Treatment Of Thoracolumbar Vertebral Fractures Research Articles

Should the level of the posterior instrumentation combined with the intermediate screw be a short segment or a long segment in thoracolumbar fractures with fusion to the fractured segment?

It was aimed to compare the results of long segment posterior instrumentation with intermediate pedicular screw + fusion at the level of the fractured segment including one vertebra above and one below the fractured vertebra (LSPI) and short segment posterior instrumentation with intermediate pedicular screw + fusion at the level of the fractured segment including one vertebra above and one below the fractured vertebra (SSPI) in the surgical treatment of thoracolumbar vertebral fractures. Ninety patients with thoracolumbar vertebral (T11-L2) fractures operated between March 2015 and February 2022 were included in this retrospective study. The patients were divided into two groups as those who underwent LSPI (n, 54; age, 40.3) and those who underwent SSPI (n, 36; age, 39.7). Radiological evaluations like vertebral compression angle (VCA), vertebral corpus heights (VCH), intraoperative parameters, and complications were compared between the groups. Correction in early postoperative VCA was statistically significantly better in LSPI (p = 0.003). At 1-year follow-up, postoperative VCA correction was significantly more successful in LSPI (p = 0.001). There was no difference between the two groups in terms of correction loss in VCA measured at 1-year follow-up. There was no statistically significant difference between the two groups in terms of postoperative VCH, VCH at 1-year follow-up, and correction loss in VCH. LSPI provides better postoperative kyphosis correction of the fractured vertebra than SSPI. Regarding the segment level of posterior instrumentation, there was no difference between the two groups in terms of the loss of achieved correction of VCA, ABH, and PBH at 1-year follow-up. Operating a thoracolumbar fracture with LSPI will lengthen the operation and increase the number of intraoperative fluoroscopies compared to SSPI.

The effect of the size of pedicle screw on the long-term radiological and clinical results of short-segment posterior instrumentation in the management of thoracolumbar vertebral fractures.

It was aimed at evaluating the effect of the size of the pedicle screw placed on the fractured vertebra on the long-term radiological and clinical results of short-segment posterior instrumentation applied in the surgical treatment of thoracolumbar vertebral fractures. This retrospective study included 36 patients who underwent short-segment posterior instrumentation surgery for a single-level thoracolumbar (T11-L2) fracture between January 2015 and March 2021. The patients included in the study were divided into 2 groups according to the size of the pedicle screw placed in the fractured vertebra (group A: intermediate screw 4.5 mm, ≤35 mm+less than 50% of the vertebral corpus length, m/f: 13/4, n: 17, age: 36.5; group B: intermediate screw 5.5 mm, ≥40 mm+more than 70% of the vertebral corpus length, m/f: 11/8, n: 19, age: 42.6). All patients were periodically evaluated clinically and radiologically. Vertebral compression angle (VCA), anterior and posterior vertebral body height (ABH-PBH), intraoperative parameters (instrumentation time and intraoperative fluoroscopy number), and complications were compared between the 2 groups. Both groups were comparable with respect to age, sex, level of injury, AO classification, mechanism of injury, and American Spinal Cord Injury Association impairment scale. Restoration of VCA and vertebral corpus heights was achieved sufficiently in both groups after operation (P < .0001). There was no significant difference between the 2 groups in terms of early postoperative VCA, VCA measured at final follow-up, or loss of correction in VCA. At the last follow-up, PBH was statistically significantly better preserved in group B (P=.0424). There was no difference between the 2 groups in terms of operation time and the number of intraoperative fluoroscopies. Implant failure was observed in 1 patient in group A. This study has revealed that using a long, thick pedicle screw placed in the fractured vertebra can better preserve the PBH at the final follow-up. No correlation was found between the size of the intermediate screw and the preservation of the correction in the postoperative vertebral heights and VCA during the follow-up. Level III, Therapeutic Study.

