Treatment Of Thoracolumbar Spine Fractures Research Articles

Progress in the Treatment of Thoracolumbar Spinal Fractures with Internal Fixation of Injured Vertebrae with Screws

Progress in the Treatment of Thoracolumbar Spinal Fractures with Internal Fixation of Injured Vertebrae with Screws

Isolated posterior stabilization in type B and C thoracolumbar fractures associated with ankylosing spine disorders: A single center experience with clinical and radiological outcomes.

Fractures in ankylosing spine disorders (ASD) are associated with high complication and mortality rates. During the posterior stabilization of these fractures, reduction is often partial, resulting in the persistence of a significant anterior diastasis. Our objective was to evaluate the safety and efficiency of isolated posterior stabilization in elderly ASD patients, without direct reduction of the anterior diastasis, in terms of clinical and radiological outcomes, complications, and mortality. This retrospective study included 46 patients, mean age 79.3years, with ASD, who underwent isolated posterior stabilization, open or percutaneous, for thoracolumbar fractures. The average follow-up was 21.7months, with a minimum follow-up of 6months. Autonomy (Parker score) and radiological results (lordotic angulation) were analyzed pre-and post-operatively. Autonomy was maintained at the last follow-up, with no significant difference in Parker's score. The consolidation rate was 94.6%. No implant failure was recorded. Despite the absence of an anterior procedure, lordotic angulation was significantly reduced by 2.6° at 6months (p=0.02). The rate of surgical complications following open surgeries was 10.9% (n=5), of which 6.5% were infections. No surgical complications were reported in percutaneous surgeries. The rate of medical complications was 67.4% (n=31), with a rate of 88.2% in the open surgery group, compared to 55.2% in the percutaneous surgery group. An open approach was associated with a five-fold higher risk of complications (p=0.049). Nine patients died during follow-up (19.6%). Isolated posterior stabilization in the treatment of thoracolumbar spine fractures in elderly ASD patients is a safe technique promoting autonomy preservation, and high radiological bony healing with acceptable complication and mortality rates. The persistent anterior gap is partially reduced when the spine is loaded and does not seem to require an anterior procedure, thus decreasing complications. Percutaneous surgery should be the technique of choice to reduce surgical complications.

The effectiveness of short hybrid stabilization with sublaminar bands and transpedicular screws in the treatment of thoracolumbar spine fractures.

Long constructs have always been widely recommended for the treatment of thoracolumbar fractures, due to their biomechanical stability and minimal postoperative loss of correction. However, short constructs have significant advantages, since they enable for better postoperative lumbar mobility and reduce the risk of adjacent segment degeneration. The purpose of this study is to evaluate the safety and efficacy of hybrid screw/sublaminar bands short constructs, used for the treatment of thoracolumbar fractures. From June 2015 until November 2017, 20 consecutive patients (14 male, 6 female) with an average age of 52.9 years, exhibiting at least one traumatic fracture in the thoracolumbar region, were treated with hybrid screw/sublaminar bands short constructs. The data for analysis included: duration of the intervention, intraoperative blood loss, complications, and clinical and radiographic postoperative results, compared with the standard for thoracolumbar fixation. The use of this type of construct allowed for simple reduction, stabilization of the fractures, and restoration of the physiological spine curvatures. During the postoperative period none of the patients had neurological worsening. 18 out of 20 patients were followed up for two years. One patient sustained implant failure six months after surgery and underwent a surgical implant revision with traditional long fixation. After two years, stability and fusion were obtained in all patients, along with correct spine alignment. Hybrid screw/sublaminar bands short constructs seem to be effective in the treatment of thoracolumbar fractures, providing the same clinical results of the state-of-the-art pedicular screw/rod long constructs, but in addition they allow for better postoperative lumbar mobility and subsequently reduce the risk of adjacent segments degeneration. The results of this clinical case series might support the initiation of prospective randomized trials with more patients, a longer follow-up period, and control groups.

