolumbar burst fractures is a pivotal consideration. Our findings indicate that SSF and LSF yield comparable outcomes in fusion, postoperative pain relief, functional recovery, and complication rates. The marginal advantages associated with LSF are of negligible clinical significance. This study underscores the importance of individualized decision-making, emphasizing patient-specific criteria and surgeon expertise in selecting the most appropriate fixation strategy for thoracolumbar burst fracture management. Personalized treatment plans are paramount in optimizing patient outcomes in this clinical scenario.

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.

A Review of Spinal Twine Injury and Its Management

There is no universal agreement on the best procedure for treating lower cervical dislocation because anterior reduction and interbody fusion fixation have not been directly compared to posterior reduction and short-segmental pedicle screw fixation. This study compares the long-term effects of severe cervical dislocation with spinal cord injury treated using an anterior versus a posterior method. A total of 149 patients (follow-up rate of 84.1%) could be followed for more than 10 years. 67 patients had posterior reduction and short-segmental pedicle screw fixation, while 92 patients underwent anterior reduction and interbody fusion and fixation. Surgical or post-operative problems as well as the Japanese Orthopaedic Association (JOA) scores, the Neck Disability Index (NDI), the American Spinal Injury Association grading (ASIA), Odom's criteria, cervical kyphosis, and operating parameters were assessed. 10 to 17 years were spent monitoring the patients. At the follow-up, there was no discernible difference between the two groups' primary JOA scores, NDI scores, or ASIA scores. The posterior method was linked to a larger loss of alignment at the last follow-up and by two years (P = 0.012 and P 0.001, respectively).

Unipedicular-Screw Index Vertebra Manipulation Technique for Minimally Invasive Short-Segment Thoracolumbar Fracture Fixation.

Minimally invasive spine surgery (MIS) has revolutionized fixation of thoracolumbar fractures with burst elements. Recent studies have proven that percutaneous pedicle screw instrumentation is as effective as open instrumentation but with reduced intraoperative blood loss and operative duration. Techniques such as short-segment pedicle screw fixation including the fractured vertebra have shown satisfactory radiological correction and functional outcomes, avoiding the need for extensile posterior constructs. In the present study, the authors our technique utilizing unipedicular index vertebra fixation and manipulation in MIS for thoracolumbar fractures with burst elements. To our knowledge, this technique is not well described in literature as open approaches are often adopted for the above. The authors sought to highlight the 2-year radiological and functional outcomes of 20 consecutive patients who underwent this technique. A retrospective review of prospectively collected data was conducted on 20 patients with thoracolumbar fractures with burst elements who underwent fixation using our technique. Patient data collected included demographic characteristics, mechanism of injury, associated injuries, neurological deficit at the time of admission, pre- and postoperative neurological evaluation, and length of hospital stay. Radiological investigations included plain radiographs, computed tomography of the spine with reconstruction, and magnetic resonance imaging of the spine, which provided data for radiological fracture classifications such as AO Spine and derivation of Thoracolumbar Injury Classification and Severity Score, as well as preoperative planning. Radiological investigations in the postoperative period were carried out by standing radiographs or EOS whole spine at each postoperative follow-up for up to 2 years. Radiological parameters-vertebral wedge angle, regional kyphosis angle, coronal Cobb angle, and anterior and posterior vertebral body heights-were recorded at preoperative, intraoperative, postoperative, and up to 2-year follow-up. Clinical outcome scores (visual analog score [VAS] and Oswestry Disability Index [ODI]) were also recorded at similar timepoints. Radiological outcomes reflect significant lordotic corrections of the vertebral wedge angles up to 2-year follow-up when compared with preoperative values (intraoperative: P = 0.06; postoperative: P = 0.001; 3 months: P = 0.002; 6 months: P = 0.004; 1 year: P = 0.011; 2 years: P = 0.016). Additionally, significant lordotic corrections of regional kyphosis angles (intraoperative: P = 0.00; postoperative: P = 0.00; 3 months: P = 0.031; 6 months: P = 0.039) and increases in anterior vertebral body heights (postoperative: P = 0.001; 3 months: P = 0.010; 6 months: P = 0.020) at up to 6-month follow-up were found. Preoperatively, median VAS of 85 (range 30-100) and ODI of 90 (range 40-98) were recorded. Statistically significant improvements in VAS and ODI were found across all timepoints when compared with preoperative values, with a mean VAS of 11.5 (SD 4.8) and ODI of 9.9 (SD 4.5) at 2-year follow-up. Surgical management of thoracolumbar fractures with or without neurological deficit has a role in reducing nursing requirements and postoperative morbidity in patients with polytrauma and other associated injuries. Our approach in treating thoracolumbar fractures with burst elements using MIS short-segment fixation and unipedicular screw manipulation technique shows satisfactory radiological correction and high rates of fracture union while reducing approach-related morbidity and improving functional outcomes.