Effectiveness of sagittal top compression reduction technique in treatment of thoracolumbar vertebral fractures

To investigate the effectiveness of sagittal top compression reduction technique in the treatment of thoracolumbar vertebral fractures. A retrospective analysis was conducted on the clinical data of 59 patients with thoracolumbar vertebral fractures who met the selection criteria and were admitted between November 2018 and January 2022. Among them, 34 patients were treated with sagittal top compression reduction technique (top pressure group), and 25 patients were treated with traditional reduction technique (traditional group). There was no significant difference in baseline data between the two groups ( P>0.05), including gender, age, fracture segment, cause of injury, AO classification of thoracolumbar vertebral fractures, thoracolumbar injury classification and severity (TLICS) score, American Spinal Injury Association (ASIA) grading, surgical approach, preoperative vertebral body index, height ratio of the anterior margin of injured vertebra, injured vertebra angle, segmental kyphosis angle, visual analogue scale (VAS) score, and Oswestry disability index (ODI). The operation time, intraoperative blood loss, and incidence of complications between the two groups were recorded and compared. After operation, VAS score and ODI were used to evaluate effectiveness, and X-ray and CT examinations were performed to measure imaging indicators such as vertebral body index, height ratio of the anterior margin of injured vertebra, injured vertebra angle, and segmental kyphosis angle. There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). No complication such as dural sac, nerve root, or vascular injury was found during operation, and all incisions healed by first intention. Patients in both groups were followed up 6-48 months, with an average of 20.6 months. No loosening, breakage, or failure of internal fixation occurred during follow-up. The imaging indicators, VAS score, and ODI of the two groups significantly improved at 1 week and last follow-up when compared to preoperative ones ( P<0.05). At last follow-up, the VAS score and ODI further significantly improved when compared to 1 week after operation ( P<0.05). At 1 week after operation and last follow-up, the vertebral body index, segmental kyphosis angle, injured vertebra angle, and ODI in the top pressure group were significantly better than those in the traditional group ( P<0.05). There was no significant difference in VAS score and height ratio of the anterior margin of injured vertebra between the two groups at 1 week after operation ( P>0.05), but the two indicators in the top pressure group were significantly better than those in the traditional group at last follow-up ( P<0.05). The treatment of thoracolumbar vertebral fractures with sagittal top compression reduction technique can significantly improve the quality of vertebral reduction, and is superior to traditional reduction techniques in relieving pain and improving spinal function.

Treatment of Thoracolumbar Vertebral Fractures through Paraspinal Muscle Space Approach

Treatment of Thoracolumbar Vertebral Fractures through Paraspinal Muscle Space Approach

Effect of percutaneous minimally invasive pedicle screw internal fixation in the treatment of thoracolumbar vertebral fractures and its impact on quality of life.

ABSTRACTObjectives:To investigate and analyze the effect of percutaneous minimally invasive pedicle screw internal fixation in the treatment of thoracolumbar vertebral fractures and its impact on quality of life.Methods:Fifty patients with thoracolumbar vertebral fracture admitted to our hospital from January 2015 to December 2018 were selected and divided into two groups according to different treatment regimens. The observation group was treated with minimally invasive percutaneous pedicle screw internal fixation, while the control group was treated with traditional posterior approach open pedicle screw internal fixation. The surgery time, incision length, intraoperative blood loss, postoperative drainage, hospitalization time, ambulation time, fracture healing time and postoperative VAS scores were compared between the two groups. In addition, the cobb angle, the sagittal plane index, and the anterior vertebral height were compared between the two groups before and after surgery, as were the Oswestry Disability Index (ODI) at 1d, 3 months, and 6 months postoperatively.Results:The surgery time, incision length, postoperative pain level, postoperative drainage and intraoperative blood loss of the observation group were less than those of the control group (P<0.05). The postoperative Cobb angle of the two groups decreased, the sagittal plane index as well as the anterior vertebral height increased (P<0.05). The Oswestry index of the observation group was better than that of the control group at one day and three months postoperatively, with a statistical significance between the two groups (P<0.05). The complication rate of the observation group was significantly lower than that of the control group (P<0.05).Conclusion:Percutaneous minimally invasive pedicle screw internal fixation is safer than the traditional open pedicle screw internal fixation, and it is more worthy of clinical promotion.