Minimally Invasive (Percutaneous) Pedicle Srews as the Treatment of Choice in Thoracolumbar Spine Fractures

Introduction. Minimally invasive techniques of transpedicular fusion have become very common and seem to displace classical open techniques. Pedicle screws fusion is the procedure of choice in unstable traumatic lumbar and thoracic spine fractures of.Aim. The aim of the study was to answer whether open techniques are still used in injuries or whether they have been completely replaced by MISS.Material and Methods. The manuscript presents an analysis of patients treated in 2017–2021 in the Department of Neurosurgery, Neurotraumatology and Pediatric Neurosurgery of Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University.Results. Based on the analysis of medical documentation, it was found that every case of traumatic thoracolumbar spine fracture in 2017–2021 was treated using minimally invasive techniques. According to the documentation, the last case of using open surgical technique in the case of trauma was in 2016. It was noted that percutaneous techniques dominated the surgical treatment of thoracolumbar spine fractures and replaced the classic techniques in our department, which are used only, in some cases, in treatment of non-traumatic spondylolisthesis.Conclusions. Therefore, percutaneous techniques are currently the procedure of choice in spine injuries fusion in our hospital. The use of percutaneous techniques reduces the surgical traumatization of tissues (it is important to avoid additional traumatization and blood loss in traumatic patients). It has been pointed out that these procedures are performed by neurosurgeons who, in teaching process, used percutaneous techniques often and now prefer this method. The use of percutaneous techniques has important aspect in the field of neurosurgical nursing, because care of the operated area consists in observing few (4–16) smaller wounds, not one long wound (as in classic techniques), and these wounds are located directly above the titanium screw tips, which must under neurosurgical nurse care. (JNNN 2022;11(1):3–7)

Placement of Percutaneous Screw through pedicle of fractured Vertebrae in fixation of Thoracolumbar spinal fractures - an observational analysis

Aim: To investigate the safety and effectiveness of percutaneous pedicle screw placement at the level of fractured vertebrae in the treatment of thoracolumbar spinal fractures. Methods: The experiment enrolled 40 participants in stages. Percutaneous pedicle screw fixation classified patients into two groups: those who had a fractured vertebra insertion of pedicle screw (fractured group) and those who did not (the "unfractured group") (control group). The duration of the surgery and the volume of blood loss were both documented. In clinical study, both the ODI and the visual analogue scale were utilized (VAS). Cobb angle, vertebral body index (VBI), and anterior vertebral body height were used for radiographic follow-up (CA). Results: The two groups did not differ significantly in terms of operation time and intraoperative blood loss. VAS and ODI scores remained stable across all follow-up periods. In comparison to the control group, the fragmented group exhibited a higher rate of rectification and a lower rate of AVBH and VBI loss. There was no significant difference between the two groups in terms of CA correction and correction loss following surgery. Conclusion: If a patient suffers a type A fracture of the thoracolumbar spine, percutaneous screw fixation combined with intermediate screws may be beneficial in assisting the patient in healing and preserving their vertebral height. Keywords: Thoracolumbar spinal fractures, screw, vertebrae

Indications for Nonsurgical Treatment of Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations.

Thoracolumbar spine is the most injured spinal region in blunt trauma. Literature on the indications for nonoperative treatment of thoracolumbar fractures is conflicting. The purpose of this systematic review is to clarify the indications for nonsurgical treatment of thoracolumbar fractures. We conducted a systematic literature search between 2010 to 2020 on PubMed/MEDLINE, and Cochrane Central. Up-to-date literature on the indications for nonoperative treatment of thoracolumbar fractures was reviewed to reach an agreement in a consensus meeting of WFNS (World Federation of Neurosurgical Societies) Spine Committee. The statements were voted and reached a positive or negative consensus using the Delphi method. For all of the questions discussed, the literature search yielded 1,264 studies, from which 54 articles were selected for full-text review. Nine studies (4 trials, and 5 retrospective) evaluating 759 participants with thoracolumbar fractures who underwent nonoperative/surgery were included. Although, compression type and stable burst fractures can be managed conservatively, if there is major vertebral body damage, kyphotic angulation, neurological deficit, spinal canal compromise, surgery may be indicated. AO type B, C fractures are preferably treated surgically. Future research is necessary to tackle the relative paucity of evidence pertaining to patients with thoracolumbar fractures.

