Treatment Of Thoracolumbar Fractures Research Articles

Short Posterior Stabilization in Combination With Cement Augmentation for the Treatment of Thoracolumbar Fractures and the Effects of Implant Removal.

Study Design:Retrospective case series.Objective:Short posterior stabilization with vertebroplasty is one treatment option for thoracolumbar burst fractures (AO A3). Whether it avoids progression in segmental kyphosis, especially after implant removal, is unclear. In a retrospective case-control study, its stability and the effect on intervertebral discs with and without implant removal was studied.Methods:Fifty-nine consecutive patients were treated with bisegmental short posterior instrumentation and additional vertebroplasty of the fractured vertebra. Twenty-nine patients (male/female 17/12; age: 41.7 ± 15.4 years) underwent implant removal. Changes of segmental kyphosis and disc heights between both groups (with and without implant removal) were compared on lateral X-rays preoperative, postoperative, after 1 year and after implant removal. Risk factors for loss of reduction were analyzed.Results:Kyphosis increased up to 12 months after implant removal. The loss of bisegmental correction was 6.0 ± 4.2 (range 0° to 16°) 12 months after implant removal. Risk factors for loss of reduction are younger patient age, fractures of the thoracolumbar junction (Th12), and degree of traumatic kyphosis. Intervertebral discs traversed by the stabilization lose height and don’t recover within 1 year after implant removal. Without implant removal, disc height of the lower adjacent level is reduced after 24 months.Conclusions:Short posterior stabilization in combination with vertebroplasty is a treatment alternative for thoracic and lumbar AO A3 fractures. After implant removal kyphosis increases, predominantly in the segment above the augmented vertebra. Risk factors for loss of reduction include younger age, fractures of the thoracolumbar junction (T12), and higher fracture kyphosis.

Discussion on certain hot issues on treatment of thoracolumbar fractures

Discussion on certain hot issues on treatment of thoracolumbar fractures

Efficacy comparison of percutaneous pedicle instrumentation combined with vertebral fracture fixation or vertebral augmentation for treatment of osteoporotic thoracolumbar fractures in elderly patients

Objective To compare the outcomes of percutaneous pedicle instrumentation combined with vertebral augmentation or vertebra pedicle instrumentation for treatment of osteoporotic thoracolumbar fractures (OVCF) in elderly patients. Methods A retrospective case cohort study was conducted on 62 patients with OVCF manifesting non-neurological symptoms treated from January 2009 to January 2012. There were 22 males and 30 females, with a mean age of 61.3 years (range, 55 to 70 years). Fracture level was T11 in 8 patients, T12in 20, L1 in 22 and L2 in 12. Treatments included percutaneous pedicle instrumentation combined with vertebral fracture fixation in 36 patients (Group A) and percutaneous pedicle instrumentation combined with vertebral augmentation in 26 patients (Group B). Operation time, intraoperative blood loss, anterior vertebral body height, sagittal Cobb angle and visual analogue score (VAS) were compared between the two groups. Results All patients were followed up for average 46.5 months (range, 36 to 58 months). Operation time in Group A [(82.6±16.2)min] was shorter than that in Group B [(96.8±20.6) min] (P 0.05). At the final follow-up, the ratio of anterior vertebral height and Cobb angle in Group B [(87.8±2.5)%, (7.8±3.5)°] were better than these in Group A [(82.6±3.2)%, (9.1±1.8)°] (P 0.05). Bone cement leakage was seen in four patients in Group B. During the perioperative period, there were 3 patients with lung infection in Group A and 1 patient with lower limb deep vein thrombosis in Group B. No implant failure occurred in both groups. Conclusion Both procedures are effective in treating elderly patients with OVCF, but percutaneous pedicle instrumentation combined with vertebral augmentation is associated with better results in maintaining vertebral height and preventing kyphosis. Key words: Osteoporotic fractures; Spinal fractures; Fracture fixation, internal

Efficacy of one-stage posterior-anterior approach for treatment of severe thoracolumbar fractures