Percutaneous curved vertebroplasty in the treatment of thoracolumbar osteoporotic vertebral compression fractures: a prospective study

Objective To investigate the clinical effect of percutaneous curved vertebroplasty in the treatment of thoracolum-bar osteoporotic vertebral compression fractures (OVCFs). Methods All of 85 patients with single thoracolumbar vertebral OVCFs who met the admission criteria from January 2017 to July 2018 were divided into three groups according to the random dig-its table method. They were treated with percutaneous curved vertebroplasty, routine unipedicular PVP and routine bipedicular PVP respectively. There were 25 patients in the percutaneous curved vertebroplasty group, 6 males and 19 females; aged 56-80 years, with an average age of 70.6±9.7 years. Fracture vertebral body distribution: T10 2 cases, T11 4 cases, T12 3 cases, L1 9 cases, L2 3 cases, L3 1 case, L4 1 case and L5 2 cases. There were 32 patients in the routine unipedicular PVP group, 6 males and 26 fe-males; aged 58-75 years, with an average age of 69.5±9.3 years. Fracture vertebral body distribution: T10 2 cases, T11 4 cases, T12 5 cases, L1 11 cases, L2 6 cases, L3 1 case, L4 1 case and L5 2 cases. There were 28 patients in the routine bipedicular PVP group, 5 males and 23 females; aged 59-81 years, with an average age of 69.8±8.8 years. Fracture vertebral body distribution: T10 2 cases, T11 4 cases, T12 4 cases, L1 10 cases, L2 4 cases, L3 1 case, L4 1 case and L5 2 cases. The operation time, injected cement volume, in-traoperative blood loss were recorded and analyzed. Preoperative, postoperative 1 week and 3 months visual analogue scale scores and oswestry disability index were adopted to value the clinical improvements. Preoperative, postoperative 1 week and 3 months relative vertebral height and kyphosis correction, and the cement leakage rate were measured and analyzed. Results There was no significant difference in the data of gender, age, VAS scores, ODI and distribution of fracture vertebrae among the three groups (P>0.05), and the baseline data was comparable. The average VAS score in the percutaneous curved vertebroplasty group was 2.3±0.5 at 1 week after surgery, that of the routine unipedicular PVP group was 2.4±0.4 and that of the routine bipe-dicular PVP group was 2.4±0.4; the average ODI in the percutaneous curved vertebroplasty group was 19.8%±3.9%, that of the routine unipedicular PVP group was 20.0%±4.1% and that of the routine bipedicular PVP group was 19.9%±3.8%; they were lower than the preoperative data, which were statistically significant (P 0.05). Operation time 39.10±2.00 min vs 38.70±1.70 min, injected cement volume 3.60±0.11 ml vs 3.50±0.13 ml and blood loss 5.10±0.30 ml vs 5.00±0.40 ml of the percutaneous curved vertebroplasty group and the routine unipedicular PVP group were less than those of the routine bipedicular PVP group, which were statistically significant (P<0.05). Conclution Percutaneous curved vertebroplasty could achieve satisfactory clinical outcomes for OVCFs, with advantages of less operation time, less blood loss, limited X-ray expo-sure, less injected cement volume, and more balanced augmentation for stabilization of the affected vertebrae and total verte-bral column. Key words: Thoracic vertebrae; Lumbar vertebrae; Osteoporosis; Spinal fractures; Vertebroplasty

Some controversial issues on surgical strategies for thoracolumbar fractures

Thoracolumbar fractures are common spinal injuries and have complicated pathological mechanism. Different types of thoracolumbar fracture have different treatment principles and methods. At the same time, many clinical treatment methods have their own indications. With the improvement of the concept of spinal surgery, the treatment of thoracolumbar vertebral fracture is also improving, and controversy over the optimal treatment strategy has never ceased, such as the surgical approach, the minimally invasive surgical technology, the selection of surgical methods for post-traumatic thoracolumbar kyphosis and the treatment of special thoracolumbar fracture types. The author summarizes the literatures on thoracolumbar injuries published in this issue so as to provide better references for clinical treatment of thoracolumbar fractures. Key words: Spinal fractures; Thoracic vertebrae; Lumbar vertebrae; Surgical procedures, operative

Is cast an option in the treatment of thoracolumbar vertebral fractures?