Percutaneous Spine Fusion Combined with Whole-Body Traction in the Acute Surgical Treatment of AO A- and C-Type Fractures: A Technical Note

A diminished level of pain following the operation and shortened hospitalization are the distinct advantages of minimally invasive spine surgery (MISS). However, manipulating the spine with additional MISS tools (e.g., distraction and compression devices) is often cumbersome. Our paper draws attention to a cost-free, fast, indirect decompression method that can be used in the acute treatment of thoracolumbar spine fractures. The presented method involves ligamentotaxis by whole-body traction in the operating room combined with percutaneous spine fixation. Fifteen patients with thoracolumbar injuries A type and C type (without distraction) by AO classification were operated sequentially with the combination of whole-body traction and percutaneous minimally invasive spine fixation. Data were analyzed retrospectively. A total of 139 screws were implanted into 70 segments in 6 female and 9 male patients. The average clinical follow-up was 16 months. Average preoperative traumatic kyphosis was 17 degrees, and an average postoperative kyphosis was 1.8 degrees. The fractured vertebrae's height gain was an average of 11.0 mm (range 3.9-21.9 mm) ventrally and an average of 5.4 mm (range 1-11.2 mm) dorsally after the surgeries. The spinal canal space narrowing showed an average 6.5 mm improvement postoperatively. Operative time averaged 2 hours and 34 minutes, and blood loss averaged 250 mL (range 150-400 mL). No neurologic complications and wound healing problems were observed. The combination of MISS and whole-body traction provided successful anatomical correction in thirteen of the fifteen cases of compression type thoracolumbar fractures without extensive surgical exploration.

Analysis of outcome of percutaneous versus open pedicle screw fixation in the treatment of thoraco-lumbar spine fractures: a prospective comparative study

<p><strong>Background:</strong> Aim of the study was to evaluate the effectiveness between percutaneous and open pedicle screw fixation in the treatment of traumatic thoracolumbar burst fractures with spinal injury.</p><p><strong>Methods:</strong> A prospective comparative study including thirty patients with thoracolumbar burst fracture were equally divided into an open pedicle screw fixation (OPSF) group and a percutaneous pedicle screw fixation (PPSF) group. Demographic characteristics, clinical and radiological outcomes, and adverse events were assessed and compared between the 2 groups.</p><p><strong>Results:</strong> Demographic and clinical features including age, gender, fracture level, mechanism of injury and neurological status in both groups were not significantly different (all p>0.05). The PPSF group exhibits significantly lower operative time, intraoperative blood loss, and hospital stay compared with the OPSF group (all p<0.05). There was no significant difference in the sagittal Cobb′s angle (CA), fracture vertebral body angle (VBA), anterior vertebral body height (AVBH) on pre-operative, immediate post-operative and final follow up between the two surgical techniques (all p>0.05). Visual analogue scale (VAS) remarkably decreased in both groups after surgery but difference was not statically significant (p=0.808). Common postoperative complications in both groups were superficial infections, pressure ulcer and urinary tract infection (UTI) worsening. Hardware failure was seen only in one case of PPSF group.</p><p><strong>Conclusions:</strong> Patients with thoracolumbar burst fractures can be effectively managed with PPSF/OPSF. There were no significant differences in radiological and clinical outcomes and post-op complications between 2 groups but blood loss, operative time and hospitalization stay were less in percutaneous group, which may represent a potential benefit.</p><p><strong> </strong></p>

Open versus minimally invasive percutaneous surgery for surgical treatment of thoracolumbar spine fractures- a multicenter randomized controlled trial: study protocol