Posterior cervical pedicle screw rod short-segment internal fixation for the treatment of atlantoaxial fracture and dislocation

To investigate the clinical efficacy of posterior cervical pedicle screw short-segment internal fixation for the treatment of atlantoaxial fracture and dislocation. The clinical data of 60 patients with atlantoaxial vertebral fracture and dislocation underwent surgery between January 2015 and January 2018 were retrospectively analyzed. The patients were divided into study group and control group according to different surgical methods. There were 30 patients in study group, including 13 males and 17 females, with an average age of (39.32±2.85) years old, were underwent short-segment internal fixation with posterior cervical pedicle screws. There were 30 patients in control group, including 12 males and 18 females, with an average age of (39.57±2.90) years old, were underwent posterior lamina clip internal fixation of the atlas. The operation time, intraoperative blood loss, postoperative ambulation time, hospitalization time and complications between two groups were recorded and compared. The pain visual analogue scale(VAS), Japanese Orthopedic Association(JOA) score of neurological function, and fusion status were evaluated between two groups. All patients were followed up for at least 12 months. The study group was better than control group in operation time, intraoperative blood loss, postoperative off-bed activity time, and hospital stay (P=0.000). One case of respiratory tract injury occurred in study group. In control group, 2 cases occurred incision infection, 3 cases occurred respiratory tract injury, and 3 cases occurred adjacent segmental joint degeneration. The incidence of complications in study group was lower than that in control group (χ2=4.705, P=0.030). At 1, 3, 7 days after operation, VAS of study group was lower than that of control group(P=0.000). At 1, 3 months after operation, JOA score of study group was higher than that of control group(P=0.000). At 12 months after operation, all the patients in the study group achieved bony fusion. In control group, there were 3 cases of poor bony fusion and 3 cases of internal fixation fracture, the incidence rate was 20.00%(6/30). The difference between two groups was statistically significant (χ2=4.629, P=0.031). Posterior cervical short-segment pedicle screw fixation for atlantoaxial fracture and dislocation has the advantages of less trauma, shorter operation time, fewer complications, and less pain, and can promote the recovery of nerve function as soon as possible.

A comparative study of PSPVP and PSIBG inthe treatment of stageII-III Kummell's disease.

Percutaneous kyphoplasty (PKP) or percutaneous vertebroplasty (PVP) are commonly employed for Kummell's disease in stagesII-III; however, these techniques produce some complications. To compare the clinical efficacy and imaging results of percutaneous vertebroplasty + bone cement-augmented short-segment pedicle screw fixation (PSPVP) versus transpedicular intracorporeal bone grafting + pedicle screw fixation (PSIBG) in the treatment of stageII-III Kummell's disease. A total of 69 patients admitted between November 2017 and March 2021 were included in this study; 36 of these were treated with PSPVP, and 33 were treated with PSIBG. Patients in the two groups were compared in terms of perioperative, follow-up, and imaging data. No statistically significant differences were found between the two groups in terms of operation duration (P >0.05). However, the PSPVP group was superior to the PSIBG group in terms of incision length, intraoperative blood loss, and length of stay (P <0.05). All patients were followed up for more than 12 months. The VAS score, height of anterior vertebral margin, kyphosis Cobb angle, wedge angle of the affected vertebra at seven days after surgery and last follow-up, and the ODI index at the last follow-up of the two groups were significantly improved compared with figures before surgery (P <0.05). Compared with values before surgery, no statistically significant differences were found in the height of the posterior vertebral margin in the PSPVP group at seven days after surgery and at the last follow-up (P >0.05). There were also no statistically significant differences in the VAS score, ODI index, kyphosis Cobb angle, and wedge angle of the affected vertebra between the two groups at corresponding time points (P >0.05). The heights of the anterior and posterior vertebral margins in the PSIBG group were better than those in the PSPVP group after surgery and at the last follow-up (P <0.05). In the PSPVP group, a pedicle screw fracture occurred in one patient two months after surgery, while an upper adjacent vertebral fracture occurred in one patient eight months after surgery. Both PSPVP and PSIBG can achieve good early clinical efficacy in the treatment of stage II-III Kummell's disease, with PSPVP being relatively less invasive while producing a poorer orthopedic effect and more complications than PSIBG.