Background:Thoracolumbar vertebral fractures are common in high-energy trauma and often are associated to other concomitant injuries. Currently, brace and Closed Reduction and Casting (CRC) are the two conservative treatments proposed by literature. Despite CRC was widely used in the past, today brace is preferred. The aim of our study is to evaluate clinical and radiographic outcomes of thoracolumbar type A fractures, not associated with other injuries, treated with CRC.Materials and Methods:We retrospectively evaluated all patients treated from 2008 to 2015, with a mean age of 26.69 years (range 15–45). All patients were affected by AO type A fracture: 26 type A1, 17 type A2, and 21 type A3. All patients were evaluated by X-ray, computed tomography, and magnetic resonance imaging. Radiological evaluations included vertebral kyphosis (VK), segmental kyphosis (SK), regional kyphosis (RK) angle, and vertebral ratio (VR) measures. Patients were clinically assessed through visual analog scale, Oswestry Disability Index, Roland–Morris Disability Questionnaire, and Short Form 36 Health Survey.Results:Seventy-four patients (41 males and 33 females) were included in the study. At follow-up (mean 28.48 months ± 5.16), we found significant improvements in VK (P = 0.000013), SK (P = 0.000455), and RK (P = 0.000016). No significant differences were observed in VR (P = 0.26). Good clinical results were reported in patients in all scores and 90.7% of patients returned to work.Conclusions:Closed reduction and casting is still a reliable treatment option in selected thoracolumbar fractures without spinal cord involvement. A correct fracture evaluation, patient compliance, and motivation are essentials.Level of evidence:IV.

P94 - Kyphoplasty vs Orthosis for Treatment of Thoracolumbar Vertebral Fractures in the Workers' Compensation Population

BACKGROUND CONTEXT: Kyphoplasty, a minimally invasive vertebral augmentation procedure for fracture reduction and stabilization, has been used to minimize pain from vertebral compression fractures (VCFs), while also restoring vertebral height and local spinal lordosis. Although several studies have suggested the efficacy of kyphoplasty for the treatment of painful VCFs, kyphoplasty remains a controversial treatment modality for VCFs. Interestingly, no studies have analyzed kyphoplasty in the clinically distinct workers' compensation (WC) population.

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

Clinical efficacy of percutaneous kyphoplasty in management of osteoporotic thoracolumbar vertebral compression fracture in the elderly

Objective To evaluate the clinical efficacy of percutaneous kyphoplasty (PKP) in surgical treatment of osteoporotic thoracolumbar vertebral compression fracture in the elderly. Methods From March 2007 to February 2013, 210 cases (100 males and 110 females; 55-91 years of age, mean 72.5 years) of osteoporotic vertebral compression fracture were treated with PKP. Single-segment fracture was observed in 180 cases, two-segment fracture in 20 cases and three-segment fracture in 10 cases. Lesion involved in 250 vertebrae located in the T6-L5 segment. Bone cement injected into each vertebra was 3-5 ml (mean, 4 ml). Treatment effects were assessed with vertebral height, Cobb angle and visual analogue score (VAS). Results At the follow-up of 6-15 months (mean 11 months), thoracic back pain significantly alleviated or disappeared. After operation, improvements were observed in VAS[(8.7±1.2) points vs (2.6±0.7) points], anterior vertebral height loss [(11.0±3.2) mm vs(5.5±0.8) mm], central vertebral height loss [(8.6±1.1) mm vs (3.3±1.0) mm], and Cobb angle [(29.8±4. 5)° vs (16.7±3.4)°] (P <0.01). Four patients appeared no pain or numbness in lower limbs although cement leak into disc. Whereas two patients had lower extremity nerve irritation because of cement leak into the spinal canal and recovered after symptomatic treatment. Conclusion PKP is an effective method for treatment of osteoporotic vertebral compression fracture in the elderly, for it can rebuild vertebral height, increase vertebral rigidity as well as stability and relieve thoracic back pain. Key words: Spinal fractures; Osteoporosis; Percutaneous kyphoplasty

Nursing strategy after percutaneous external transpedicle fixation combined with vertebral screw in the treatment of thoracolumbar vertebral fracture