Objective To observe the outcomes of one-stage posterior short-level pedicle screw fixation combined with anterior fixation of severe thoracolumbar fractures. Methods A retrospective case series study was performed on 21 patients with severe thoracolumbar fractures stabilized by posterior short-level pedicle fixation combined with anterior internal fixation at one stage from January 2012 to December 2014. There were 16 males and 5 females, at age of 17 and 64 years [(38.7±11.4)years]. The involved segments included T11 in 2 patients, T12 in 5, L1 in 6 and L2 in 8. For AO fracture classification, type A fractures were seen in 4 patients, type B in 7 and type C in 10. Thoracolumbar injury classification and severity score (TLICS) was (8.12±0.87)points (range, 7-10 points). Frankel neurological performance scale was Grade B in 8 patients, Grade C in 11 and Grade D in 2. Operation time, blood loss, nerve function, kyphosis correction and complications were reported. Results Operation time was (234.5±57.3)min (range, 180-360 min), and blood loss was (387.4±124.4)ml (range, 260-950 ml). Time of follow-up was (19.8±3.5)months (range, 14-25 months). Nerve function of 18 patients was improved by at least one Frankel scale. Cobb angle was (4.1±5.3)° at postoperative 3 days and (4.0±4.9)°at the final follow-up, showing significant differences from that before operation [(-9.3±4.2)°] (P<0.05). While the difference of Cobb angle did not differ significantly at postoperative 3 days and at final follow-up. No cerebrospinal fluid leakage, vascular injury, incision infection or nerve function deterioration occurred. Conclusion One-stage posterior short-level pedicle screw fixation combined with anterior decompression and bone graft fixation is characterized by short operation time, few blood loss, good correction of traumatic kyphosis and good neurological recovery, indicating a good surgical choice for severe thoracolumbar fractures. Key words: Thoracic vertebrae; Lumbar vertebrae; Fracture fixation, internal

The clinical application of lateral extracavitary approach in the treatment of thoracolumbar burst fractures

Objective To explore the outcome of lateral extracavitary approach to anterior lateral decompression and bone fusion and internal fixation operation for thoracolumbar burst fracture with nerve injury. Methods The clinical data of 22 patients with thoracolumbar (T11-L2) burst fracture with nerve injury of lateral extracavitary approach to anterior lateral decompression and bone fusion and internal fixation operation were analyzed. The radiographic data of cobb angle, vertebral height compression percentage and spinal canal encroachment rate were compared. All data were collected pre-operation, post-operation and at last follow-up. According to clinical manifestations, recovery of neurological function before and after operation assessed by the American Spinal Injury Association (ASIA) classification and improvement rate of Japanese Orthopaedic Association (JOA) score from post-operation to last follow-up were compared. Results All 22 cases were followed up after operation for (18.0±7.2) months. The Cobb angle in pre-operative was (20.532±4.045)°, in post-operation days was (5.936±1.081)°, in last follow-up was (6.564±0.984)°. The difference was statistically significant before and after operation (t=14.822, P=0.000). Same difference at the last follow-up and preoperative comparison (t=16.134, P=0.000). There was no significant difference between the last follow-up and postoperative (t=-1.834, P=0.081). The percentage of vertebral height compression in pre-operative was (51.182±7.670)%, post-operation days was (91.773±2.308)%, in last follow-up was (90.545±4.284)%. At the post-operative, there was a significant difference compared with preoperative (t=-21.509, P=0.000). Between the last follow-up and preoperative aiso a significant difference (t=-18.990, P=0.000). No significant difference between the last follow-up and postoperative (t=1.528, P=0.141). The spinal canal encroachment rate in Preoperative was (34.818±5.142)%, post-operation days was (3.155±0.578)%, in last follow-up was (3.300±0.478)%. A significant difference between the postoperative and preoperative (t=29.136, P=0.000). In the same sense, the last follow-up compared with preoperative (t=28.304, P=0.000). To the contrary, no significant difference between the last follow-up and post-operative (t=-1.560, P=0.134). The ASIS score of patients there are 2 patients with complete injury, 12 patients received 1 levels of improved, and 8patients obtained 2 levels. The improvement rate of JOA score was improved in different degree expect 2 patients with complete injure, postoperative patients with excellent and good were 14 cases and 19 were followed up at the last follow-up. The excellent and good rate of post-operation was 86.363%, the excellent and good rate of the last follow-up was 63.645%, obviously improve between them. Conclusion The operation of lateral extracavitary approach to anterior lateral decompression and bone fusion and internal fixation can correct spinal kyphosis, restore and maintain vertebral height effectively, decompress the spinal canal completely and obtain satisfactory recovery in never function in the treatment of thoracolumbar burst fracture with nerve injury, which is an effective surgery. Key words: Lateral extracavitary approach; Ventrolateral decompression; Thoracolumbar; Brust fracture