BackgroundThoracolumbar fractures are most frequent along the spine, and surgical treatment is indicated for unstable fractures. Percutaneous minimally invasive surgery was introduced to reduce the pain associated with the open posterior approach and reduce the morbidity of the procedure by avoiding damage and dissection of the paravertebral muscles. The goal of this study is to compare the surgical treatment of fractures of the thoracolumbar spine treated by the conventional open approach and the percutaneous minimally invasive approach using similar types of pedicle spine fixation systems.Methods/designsThis study is designed as a multi-center, randomized controlled trial of patients aged 18–65 years who are scheduled to undergo surgical posterior fixation. Treatment by the conventional open approach or percutaneous minimally invasive approach will be randomly assigned. The primary outcome measure is postoperative pain, which will be measured using the visual analogue scale (VAS). The secondary outcome parameters are intraoperative bleeding, postoperative drainage, surgery time, length of hospital stay, SF-36, EQ-5D-5 l, HADS, pain medication, deambulation after surgery, intraoperative fluoroscopy time, vertebral segment kyphosis, fracture vertebral body height, compression of the vertebral canal, accuracy of the pedicle screws, and breakage or release of the implants. Patient will be followed up for 1, 2, 3, 6, 12 and 24 months postoperatively and evaluated according to the outcomes using clinical and radiological examinations, plain radiographs and computed tomografy (CT).DiscussionSurgical treatment of thoracolumbar fractures by the open or percutaneous minimally invasive approach will be compared in a multicenter randomized study using similar types of fixation systems, and the results will be evaluated according to clinical and radiological parameters at 1, 2, 3, 6, 12 and 24 months of follow-up.Trial registrationClinicalTrial.gov approval number: 1.933.631, code: NCT03316703 in may 2017.

The Predictive Value of the Load Sharing Classification Concerning Sagittal Collapse and Posterior Instrumentation Failure: A Systematic Literature Review.

Study design:Systematic review.Objective:In 1994, the Load Sharing Classification (LSC) was introduced to aid the choice of surgical treatment of thoracolumbar spine fractures. Since that time this classification system has been commonly used in the field of spine surgery. However, current literature varies regarding its use and predictive value in relation to implant failure and sagittal collapse. The objective of this study is to assess the predictive value of the LSC concerning the need for anterior stabilization to prevent sagittal collapse and posterior instrumentation failure.Methods:An electronic search of PubMed, Medline, Embase, and the Cochrane Library was performed. Inclusion criteria were (1) cohort or clinical trial (2) including patients with thoracolumbar burst fractures (3) whose severity of the fractured vertebrae was assessed by the LSC.Results:Five thousand eighty-two articles have been identified, of which 21 articles were included for this review. Twelve studies reported no correlation between the LSC and sagittal collapse or instrumentation failure in patients treated with short-segment posterior instrumentation (SSPI). Seven articles found no significant relation; 5 articles found no instrumentation failure at all. The remaining 9 articles experienced failure in patients with a high LSC or recommended a different surgical technique.Conclusions:Although the LSC was originally developed to predict the need for anterior stabilization in addition to SSPI, many studies show that SSPI only can be sufficient in treating thoracolumbar fractures regardless of the LSC. The LSC might have lost its value in predicting sagittal collapse and posterior instrumentation failure.