Minimally Invasive Fixation in Osteoporotic Vertebral Fractures: A Review Article

here are several surgical strategies which have been proposed to treat the osteoporotic patient with vertebral fracture, ranging from vertebral body cement augmentation, percutaneous/mini-open short segment pedicle screw fixation, and cortical bone trajectory screw to kyphotic deformity correction surgery. Minimally invasive spine surgery has the potential benefits of faster recovery, reduced blood loss, less postoperative wound pain, lower infection risk, and shorter length of hospital stay. Novel surgical techniques such as percutaneous instrumentation fixation, cortical bone trajectory technique, screw cement augmentation, and vertebral body augmentation are developed. However, various complications have been reported, including pedicle fracture, instrumentation loosening, adjacent-level disc degeneration with herniation, and progressive junctional kyphosis. The purpose of this review was to outline various advancements in minimally invasive spinal surgery for patients with osteoporosis. Minimally invasive surgical techniques for fixation including percutaneous instrumentation, cortical bone trajectory technique, screw cement augmentation, and vertebral body augmentation have benefited patient with osteoporosis. Studies and discussions about short-segment pedicle screw fixation (one level above and below the fracture level) have shown that it provides enough stability for thoracolumbar burst fractures. There are also complications, including cement embolism, adjacent vertebral fracture, neuraxial anesthesia, and infection, which have been observed with the above technique. With the advancement of instrument and technique, the complication rate decreased in recent studies. Minimally invasive fixation still has many advantages for patients with osteoporosis. Many of these studies and strategies only have evidence from biomechanical and cadaveric studies and require further clinical trials to establish their clinical efficacy.

Evaluation of vertebral shortening and interbody fusion with short segment pedicle screw fixation for unstable thoracolumbar fractures

BackgroundVarious operative procedures have been described for the treatment of traumatic paraplegia caused by unstable thoracolumbar fractures. We prospectively evaluated interbody fusion (IBF) with SS-PSF in these cases with regard to clinico-radiological outcome with the objectives: (1) Does IBF and short segment pedicle screw fixation (SS-PSF) prevent progression of kyphotic angle after surgery? (2) Can this procedure be safely performed in the setting of acute trauma?. MethodsSixteen patients suffering from traumatic paraplegia caused by acute unstable thoracolumbar fractures were enrolled prospectively and underwent IBF with SS-PSF. They were evaluated for magnitude of shortening in spine, progression of kyphotic angle, and neurological improvement by American spinal injury association scale (ASIA). ResultsOut of total sixteen, 14 patients were ASIA grade A and 2 were grade C, at the time of presentation. Thirteen out of these 14 remained grade A and one improved to B. Both the patients who had grade C involvement at the time of presentation improved to grade D at one-year follow-up. The mean blood loss was 750 ml (range; 650 ml–1150 ml). Mean kyphotic angle decreased from 20.6° (range; 13° to 37°) preoperatively to 6.2° (range; 3° to 10°) at postoperative day 2 (p = 0.002). Its mean value after 6 months was 6.5° (range; 3° to 11°). The procedure resulted in mean spinal column shortening of 18 mm (range; 16 mm–22 mm) in the spinal column. All the patients achieved bony union by a mean duration of 3.9 months (range; 3 months–6 months). ConclusionsIBF with SS-PSF has the shortest possible instrumented construct for thoracolumbar junction fusion done by posterior approach. The interbody fusion for unstable thoracolumbar junction fractures prevents the progression of kyphotic angle post-operatively. Level of evidenceLevel 4.

Study on results of laminectomy with short-segment pedicle screw fixation in dorsolumbar fractures with respect to anatomical reduction, functional recovery and pain

Study on results of laminectomy with short-segment pedicle screw fixation in dorsolumbar fractures with respect to anatomical reduction, functional recovery and pain

Observational study of short-segment pedicle screw fixation for dorsolumbar spine injury: A prospective study