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

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

Comparison of curative effect of unilateral and bilateral vertebral pedicle screw instrumentation for treatment of thoracolumbar burst fractures

Objective To compare the efficacy of unilateral and bilateral pedicle screw instrumentation for treatment of thoracolumbar burst fractures. Methods A retrospective case-control analysis was made on 50 patients with thoracolumbar burst fractures free from neurological deficit admitted between January 2008 and October 2013. There were 37 males and 13 females, aged from 24 to 51 years (mean, 36 years). Injuries were caused by high falls in 23 patients, traffic accidents in 18 and crashing accidents in 9. Distribution of the injured segment was T11 in 6 patients, T12 in 16, L1 in 20 and L2 in 8. Based on the surgical procedures, the patients were assigned to unilateral pedicle screw fixation group (n=35) and bilateral pedicle screw fixation group (n=15). Operation time, intraoperative blood loss and hospital length of stay were recorded. Visual analogue scale (VAS), Oswestry disability index (ODI), kyphotic angle and anterior vertebral height were evaluated before surgery, after surgery and at 1-year follow-up. Results No screw lessening, screw breakage or infection occurred at 1-year follow-up. Unilateral and lateral pedicle screw instrumentation groups revealed no significant differences in operation time [(81.4± 10.0)min vs. (83.3±13.6)min], intraoperative blood loss [(194.0±65.4)ml vs. (212.0±61.9)ml] and hospital length of stay [(10.3±1.3)d vs. (9.9±1.5)d] (P>0.05). After operation, VAS and ODI in unilateral pedicle screw instrumentation group (3 points, 73.9) showed no significance from these in lateral pedicle screw instrumentation group (2 points, 72.1) (P>0.05). VAS was within 1 point and ODI was within 20 at 1-year follow-up, showing no significant differences between the two groups (P>0.05). After operation, correction of kyphotic Cobb angle and restoration of anterior vertebral body height in unilateral pedicle screw instrumentation group (8°, 26.7%) showed no significance from these in lateral pedicle screw instrumentation group (11°, 32.1%) (P>0.05). Loss of local kyphotic Cobb angle and anterior vertebral body height in unilateral pedicle screw instrumentation group (2°, 3%) showed no significance from these in lateral pedicle screw instrumentation group (1°, 2%) at 1-year follow-up (P>0.05). Conclusion Both methods have comparable efficacy in restoring vertebral height and improving spinal kyphosis for treatment of thoracolumbar burst fractures. Key words: Spinal fractures; Fracture fixation, internal; Pedicle screws

Research progress of surgical treatment of thoracolumbar fractures

Research progress of surgical treatment of thoracolumbar fractures

Design and clinical application of a new extracorporeal reduction device for percutaneous pedicle screw fixation in treatment of thoracolumbar fractures

To design a new extracorporeal reduction device for percutaneous pedicle screw fixation of thoracolumbar fractures (short for "new reduction device"), and to evaluate its effectiveness. According to the mechanism of thoracolumbar fractures and biomechanics characteristic of reduction, a new reduction device was designed and used in a combination with long U-shaped hollow pedicle screw system. Between January 2014 and January 2016, 36 patients (group A) with single segment thoracolumbar fracture without neurological complications underwent percutaneous pedicle screw fixation, and the clinical data were compared with those of another 39 patients (group B) with thoracolumbar fracture underwent traditional open pedicle screw fixation. There was no significant difference in gender, age, cause of injury, classification of fractures, segments of fractures, injury to operation interval, height percentage of injury vertebrae, and kyphotic angle between 2 groups ( P>0.05). The 2 groups were compared in terms of operation time, length of incision, intraoperative blood loss, drainage volume, visual analogue scale (VAS) at postoperative 24 hours, fluoroscopy frequency, ambulation time, height percentage of injury vertebrae, kyphotic angle and correction. Group A was significantly better than group B in the operation time, length of incision, intraoperative blood loss, drainage volume, VAS score at postoperative 24 hours, and ambulation time ( P<0.05). However, fluoroscopy frequency of group B was significantly less than that of group A ( P<0.05). All patients were followed up 11.2 months on average (range, 7-15 months). There was no intraoperative and postoperative complications of iatrogenic nerve injury, infection, breakage of internal fixation. Mild pulling-out of pedicle screws occurred in 1 case of group A during operation. The kyphotic angle and height percentage of the fractured vertebral body were significantly improved at 3 days after operation when compared with preoperative ones ( P<0.05), but no significant difference was found between 2 groups at 3 days after operation ( P>0.05). Minimally invasive extracorporeal reduction device for percutaneous pedicle screw fixation is an effective and safe treatment of thoracic vertebrae and lumbar vertebrae fractures, because of little trauma, less bleeding, and quicker recovery.