Indications for the monosegmental stabilization of thoraco-lumbar spine fractures

To evaluate the efficacy and to underline the right indications of the posterior monosegmental stabilization for the treatment of thoraco-lumbar spine fractures. Twenty patients underwent a monosegmental stabilization at our Institution and were retrospectively reviewed with a minimum follow-up of two years. All the patients had a clinical and radiological assessment before, after the surgery and at final follow-up. All data were evaluated by one independent observer. Data collected were Denis pain and work scale, somatic kyphosis (SK), somatic height (SH), and compression percentage (CP). The mean pre-operative SK angle measured between the upper and lower end plate of the fractured vertebra was 23.6°. The mean SK immediately after surgery was 12.8° and at final follow-up was 13.9°. The mean pre-operative SH was 21.9mm, the mean value after surgery was 26.5mm, and at final follow-up was 24.8mm. The mean pre-operative CP was 66.7%, the mean value after surgery was 80.9%, and at final follow-up was 75.3%. At final follow-up, 75% of the patients had no pain or moderate pain and 95% of the patients returned to a full time work. Monosegmental stabilization with fusion is a safe and effective method to treat well selected thoracolumbar spine fractures. The right indications are type A1, type B2, and type A3 with a load sharing of less than 7 points and some very well selected type C fractures in which there is not lateral and rotatory displacement.

Treatment of Fractures of the Thoracolumbar Spine: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU).

Study Design: consensus paper with systematic literature review.Objective:The aim of this study was to establish recommendations for treatment of thoracolumbar spine fractures based on systematic review of current literature and consensus of several spine surgery experts.Methods:The project was initiated in September 2008 and published in Germany in 2011. It was redone in 2017 based on systematic literature review, including new AOSpine classification. Members of the expert group were recruited from all over Germany working in hospitals of all levels of care. In total, the consensus process included 9 meetings and 20 hours of video conferences.Results:As regards existing studies with highest level of evidence, a clear recommendation regarding treatment (operative vs conservative) or regarding type of surgery (posterior vs anterior vs combined anterior-posterior) cannot be given. Treatment has to be indicated individually based on clinical presentation, general condition of the patient, and radiological parameters. The following specific parameters have to be regarded and are proposed as morphological modifiers in addition to AOSpine classification: sagittal and coronal alignment of spine, degree of vertebral body destruction, stenosis of spinal canal, and intervertebral disc lesion. Meanwhile, the recommendations are used as standard algorithm in many German spine clinics and trauma centers.Conclusion:Clinical presentation and general condition of the patient are basic requirements for decision making. Additionally, treatment recommendations offer the physician a standardized, reproducible, and in Germany commonly accepted algorithm based on AOSpine classification and 4 morphological modifiers.

Minimally Invasive Spine Osteosynthesis (MISO) Technique Versus Traditional and Paraspinal Posterior Open Approaches for Treatment of Thoracolumbar Spine Fractures

Minimally Invasive Spine Osteosynthesis (MISO) Technique Versus Traditional and Paraspinal Posterior Open Approaches for Treatment of Thoracolumbar Spine Fractures

Clinical value of posterior transpedicular fixation combined with vertebroplasty in the treatment of thoracolumbar spine fractures in elderly patients

Objective To investigate the clinical value of posterior transpedicular fixation combined with vertebroplasty in the treatment of thoracolumbar spine fractures in elderly patients. Methods Forty-eight patients with thoracolumbar spine fractures were included in the study.All the patients received posterior transpedicular fixation combined with vertebroplasty.Posterior spinal Cobb's angles, vertebral compression rates, spinal stenosis, Frankel classification and VAS scores before and after operation were compared. Results The mean operative time was (125.9±58.3) min, the average intraoperative fluoroscopy time was (14.0±3.8) min, and the average intraoperative blood loss was (408.7±62.3) ml.There was no internal fixation loosening, fracture, wound infection, swelling and nonunion in 48 cases on average follow-up (19.1±3.6) months.2 cased experienced bone cement leakage but no neurological symptoms.After the treatment, Cobb 's angles changed significantly (F=168.51, P<0.05). Cobb’s angles at 1 months and 6 months after operation were significantly lower than that before the operation ( (2.8±0.8)°vs.(4.3±1.1)°vs.(24.1±6.8)°, P<0.05). Vertebral compression rates changed significantly (F=95.16, P<0.05). Vertebral compression rates at 1 months and 6 months after operation were significantly lower than the preoperative vertebral compression rate ( (10.1±3.7)% vs.(14.5±3.9)% vs.(40.2±8.8)%, F=74.62, 62.68, P<0.05). The spinal stenosis rates changed significantly (F=254.85, P<0.05), the spinal stenosis rates at 1 months and 6 months after operation were significantly lower than the preoperative one ( (7.2±2.4)% vs.(10.3±3.6)% vs.(43.2±5.4)%, F=48.83, 36.26, P<0.05). VAS scores changed significantly (F=56.84, P<0.05). VAS scores at 1 months and 6 months after operation were significantly lower than preoperative VAS score ( (3.5±1.7) vs.(2.6±1.5) vs.(6.8±2.8), F=10.88, 9.59, P<0.05). As paired rank test showed, the Frankel classification were significantly improved after operation (Z=5.64, P<0.05). Conclusion Posterior transpedicular fixation combined with vertebroplasty has a significant curative effect on the treatment of thoracolumbar spine fractures in elderly patients. Key words: Posterior transpedicular fixation; Vertebroplasty; Thoracolumbar spine fractures