Objective To explore nursing strategy after percutaneous external transpedicle fixation combined with vertebral screw in the treatment of thoracolumbar vertebral fracture.Methods 60 patients with thoracolumbar vertebral fracture in our hospital from December 2011 to December 2013 were selected and divided into basic nursing group and comprehensive nursing group according to their diagnostic order.Compared complications and satisfaction rate in two groups.Results Incidences of puncture pain,stenttract infection and fixation loose in comprehensive nursing group were 6.67％,3.33％ and 6.67％,those in basic nursing group were 33.33％,30.00％ and 36.67％.Satisfaction rate in comprehensive nursing group was higher than that in basic nursing group (93.33％ vs.63.33％,P ＜ 0.05).Conclusions Comprehensive nursing strategy in patients with thoracolumbar vertebral fracture undergoing percutaneous external transpedicle fixation combined with vertebral screw can significantly decrease the occurrence of complication,improve treatment safety,and greatly shorten the recovery time,with high patients' satisfaction rate,worthy of promotion. Key words: Percutaneous external transpedicle fixation; Thoracolumbar spine; Fracture; Bone transplantation; Nursing strategy

Surgical Treatment of Thoracolumbar Fractures:Anterior Versus Posterior Approach

Background Data: Treatment of thoracolumbar vertebral fractures is highly controversial. The most important factor determining treatment strategy is whether the patient has a neurological injury. Purpose: This work studied the results of the surgical treatment of thoracolumbar fractures admitted at the Neurosurgery Department of Benha University Hospitalbetween January 2006 and June 2014 and tried to outline the indications of either the anterior or the posterior approach based on this experience. Study Design: Descriptive retrospective clinical case study. Patients and Methods: This is a retrospective study of the medical records of 72 patients who were hospitalized with the diagnosis of traumatic thoracolumbar spinal fracture and operated upon at the neurosurgical department of Banha University between January2006 and June 2014. Sixty patients operated through the anterior approach, where 12 operated through the anterior approach. Results: Clinical outcome: Posterior group: no patient experienced neurological deterioration postoperatively. Preoperative low back/leg pain improved greatly in most patients (54 out of 60) and remained the same in 6 patients based on the VAS for pain. Anterior group: According to ASIA; patients grade A (N=6) and D (N=1), remained thesame post-operatively, whereas, of the other patients with incomplete cord lesion (N=5), three improved one grade and two did not improve at the last follow-up. Radiological outcome: Posterior group: Preoperatively, most patients experienced loss of more than 40% of the vertebra body’s height and compromise of more than 40% in canal. Its overallmean values were 42.5±11.5% and 50.6±10.2%, respectively. No statistically significant correlation appeared between the canal compromise and loss of vertebral body height (P>0.05). However, the mean kyphotic deformities measured preoperatively and at within 12 months follow-up, were 19.2±5.5 degrees and 8.0±3.6 degrees. The meanmid-sagittal diameter improved from 9.2±3.1 mm before surgery to 15.1±0.8 mm at the 12 months follow-up visit, with a significant difference between preoperative and postoperative values (P<0.01). The mean vertebral body height before surgery was 42.5±11.5%. At the 12-month follow-up visit, this score showed a statistically significant increase, to 69.0±11.4% (P<0.01). Anterior group: The preoperative segmental kyphosis improved postoperatively (at the three month follow up visit) from a mean of 26.5o (range 16- 35o) to a mean of 11o (range 5- 17o). This correction was maintained in all but three patients who lost correction of a mean 3o (at the end of the follow up visits- at 12 months). None of the patients had implant failure. All patients had bone fusion on final follow up plain radiography. Conclusion: Posterior surgery is performed primarily in the treatment of burst fractures without neurological deficit. Anterior decompression is indicated in an incomplete neurologic deficit with marked canal compromise and intact posterior ligamentous complex. Both approaches are safe and efficient in retaining the stability of the spine. (2014ESJ071)

Comparative analysis on curative effects of percutaneous vertebroplesty and kyphoplasty in the treat-ment for thoracolumbar vertebral compression fracture