Comparison of efficacy of KumaFix posterior spinal screw / rod system and posterior U-shape screw / rod system for treatment of thoracolumbar vertebral body fractures

Objective To compare the efficacy of KumaFix posterior spinal screw/rod system (KumaFix system) and posterior U-shape screw/rod system for treatment of thoracolumbar vertebral body fractures. Methods A total of 131 patients with thoracolumbar vertebral body fractures treated from January 20ll to July 2011 were prospectively analyzed. All patients showed thoracolumbar injury classification and severity score (TLICS) more than 5 points and spinal load-sharing classification (LSC) score of 4-6. The patients were assigned to two groups according to the coin toss method: group A (n=72, treated with reduction and fixation with KumaFix system in combination with transpedicular bone grafting of fractured vertebrae) and group B (n=59, submitted to posterior reduction and fixation with U-shaped screw/rod system in combination with transpedicular bone grafting of fractured vertebrae). In group A, there were 41 male and 31 female patients at age of (41.2±4.9)years (range, 20-53 years). In group B, there were 33 male and 26 female patients at age of(40.6±4.5)years (range, 21-51 years). The two groups were analyzed and compared in aspects of operation time, blood loss, anterior vertebral height ratio, middle vertebral height ratio, posterior vertebral height ratio, kyphosis angle, Oswestry disability index (ODI) and incidence of adjacent segment degeneration. Results All patients were followed up for mean 5.3 years (range, 5.1-5.8 years). Operation time and blood loss were (72.5±21.8)min and (320.6±90.0)ml in group A, less than (104.3±20.7)min and (421.0±84.5)ml in group B ( P<0.05). Both groups achieved obvious improvements in anterior vertebral height ratio, middle vertebral height ratio, posterior vertebral height ratio and kyphosis angle after operation(P<0.05). At the last follow-up, the middle vertebral height ratio was (92.0±2.8)% in group A, better than (84.1±5.1)% in group B (P<0.05). Both groups showed improvement in ODI after operation(P<0.05). At the last follow-up, ODI and incidence of adjacent segment degeneration were 11.9±7.1 and 0 in group A, decreased compared to 20.9±6.7 and 12% in group B (P<0.05). Conclusions For thoracolumbar vertebral body fractures, the KumaFix system has better reduction effect than U-shape screw/rod system. Meanwhile, the KumaFix system can avoid negative effect. Key words: Spinal fractures; Thoracic vertebrae; Lumbar vertebrae; KumaFix system

Comparison of posterior 1/3 corpectomy reconstruction versus subtotal corpectomy reconstruction for thoracolumbar burst fractures