Certain disputable issues in diagnosis and treatment of thoracolumbar spine fractures

Certain disputable issues in diagnosis and treatment of thoracolumbar spine fractures

How safe is minimally invasive pedicle screw placement for treatment of thoracolumbar spine fractures?

Prospective analysis of patients who underwent minimally invasive posterior instrumentation. The purpose of this study was to evaluate the safety of minimally invasive pedicle screw placement in patients with unstable thoracic and lumbar spine fractures using the conventional fluoroscopy technique. Although wound infection, haematoma, and new neurological deficit due to screw malplacement remain a common source of morbidity, estimates of their rates of occurrence remain relatively limited. 2052 percutaneous pedicle screws in 433 consecutive patients were evaluated. The accuracy of pedicle screw placement was based on evaluation of axial 3-mm slice computed tomography scans. Morbidity and mortality data were collected prospectively. A total of 2029 of 2052 screws (99%) had a good or excellent position. 5 screws (0.2%) showed a higher grade violation of the medial pedicle wall. Seven patients (1.8%) needed revision due to screw malposition (3 pat.), surgical site infection, postoperative haematoma, implant failure (2 pat.), and technical difficulties. Minimally invasive transpedicular instrumentation is an accurate, reliable, and safe procedure to treat thoracic and lumbar spine fractures.

Balloon kyphoplasty: errors and complications

Introduction. Percutaneous balloon kyphoplasty was developed for vertebral compression fractures minimally invasive treatment. Subsequently, this technique has been widely and successfully used for traumatic and tumor spine fractures treatment. However, the data complications during manipulation are insufficient in the literature.Goal. Estimate the frequency and nature of intraoperative and postoperative complications during balloon kyphoplasty.Materials and methods. We have studied the results of treatment 63 patients (a total 75 levels of compression), which percutaneous balloon kyphoplasty was performed. We present patients with traumatic and osteoporotic thoracolumbar fractures ages of 19 to 85 years. Women were 35, men were 28.Results and discussion. Neurological and infectious complications did not occur. In 3 cases (4%) was observed paravertebral bone cement leakage, in 1 case (1.3%) intradiscal and 1 case (1.3%) intravascular. The total percentage of complications is comparable with literature data for this operations type. Clinically significant manifestations of these incidents had not.Conclusions. Percutaneous balloon kyphoplasty — a safe method of minimally invasive treatment of thoracolumbar spine fractures. Careful planning and technically correct execution of its by trained staff allows us to reduce complications to a minimum.