[Objective]To explore and compare the clinical efficacy of treatment of thoracolumbar vertebral compression fracture by percutaneous vertebroplasty(PVP) and percutaneous kyphoplasty(PKP).[Methods]46 cases of thoracolumbar vertebral compression fractures in patients with surgical Methods were divided into vertebral angioplasty group and kyphoplasty group,intraoperative blood loss of two groups,operative time,the bone cement injected volume,bone cement leakagerate and clinical efficacy before and after surgery were compared in two groups.Resrlts Patients were successfully completed with surgery,infection,complications of hematoma,nerve root injury,and vertebral body fractures.There was no statistical significant difference in operative time and blood loss in two groups(P＞ 0.05).But there was significant differences in the injection volume of hone cement,bone cement leakage rate between the two groups (P＜0.05).Two groups' restoring vertebral height extent had significant improvement in VAS score than the preoperative group,difference was statistically significant (P＜ 0.05) but no significant difference found between two groups (P＞ 0.05).Mter 2weeks in PVP group,and the PKP group,1 year after the efficiency difference was not significant (P＞ 0.05).[Conclusion]s PVP and PKP treatment of thoracic and lumbar vertebral compression fracture may derive significant clinical efficacy,with less trauma,shorter operative time,less bleeding,fewer complications,minimally invasive characteristics.PKP can effectively correct the kyphosis,greatly reduce the occurrence of bone cement leakage than PVP increased security,hut the cost is higher; PVP operation is relatively simple,inexpensive,hut the bone cement leakage rate is relatively high.It should be combined with a vasiety of factors to select the appropriate surgical clinical. Key words: Percutaneous vertebroplasty(PVP); Percutaneous kyphoplasty(PKP); Compression fracture; Osteoporosis; Bone cement; Curative effect

Short-term therapeutic effect of vertebral pillar block insertion through vertebral pedicle in treatment of thoracolumbar vertebral fractures

Objective To study the therapeutic effect of vertebral pillar block insertion through vertebral pedicle in treatment of thoracolumbar vertebral fractures. Methods The study involved 23patients (25 vertebrae and 47 vertebral pillar blocks) with thoracolumbar vertebral fractures treated with vertebral pillar block insertion through vertebral pedicle in our hospital from March 2008 to July 2009.There were two patients with T11 fractures, nine with T12 fractures, seven with L1 fractures and five with L2 fractures (four patients were treated with decompression by fenestration between vertebral plates and vertebral pedicle fixation with vertebral pillar block). Surgical operation, operation duration, blood loss during operation, postoperative and follow-up X-ray films were observed, and the ratio of anterior vertebral height and normal height, degree of Cobb angle correction and early postoperative recovery were determined. Results Twenty-three patients were followed up for 7-16 months (mean 12.5 months),which showed little postoperative vertebral height loss and significantly improved postoperative anterior vertebral compression rate and the Cobb angle (P ＜ 0. 05). Conclusions Vertebral pillar block can effectively restore the mechanical properties of vertebral bodies, reduce further loss of vertebral height,kyphosis reproduction and other complications and take advantages of shorter operative time, less bleeding, faster recovery and better adaptation to the biological fixation in treatment of thoracolumbar vertebral fractures. Key words: Spinal fractures; Thoracic vertebrae; Lumbar vertebrae; Vertebral pillar

Percutaneous vertebroplasty for treatment of osteoporotic thoracolumbar vertebral compression fracture by filling auto-solidification calcium phosphate cement

目的 探讨应用经皮椎体成形术(PVP)自固化磷酸钙人工骨(CPC)充填治疗骨质疏松性胸腰椎压缩性骨折的临床疗效.方法自2004年1月起,对26例29个椎体骨质疏松性胸腰椎压缩骨折患者,采用术中手法复位、PVP 自固化CPC充填治疗.结果 26例患者经单侧或双侧椎弓根穿刺椎体成形术成功治愈.胸腰椎自固化CPC平均充填量为4.6 mL.术中CPC渗漏者5例5个椎体.无一例出现严重并发症.经3～8个月(平均4.6个月)随访,术后所有患者疼痛消失.除3例椎体高度丢失15%外,其余椎体高度平均恢复达正常的80%.结论 PVP自固化CPC充填治疗骨质疏松性胸腰椎压缩性骨折是一种安全、简单、有效的方法。

Thoracoscopic anterior approach decompression and reconstruction for thoracolumbar spine diseases

To review our experience of anterior thoracoscopic decompression and reconstruction in the treatment of thoracolumbar vertebral fractures, tuberculosis and herniated disks, and to evaluate the feasibility and effectiveness of such procedures. Twelve patients who underwent thoracoscopic decompression and reconstruction of the spine since June 2003 have been reviewed retrospectively. There were 8 male and 4 female patients, with a median age of 48.4 years (range 32 to 74 years) with thoracolumbar vertebral fractures (8 patients), tuberculosis (3 patients) and herniated disks (1 patient). The average time for the thoracoscopy was 210 minutes (range 180 to 260 minutes). Blood loss averaged 600 ml (range 300 to 800 ml), and the median length of hospital stay was 12 days (range 7 to 18 days). One patient had to give up internal fixation because of severe osteoporosis. All patients were followed up at least 3 months. No severe postoperative complications occurred. No shift of the bone graft and internal fixator. Recovery of neural function was almost the same as open procedures. Thoracoscopic anterior procedures can be used safely and effectively in the treatment of thoracolumbar spine diseases. This minimally invasive approach might decrease procedure-related trauma, operative time, blood loss, and length of hospitalization and may also alleviate postthoracotomy pain.