Objective To compare posterior 1/3 corpectomy versus subtotal corpectomy in recon-struction of thoracolumbar burst fractures. Methods A prospective study was conducted in the patients who were admitted into our department for treatment of thoracolumbar burst fracture between January 2010 and December 2012. Eligible patients were randomized into an experimental group (28 cases) and a control group (34 cases). The experimental group accepted posterior 1/3 corpectomy followed by reconstruction of the in-jured vertebrae using our self-designed gate-like cage while the control group subtotal corpectomy followed by cylinder mesh cage reconstruction. Surgery time, intraoperative blood loss, neurological function improvement according to American Spinal Injury Association (ASIA) grading, visual analogue scale (VAS) score, verte-bral height, kyphosis angle and fusion time were recorded before surgery, after surgery and at the final fol-low-up in both groups. Vertebral height loss was measured to evaluate endplate subsidence at the final fol-low-up. Results All the patients were available for 24-month follow-up. All the incisions healed by one intention, and no incision infection, aggravation of neural impairment symptoms or implant breakage oc-curred. The experimental group achieved significantly less surgery time and blood loss, significantly better fusion rates at 3, 6, and 9 months after surgery, and significantly lower VAS score at the final follow-up than the control group(P 0.05), but the VAS score and vertebral height loss were significantly lower in the experimental group than in the control group(P 0.05). Conclusions Posterior 1/3 corpectomy followed by gate-like cage reconstruction is an innovative technique for thoracolumbar fractures which can promote early fusion and reduce endplate subsidence. It is as fine as traditional subtotal corpectomy plus cylinder cage reconstruction in neurological function improvement and kyphosis correction. Key words: Thoracic vertebrae; Lumber vertebrae; Fracture fixation, internal; Posterior 1/3 corpectomy and reconstruction

Intermediate screws in short segmental pedicular fixation for thoracolumbar fractures. Retrospective study Of 4 and 6-screw constructs

Introduction Short segment pedicle screw fixation is the most common treatment for thoracolumbar fractures. However, it may not be adequate to achieve and maintain reduction of the fracture and is associated with a high rate of failure. Additional procedures have been offered as alternative solutions to prevent this failure. Long segmental instrumentation or placements of screws at fracture site are some alternatives. Correction of sagittal deformity is important for the maintenance of fracture reduction and may have an effect on functional outcome. Intraoperative correction of sagittal deformity and fracture reduction can be managed easily through placement of screws at the fracture level. Objectives The purpose of this retrospective study was to evaluate the efficacy of screw placement at the fracture level in correction of deformity, maintenance of correction and preventing the failure of fixation in thoracolumbar fractures. Methods Retrospective study of patients with thoracolumbar fractures treated with 4 or 6-screw construct. Preoperative, postoperative and follow-up were evaluated. To evaluate the efficacy of fracture level screw fixation anterior vertebral height compression (%ABC), local kyphosis (KA) and load-sharing classification were compared. %ABC was calculated by using the formula adopted by Mumford et al. Local kyphosis was measured according to Cobb's method. Student t test was used for statistical analysis of variables. A p-value < 0.05 was considered statistically significant. Results The load-sharing classification was similar between the groups. The preoperative KA was statistically similar between groups (P = 0.552). The percentage of KA correction was lowest in the 4-screw construct group (P = 0.034). During follow-up, KA correction was more maintained in 6-screw construct group (P = 0.045). The average preoperative %ABC was similar in groups (P = 0.855). %ABC was more maintained in 6-screw construct group during follow-up. Conclusion Segmental fixation of fractures with screws at the level of fracture offers improved biomechanical stability and provides for additional fixation points that may aid in reduction. The 6-screw construct yields excellent results with a very low rate of failure.

Percutaneous versus traditional and paraspinal posterior open approaches for treatment of thoracolumbar fractures without neurologic deficit: a meta-analysis.

This study evaluated differences in outcome variables between percutaneous, traditional, and paraspinal posterior open approaches for traumatic thoracolumbar fractures without neurologic deficit. A systematic review of PubMed, Cochrane, and Embase was performed. In this meta-analysis, we conducted online searches of PubMed, Cochrane, Embase using the search terms "thoracolumbar fractures", "lumbar fractures", ''percutaneous'', "minimally invasive", ''open", "traditional", "posterior", "conventional", "pedicle screw", "sextant", and "clinical trial". The analysis was performed on individual patient data from all the studies that met the selection criteria. Clinical outcomes were expressed as risk difference for dichotomous outcomes and mean difference for continuous outcomes with 95% confidence interval. Heterogeneity was assessed using the χ 2 test and I 2 statistics. There were 4 randomized controlled trials and 14 observational articles included in this analysis. Percutaneous approach was associated with better ODI score, less Cobb angle correction, less Cobb angle correction loss, less postoperative VBA correction, and lower infection rate compared with open approach. Percutaneous approach was also associated with shorter operative duration, longer intraoperative fluoroscopy, less postoperative VAS, and postoperative VBH% in comparison with traditional open approach. No significant difference was found in Cobb angle correction, postoperative VBA, VBA correction loss, Postoperative VBH%, VBH correction loss, and pedicle screw misplacement between percutaneous approach and open approach. There was no significant difference in operative duration, intraoperative fluoroscopy, postoperative VAS, and postoperative VBH% between percutaneous approach and paraspianl approach. The functional and the radiological outcome of percutaneous approach would be better than open approach in the long term. Although trans-muscular spatium approach belonged to open fixation methods, it was strictly defined as less invasive approach, which provided less injury to the paraspinal muscles and better reposition effect.