Neuronavigated Percutaneous Treatment of Thoracolumbar Spine Fractures

Introduction Treatment goals of amielic thoracolumbar spine fractures are the stabilization of traumatized segment, possibly restoring the physiological spine curvature, and vertebral healing or fusion of the affected segment. Percutaneous minimally invasive techniques are becoming a viable option in the treatment of selected thoracolumbar fractures; intraoperative neuronavigation of biplanar fluoroscopy associated with preoperative CT scan allows precise pedicle insertion and reduces intraoperative X-ray exposure. Materials and Methods Over a period of 2 years, 43 patients with thoracolumbar fractures at our institution were elected for minimally invasive surgery using neuronavigated technique. All patients experienced one or two thoracolumbar fractures (varying from A3.1 to B2.3, according to the AO/Magerl classification) without neurological deficits. Pain profile was assessed by visual analog scale (VAS) and all radiological findings were evaluated with vertebral body index (VBI), vertebral body angle (VBA), and Cobb angle. Procedures used for treatment include kyphoplasty alone and short segment percutaneous pedicle screw fixation with or without vertebral body augmentation. All the procedures were performed under general anesthesia, but for collaborating patients who need kyphoplasty analgosedation was used. Clinical mean follow-up was 15 months (2–24 months) and has been assessed with VAS and the ability to return to their original lifestyle and/or occupation; radiographic postoperative evaluation consisted of X-ray for kyphoplasty patients and CT for those instrumented to determine the accuracy of screw placement. Results The mean surgical duration was 92 minutes (passing from 32 minutes for the fastest kyphoplasty to 170 minutes for the slowest fixation). There was no case of screw or needle malposition during kyphoplasty. Total radiation exposure was 54 seconds. Postoperatively, almost all the patients improved their symptoms and nobody needed reoperation because of postoperative complications, except for a case in which an initial screw pull-out was stopped with a second stage kyphoplasty. Conclusion Neuronavigation in minimally invasive spine surgery represents a viable solution for the treatment of amielic thoracolumbar fractures. Minimal invasive techniques have been shown to reduce blood loss, postoperative pain, and hospitalization; with the neuronavigated support, there is also a sensible reduction in X-ray exposure of patients and operative room operators.

Post-trauma scoliosis after conservative treatment of thoracolumbar spinal fracture in children and adolescents: results in 48 patients.

Authors examined a case series of patients younger than 18 years old who had sustained a traumatic thoracolumbar spine fracture to evaluate radiological and clinical findings of coronal spinal balance, after conservative treatment. From 1996 to 2014, a tricentric cohort of 48 patients with an average age of 12 years was radiographically reviewed at 50 months. Cobb angle of fractured vertebra and regional Cobb angle were measured both at baseline and follow-up. Analyses were done according to initial Risser grade, number of fractures and level of injury. There was a total of 11 scoliosis. In group with Risser grade 3 or above, with a single vertebral fracture and lumbar fracture, final regional Cobb angle was statistically higher than initial regional Cobb angle. The prevalence of scoliosis in our population is higher than those of idiopathic scoliosis; Risser grade 3 or above, lumbar fracture and a single fracture seem to account for more severe coronal deformation.

Comparative study of the clinical effect and safety of anterior surgical approach and posterior surgical approach in the treatment of thoracolumbar spinal fracture.

The clinical effect and safety of the anterior surgical approach and posterior surgical approach in the treatment of thoracolumbar spinal fracture was compared. Retrospective analyses of clinical data for 91 patients observed from March 2010 to September 2014 were made. The pre-operation and post-operation comparisons between two sets of Cobb’s angle, affected vertebra height, Frankel’s classification of spinal nerves, motion functions, and tactile functions showed statistically significant differences (P<0.05). After having the operation, the Cobb’s angle and affected vertebra height of the patient in the anterior approach group were both significantly higher than that of patients in the posterior approach group (P<0.05). The bone graft fusion rate of the patients in the anterior approach group 3 months after operation was higher than that of patients in the control group while the status of complications was worse than that of patients in the posterior approach group, both with a remarkable difference (P<0.05). Both the anterior surgical approach and posterior surgical approach have good clinical outcome for spinal fractures but they all have their respective adaption diseases. The key in the treatment of thoracolumbar spinal fractures lies in choosing proper operative approach.