Device-assisted muscle strengthening in the rehabilitation of patients after surgically stabilized vertebral fractures

Kramer M, Dehner C, Katzmaier P, Neuwirth F, Ebert V, Elbel M, Hartwig E. Device-assisted muscle strengthening in the rehabilitation of patients after surgically stabilized vertebral fractures. ObjectivesTo investigate the effects of a device-assisted muscle strengthening exercise program on the surgically traumatized multifidus musculature and on the intact longissimus and iliocostal muscles and to assess the possible relationship between patients’ reported pain symptoms and changes in muscle strength or changes in cross-sectional area (CSA) of the musculature. DesignOpen, prospective noncontrolled prepost intervention study. SettingUniversity-affiliated center for ambulant physiotherapy. ParticipantsFifteen patients who had undergone dorsal osteosynthesis for treatment of thoracolumbar vertebral fracture and who complained of persistent back pain. InterventionTwelve-week device-assisted training exercise program. Main outcome measuresPatients’ pain score, muscle strength, and the CSA of the paravertebral musculature determined by magnetic resonance imaging (MRI) were assessed before and after the exercise program. ResultsMRI findings revealed no increase in the CSA of the multifidus muscle in any patient (median change, −.27cm2). All patients, however, exhibited hypertrophy of both the longissimus and iliocostal muscles (median change, 1.39cm2). Significant increase in muscle strength was observed in 14 of 16 patients (median increase, 56%; range, 0.7%−126.4%). The median overall pain score improved from 19 (range, 7–24) to 16 (range, 5–27). The change in muscle strength and muscle CSA, however, showed no correlation. There was also no correlation between increase in muscle strength and changes in pain scores. ConclusionsThe device-assisted training program resulted in hypertrophy of the iliocostal and longissimus muscles and an increase in muscle strength in patients with surgically stabilized vertebral fractures. About half of the patients reported relief of pain. No correlation was found between hypertrophy, increase in muscle strength, and relief of pain. The surgically damaged multifidus musculature, however, did not show any change in CSA and was not accessible to rehabilitative measures.

Transpedicular Instrumentation and Short-Segment Fusion of Thoracolumbar Fractures: A Prospective Study Using a Single Instrumentation System

Eleven patients were prospectively treated with bilateral short-segment transpedicular instrumentation using the Posterior Segment Fixator (Ace Medical Co., Los Angeles, CA, U.S.A.) construct combined with posterolateral fusion using autogenous iliac crest bone graft for the treatment of thoracolumbar vertebral fractures. All patients were evaluated clinically, radiographically, and functionally for a minimum of 2 years (mean 33 months). Four of the 11 patients (36.3%) had breakage or disengagement of the caudad screws during this interval. During the follow-up period, the angle of kyphosis increased an average of 12.9 degrees. The loss of correction was greater in those patients in whom the instrumentation failed (22 degrees) than in those patients in whom it did not (7.7 degrees). Five of the patients (45.5%) had a progressive increase in the angle of kyphosis of 10 degrees or more. At follow-up, the average loss of anterior vertebral body height for all 11 patients was 14% when compared with the body height that had been attained at surgery. Six of these patients (54.5%) had 10% or more loss of anterior body height. Despite the high incidence of failure of the instrumentation, progressive increase in the angle of kyphosis, and progressive loss of anterior vertebral body height, there was no worsening in the patients' Frankel grade postoperatively. The high rate of hardware failure and major postoperative loss of fracture reduction associated with this construct suggest that posterior short-segment pedicle-screw instrumentation with the Posterior Segment Fixator was not adequate to ensure stabilization of thoracolumbar fractures in this small group of patients. Maintenance of postoperative fracture reduction was the most consistent predictor of satisfactory functional outcome.