Minimally Invasive Posterior Decompression Combined With Percutaneous Pedicle Screw Fixation for the Treatment of Thoracolumbar Fractures With Neurological Deficits: A Prospective Randomized Study Versus Traditional Open Posterior Surgery.

Prospective randomized cohort study. To compare the surgical results of minimally invasive posterior decompression combined with percutaneous pedicle screws fixation (minimally invasive surgery [MIS]) and posterior open surgery (OS) for the treatment of thoracolumbar fracture with neurological deficits. Thoracolumbar fracture with neurological deficits usually undergoes surgical intervention. OS can achieve satisfied results, but the main disadvantage is approach-related complications. No study, however, focused on the treatment of this disease by MIS through posterior approach. Sixty consecutive cases of thoracolumbar fractures with neurological deficits were randomized into MIS group and OS group. Incision length, blood loss, postoperative drainage volume, hospitalization days, blood transfusion rate, analgesic use rate, and x-ray exposure time were used to evaluate the perioperative information and Visual Analog Scale (VAS), Japanese Orthopedics Association (JOA) score, and American Spinal Injury Association grade for patients' symptom. For radiological assessment, sagittal Cobb angle, percentage of vertebral height, and vertebral wedging angle were measured. Fifty-nine of sixty patients were followed-up for at least 12 months. MIS group was superior in perioperative information (P < 0.05), except in the operative time (P = 0.165) and x-ray time (P = 0.000). The operative time seemed longer in MIS group, but no significant difference was found. The x-ray time was significantly higher in MIS group. The mean Visual Analog Scale and Japanese Orthopedics Association scores of the final follow-up in MIS group were better than that in OS group (P < 0.05). Patients in both group achieved a similar neurological recovery according to American Spinal Injury Association grade (P = 0.760). A broken screw was found in one patient in MIS group and a broken rod in one patient in OS group. MIS group has achieved the similar effect of OS group and it can minimize the approach-related complication. It also faced with some shortages, such as larger radiation dose and longer learning curve. 2.

Indirect spinal canal decompression in adult patients with thoracolumbar burst fracture

Today pedicle screw instrumentation system and short-segment fixation have been commonly used for treatment of thoracolumbar burst fractures because pedicle screw fixation allows 3-column fixation and facilitates simultaneous application of axial compression or distraction and rotational forces. Indirect decompres-sion and direct decompression are the two ways to deal with canal compromise when pedicle screw instrumentation is used. Indirect decompression is achieved to correct the canal compromise due to ligamentotaxis and hyperex-tension. The present study reviews the current research on indirect spinal canal decompression in adult patients with thoracolumbar burst fracture. Key words: Thoracic vertebrae; Lumber vertebrae; Fractures, bone; Adult; Decompression

Pedicle screw fixation combined with intermediate screw at the fracture level for treatment of thoracolumbar fractures: A meta-analysis.