Background: Traumatic injury of dorsolumbar spine is one of the most common sites of spinal injuries because of its location between rigid kyphotic thoracic and mobile lordotic lumbar spine. Its treatment by pedicle screw fixation by short segment (one level above and below the fractured vertebra) or long segment (two levels above and below the fractured vertebra) has always remained a matter of debate. The aim of this study was to assess the functional outcome of short-segment fixation in dorsolumbar spine injury.Materials and Methods: This prospective study was conducted on thirty, single-level, unstable dorsolumbar spine fracture patients, who underwent short-segment pedicle screw instrumentation at Indira Gandhi Institute of Medical Sciences, Patna, between October 2019 and September 2021. All the patients were operated by posterior approach and stabilized the vertebrae with short-segment pedicle screw instrumentation. All patients were followed up for 1 year.Results: Thirty patients (21 males and 9 females) of mean age 34.2 ± 11.74 years were included in the study. The most common mode of injury was fall from height (24 patients, 80%), followed by road traffic accident (six patients, 20%). The most common fracture pattern was compression fractures in 23 (76.67%) patients, followed by burst fractures in 7 (23.33%) patients. The most common level of injury was L1, followed by D12. Neurological improvement of at least one level was seen in 21 patients, and nine patients had no neurological improvement. There was a statistically significant correction of kyphotic angle of 14.9°. At 1 year of follow-up, 21 (70%) patients had <40% Oswestry Disability Index (ODI) and 9 (30%) patients had more than 40% ODI. Out of 30 patients, 2 (6.67%) patients had bedsore, 1 (3.33%) patient had superficial infection, and 1 (3.33%) patient had implant failure.Conclusion: The short-segment posterior instrumentation system is a very stable construct. It maintained the corrected deformity after fracture reduction and spares the motion segment which is sacrificed in the conventional long-segment fixation. The soft tissue dissection, blood loss, and duration of surgery are less in this procedure.

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

Minimally invasive short segment pedicle screw fixation for Thoraco-Lumbar Trauma: Where we stand?

Background &amp; Overview of Literature: Use of MISS or Percutaneous pedicle screws for thoracolumbar trauma has shown superiority in terms of postoperative pain, blood loss, operating time, hospital stay and incision size as compared to open surgical method. The use of MISS in thoracolumbar trauma has been limited due to the high cost and lack of posterolateral fusion. There is conflicting evidence for and against the use of MISS in AO spine A3/A4 fractures without any neurological deficit and maybe managed conservatively as well. Purpose: To establish efficacy and safety of MISS, short segment pedicle screw fixation in patients of thoraco-lumbar fractures but without any neurological deficit. Study Design: Retrospective case reports of 2 years in which 20 patients of thoraco-lumbar trauma that underwent minimally invasive short segment spine fixation were included. Material &amp; Methods: Retrospective analysis of 20 patients of thoraco-lumbar spine fractures that were operated from 2017 to 2019 at Government Medical College &amp; Hospital, Chandigarh. Patients included were in the age group of 23-70 years, operated within one week of trauma, AO type A3 and A4, and operated using short segment fixation. Our exclusion criteria were trauma more than one week old, multiple levels of fractures and non-traumatic fractures. Clinical and radiological data were collected and tabulated. Results: Most patients (8 out of 20) had fracture of D12 vertebra. 18 out of 20 patients were involved in a road traffic accident. The mean blood loss was 25.78 mL. Cobb’s angle was used to measure focal deformity and the average gain in Cobb’s angle after surgery was 10.9°. Mean loss in correction was 2.35°. All patients were pain-free after 6 months as measured on the VAS score. The average time taken in getting back to work after surgery was 26 days. Conclusion: MISS is the ideal treatment of choice in patients of thoraco-lumbar spine trauma without any neurological deficit. MISS provides higher safety, early mobilization, less blood loss during surgery, shorter recovery time, and less post-operative pain.

Percutaneous transpedicular intracorporeal cage grafting for Kümmell disease.

Osteonecrosis with progressive collapse and segmental kyphosis can lead to intersegmental instability in some osteoporotic vertebral compression fractures (OVCFs). These conditions are known as Kümmell's disease and often require anterior column reconstruction in elderly patients. We attempted anterior column reconstruction by percutaneous transpedicular intracorporeal cage grafting (PTICG) with short-segment pedicle screw fixation and described the steps, with discussions on the surgical indications and pros and cons. PTICG is expected to be an alternative to vertebral anterior column reconstruction, which can preserve the thoracolumbar posterior arch and paravertebral musculature.

Mechanical Analysis of Posterior Pedicle Screw System Placement and Internal Fixation in the Treatment of Lumbar Fractures.