Background:Use of a pedicle screw at the level of fracture, also known as an intermediate screw, has been shown to improve clinical results in managing thoracolumbar(TL) fractures, but there is a paucity of powerful evidence to support the claim. The aim of this study was to compare outcomes between pedicle screw fixation combined with intermediate screw at the fracture level and conventional pedicle screw fixation (one level above and one level below the fracture level) for thoracolumbar (TL) fractures.Methods:A meta-analysis of cohort studies was conducted between pedicle screw fixation combined with intermediate screw at the fracture level (combined screw group) and conventional pedicle screw fixation (conventional group) for the treatment of TL fractures from their inception to December 2015. An extensive search of studies was performed in PubMed, Medline, Embase, and the Cochrane library. The following outcome measures were extracted: visual analogue scale (VAS), operation time and intraoperative blood loss, Cobb angle and anterior vertebral height (AVH), and complications. Data analysis was conducted with RevMan 5.3.5.Results:From 10 relevant studies identified, 283 patients undergoing pedicle screw fixation combined with intermediate screw at the fracture level were compared with 285 conventional pedicle screw procedures. The pooled analysis showed that there was statistically significant difference in terms of postoperative Cobb angle (95% confidence interval (CI), −3.00, −0.75; P = 0.001) and AVH (95% CI, 0.04, 12.23; P = 0.05), correction loss (Cobb angle: P < 0.0001; AVH: P < 0.0001) and implant failure rate (95% CI, 0.06, 0.62; P = 0.006), and blood loss (W 95% CI, 2.22, 23.60; P = 0.02) between 2 groups. But in terms of other complications, there were no differences between 2 groups (95% CI, 0.23, 2.04; P = 0.50). No difference was found in operation time (95% CI, −5.36, 14.67; P = 0.36) and VAS scores (95% CI, −0.44, 0.01; P = 0.06).Conclusions:The combined screw fixation technique was associated with better reduction of the fractured vertebrae, less correction loss in the follow-up, and lower implant failure rate. Given the lack of robust clinical evidence, these findings warrant verification in large prospective registries and randomized trials with long-term follow-up.

Treatment of Thoracolumbar Fractures by Percutaneous Pedicle Screw Fixation Technique Combined with Three-step Reduction.

Purpose To evaluate the efficacy of percutaneous pedicle screw fixation technique combined with three-step reduction in the treatment of thoracolumbar fracture. Methods This is a retrospective study, based on medical records from the archives of the Fifth People's Hospital of Fudan University, from January 2012 to January 2015. The 49 patients with thoracolumbar fracture were treated with percutaneous pedicle screw fixation technique combined with three-step reduction. The treatment plan was determined by the AO classification and the Thoracolumbar Injury Classification and Severity classification. Baseline data included patient demographics, mechanism of injuries, fracture level, and neurologic status. Kyphotic angle correction and vertebral body height (VBH) restoration were used to assess radiologic outcome. Blood loss, operative complications, hospital stay, and pain score on the visual analog scale (VAS) were used to assess safety and clinical outcomes. Result A total of 49 patients with 51 thoracolumbar burst fractures were treated with percutaneous pedicle screw fixation technique combined with three-step reduction. There was significant improvement in kyphotic angle correction (p < 0.05) and restoration of anterior vertebral height (p < 0.05) after each reduction procedure. These improvements remained statistically significant at the latest follow-up for restoration of anterior VBH (p < 0.05) and kyphotic angle correction (p < 0.05). The preoperative VAS score was 8.2 ± 1.3, and the postoperative VAS score (3 days after the operation) was 3.5 ± 0.7. Conclusion Percutaneous pedicle screw internal fixation technique combined with three-step reduction is a relatively safe and effective technique for treating selected thoracolumbar burst fractures, and it yields satisfactory results.

Research progress in kyphoplasty and vertebroplasty for treatment of thoracolumbar osteoporotic compression fracture

Research progress in kyphoplasty and vertebroplasty for treatment of thoracolumbar osteoporotic compression fracture

EFFECTIVENESS EVALUATION OF PERCUTANEOUS MONOAXIAL SCREW COMBINED WITH INJURED VERTEBRAE POLYAXIAL PEDICAL SCREW FIXATION FOR TREATMENT OF THORACOLUMBAR FRACTURES

To explore the effectiveness percutaneous monoaxial screw combined with polyaxial pedical screw for treating thoracolumbar fracture by comparing with simple polyaxial pedicle screw fixation. Between January 2012 and June 2014, 56 cases of thoracolumbar fractures were treated by percutaneous pedicle screw fixation, the clinical data were retrospectively analyzed. Of 56 cases, 30 were treated with percutaneous monoaxial screw combined with percutaneous polyaxial pedical screw fixation (group A), 26 patients with only percutaneous polyaxial pedicle screw fixation (group B). There was no significant difference in gender, age, body mass index, injury causes, time from injury to admission, involved segments, fracture type, and preoperative American Spinal Injury Association (ASIA) stage, visual analogue scale (VAS), the anterior height of the injured vertebrae, Cobb angle, and sagittal index between 2 groups (P>0.05). The operation time, intraoperative blood loss, and complications were recorded and compared between the 2 groups. The VAS score was used to evaluate the improvement of the pain. The sagittal kyphosis Cobb angle, the anterior height of the injured vertebrae, sagittal index, and the average correction (difference between 3 days after oeration and preoperation) and loss degrees (difference between last follow-up and 3 days after operation) were measured on the X-ray films at preoperation, 3 days after operation, and last follow-up. Incision healing at stage I was obtained, no related complications occurred. The operation time and intraoperative blood loss showed no significant difference between 2 groups (P>0.05). The patients were followed up 20-42 months (mean, 32 months) in group A and 21-44 months (mean, 30 months) in group B. VAS score of group A was significantly lower than that of group B at 3 days after operation (t=-2.277, P=0.027), but no significant difference was found at last follow-up (t=-0.289, P=0.774). X-ray examination showed good position of internal fixation, with no broken nails or exit of nail. There were significant differences in the anterior height of the injured vertebrae, Cobb angle, and sagittal index between at preoperation and at 3 days and last follow-up, and between at 3 days and last follow-up in 2 groups (P<0.05). The anterior height of the injured vertebrae, Cobb angle, and sagittal index of group A were significantly better than those of group B at 3 days and last follow-up (P<0.05), and correction degree were significantly higher than those of group B (P<0.05), but loss degree was not significant between 2 groups (P>0.05). Percutaneous monoaxial screw combined with polyaxial pedicle screw fixation is better than simply polyaxial pedicle screw in effects of treating thoracolumbar fracture under the premise of strictly holding indications.

Modified Pedicle Subtraction Osteotomy as a Salvage Method for Failed Short-Segment Pedicle Instrumentation in the Treatment of Thoracolumbar Fracture.

Retrospective study. Short-segment pedicle instrumentation (SSPI) is widely used to treat thoracolumbar junction fracture. Implant failure is the most common complication of SSPI and often necessitates revision surgery. The stand-alone anterior technique for failed SSPI provides excellent decompression and anterior column reconstruction, but it is incapable of restoring normal stability. High rate of complications is solely attributable to the anterior approach. Thus, the reconstruction of the anterior column with posterior compression instrumentation is the strategy of choice. In this study, we use a modified pedicle subtraction osteotomy (PSO) technique through a single posterior approach as the salvage method for the failed SSPI. Thirteen patients with failed SSPI after thoracolumbar fracture were included and followed up at regular intervals. Revision indications include intractable pain, deteriorating neurological deficits, and progressive deformity. The modified PSO was performed. After osteotomy, the anterior cortex was thinned and the anterior longitudinal ligament was also preserved to maintain stability during correction. Autograft was inserted into the osteotomy gap to increase stability and fusion rate. The correction had been achieved with closure. We evaluated the patients' clinical symptoms, segmental kyphosis correction, bony fusion time, and complications. Segmental kyphosis correction was from preoperative average 20.9 degrees (range, 9.5-38.5 degrees) to 3.0 degrees (range, 1-5.5 degrees) immediately after operation and 6.1 degrees (range, 3-8 degrees at the last follow-up). Bony fusion was confirmed on radiographs in all patients at an average of 9.9 months (range, 7.5-12 mo) after revision surgery. There was no implant failure in any of the 13 patients. Average preoperative visual analog scale was 6.5 (range, 5-9) and reduced to 3.7 (range, 2-5) at the last follow-up. There was also a significant decrease in mean preoperative Oswestry Disability Index from 55.2 (range, 38-76) to 32.8 (range, 16-56). No patients suffered any neurological deterioration related to revision surgery. Complications were encountered in 6 patients (46.1%), including 4 with cerebrospinal fluid leak and 2 with superficial wound infection. All these complications were managed conservatively and none of them underwent reoperation. We conclude that modified PSO possesses the advantages of excellent kyphosis correction, a safe and reliable salvage alternative for the revision of SSPI failure.