Objective Image segmentation technology is applied to separate a single vertebra from the three-dimensional model of the spine, so as to separate a single vertebra image with smaller error, higher degree of automation, and better results. The objectives are to study the biomechanical characteristics of posterior short-segment pedicle screw fixation by three-dimensional finite element method, analyze the mechanical characteristics of posterior pedicle screw rod fixation system under different factors, and demonstrate the feasibility of its application in the treatment of lumbar fracture. Methods The authors searched the database for articles about the treatment of lumbar spine fracture, screw rod internal fixation system, and its mechanical parameters. The threshold segmentation method based on region segmentation method was used to segment the image, and the three-dimensional finite element model was used to analyze the biomechanical characteristics of different posterior internal fixation for lumbar spine fracture. Results The posterior pedicle internal fixation system for the treatment of multilevel spinal fractures is a mature surgical technique and has fewer postoperative complications. Transpedicle fixation is effective and reliable. It can effectively restore the coronal and sagittal curvature of the vertebral body and restore the stability of the spine better. But the choice of internal fixation method should be individualized based on fracture type, identification of critical and secondary injury sites, and stability assessment. Only after mastering the biomechanical characteristics of the posterior screw rod system for the treatment of lumbar fracture, selecting the appropriate method, and fixing the appropriate movement unit can the best fixation be achieved. Conclusion Threshold method is the most direct and simple image segmentation method. The core technology of thresholding is the selection of threshold, which will affect the final segmentation effect. The most common segmentation method is to calculate the segmentation threshold by histogram. The threshold method has less computation and good segmentation effect for the image with large contrast between background and target. Posterior pedicle screw rod system internal fixation has the advantages of less trauma, good reduction, reliable fixation, and less complications. The design, placement angle and depth of various internal fixation systems, and the number of fixed segments all show different mechanical characteristics. As long as we master the above characteristics, choose the appropriate method and fix the appropriate motor unit, and we can get the best fixation; it can be used as an effective treatment for lumbar fracture.

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.

A retrospective comparative study of clinical efficacy of percutaneous short segment pedicle screw fixation with or without screwing of the fractured vertebra with O-arm navigation

ObjectiveTo retrospectively analyze the short and long-term efficacies of O-arm-navigated percutaneous short segment pedicle screw fixation, with or without screwing of the fractured vertebra.MethodsA total of 42 patients who underwent O-arm-navigated percutaneous short segment pedicle screw fixation for the treatment of thoracolumbar fractures from February 2015 to December 2018 were selected for analysis. The patients were divided into two groups according to the surgical intervention they received: Group A received percutaneous short segment pedicle screw fixation with screwing of the fractured vertebra and Group B received percutaneous short segment pedicle screw fixation without screwing of the fractured vertebra. Radiographic analysis included Cobb angles and percentage of anterior vertebral height (AVH%). Clinical functional outcomes were assessed using the visual analog scale (VAS) for back pain and the oswestry disability index (ODI) scores.ResultsNo significant differences were observed in the operation time and intraoperative blood loss between the two groups (P > 0.05). The length of incision was statistically significantly different between the two groups (P < 0.05). There was no significant difference in Cobb angle and AVH% between the two groups before and after the surgery (P > 0.05). However, the Cobb angle and AVH% were both significantly larger in Group A than Group B at the final follow-up (P < 0.05). In terms of clinical outcomes, there were no statistically significant differences in VAS and ODI scores between the two groups (P > 0.05).ConclusionIn the short term, both minimally invasive treatments were safe and effective in treating thoracolumbar fracture. Although there was significant difference between the two groups in Cobb angle and vertebral body height at the last follow-up, the difference was small. Therefore, these specific parameters will be an important outcome measure in further investigations.

Posterior pedicle screw fixation combined with transpedicular bone grafting for treatment of single-level thoracolumbar fractures with the aid of a vertebroplasty tool

ObjectiveThis study was performed to assess the efficacy of a novel tool to assist transpedicular bone grafting in short-segment pedicle screw fixation combined with pedicle fixation at the level of the fractured vertebra (six-screw fixation).MethodsWe retrospectively analyzed 80 patients (40 in the control group and 40 in the tool-aided group) with single-level thoracolumbar fractures. Patients in the control group underwent traditional six-screw fixation combined with transpedicular bone grafting. In the tool-aided group, we introduced a novel vertebroplasty tool to assist transpedicular bone grafting. Basic information and related indicators were recorded.ResultsThere were no significant differences in the patients’ baseline characteristics or surgical outcomes between the control group and tool-aided group. Both traditional surgery and tool-aided surgery restored the height of the fractured vertebrae and decreased the Cobb angle, visual analog scale score, and Oswestry Disability Index. However, tool-aided surgery more effectively restored the height of the fractured vertebrae and reduced the visual analog scale score and Oswestry Disability Index than did traditional surgery.ConclusionVertebroplasty tool-aided surgery facilitated more precise and successful grafting of bone into damaged vertebrae than did traditional surgery and therefore might be recommended for treating single-level thoracolumbar fractures.