Unstable Thoracolumbar Fractures Research Articles

‘Armed kyphoplasty’ with posterior stabilization avoids corpectomy in complex thoracolumbar spine fractures: a case series

BackgroundComplex thoracolumbar fractures require reduction and stabilization. Posterior instrumentation alone and standard cement augmentation may represent undertreatment, while corpectomy has significant morbidity. In a series of unstable thoracolumbar fractures, we...

Short segment posterior fixation of unstable thoracolumbar vertebral fractures with fractured vertebra augmentation with intermediate pedicle screw - a clinicoradiological analysis.

Unstable thoracolumbar burst fractures are routinely encountered in orthopedic practice. Recently, short-segment fixation with pedicle screw augmentation of the fractured vertebra for unstable thoracolumbar burst fractures has gained popularity. Nonetheless, the maintenance of the kyphotic correction during the follow-up period remains controversial. This study aimed to examine the clinical-radiological outcomes, complications, and functional outcomes of fractured vertebrae augmentation with intermediate pedicle screws in short-segment instrumentation in acute thoracolumbar spine fractures. This retrospective study was conducted in the Department of Orthopedics, All India Institute of Medical Sciences, Jodhpur, using medical records from January 2021 to October 2022. Parameters such as local kyphosis correction, loss of kyphotic correction at final follow-up, anterior body height correction (%), and loss of correction (%) at final follow-up were measured as primary outcomes. Various other parameters such as operative time, blood loss, length of hospital stay, and visual analog scale were measured as secondary outcomes. The mean correction obtained via surgery in the immediate postoperative period was 13.7±2.3 degrees. The mean loss of correction at the final follow-up was 4.1±2.0 degrees, and the mean final local kyphotic angle was 7.2±2.4 degrees (P<0.05). The mean correction obtained via surgery in the immediate postoperative period was 37.2%±9.0%. The mean loss of correction at the final follow-up was 10.5%±5.3%, and the mean final anterior vertebral body height maintained was 72%±11.0% (P<0.05). Short-segment posterior fixation with pedicle screw augmentation achieves good correction of local kyphotic angle and anterior vertebral height in the immediate postoperative period, but some loss of correction at final follow-up is common. In our study, the loss of correction corresponded directly to the load-sharing score.

CLINICO-RADIOLOGICAL OUTCOMES IN SHORT SEGMENT FIXATION INCLUDING FRACTURE LEVEL FOR UNSTABLE THORACOLUMBAR JUNCTION FRACTURES (T10-L2)

Background: Thoracolumbar region being a transition zone is frequently injured during trauma. Treatment aims to achieve stable fixation while preserving mobility, prevent deformity, and improve neurology. Short-segment fixation, with fracture level pedicle screw fixation, is popular for preserving motion. This study assesses the clinico-radiological outcomes for short segment fixation including fracture level for unstable thoracolumbar fractures. Methods: This was an observational study conducted at a tertiary care center from December 2020 to November 2022 after receiving ethical approval among single level burst fractures (AO type A3 &amp; A4) at the thoracolumbar junction. Patients with AO type B and C fractures, osteoporotic burst fractures, lack of surgical consent, and multi-level vertebral fractures were excluded from the study. The study utilized ASIA impairment scale, Visual Analogue Score(VAS), and radiological parameters (Kyphotic angle and Loss of vertebral body height) to assess patients immediately, postoperatively and at 6 weeks, 3 months, and 6 months follow-up. Results: Out of 20 patients,70% of the fractures were AO type A3, while the remaining 30% were type A4. The injury resulted in a 56.25 ± 13.75% loss of vertebral height. The mean kyphotic angle improved significantly from 24.38 ± 3.77 degrees preoperatively to 5.92 ± 1.91 degrees at 6 months post-operatively. The VAS scores showed significant improvement from 7.85 ± 0.67 preoperatively to 0.65 ± 0.81 at 6 months postoperatively. Conclusions: Use of pedicle screw in the fractured vertebra can result in significant improvement in post-operative pain and kyphosis correction utilizing fewer motion segment with satisfactory clinic-radiological outcome.

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

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

Minimally Invasive Surgery for Traumatic Thoracolumbar Fractures: A Cross-Sectional Study of Spine Surgeons

To describe the perceived feasibility of minimally invasive surgical treatment of thoracolumbar fractures among spine surgeons in Latin American centers. This is a cross-sectional study on minimally invasive surgical treatment for unstable thoracolumbar fractures. We conducted an online survey of spine surgeons working in Latin American centers, administered between December 16, 2022 and January 15, 2023. A nonprobabilistic sample was selected (snowball sampling). A questionnaire was sent by email and other messaging applications. Data were extracted from 134 surgeons. The majority of the respondents were from Brazil (n=30, 22.4%), Mexico (n=24, 17.9%), Argentina (n=22, 16.4%), and Chile (n=15, 11.2%). Their mean age was 46.53years (standard deviation, 9.7; range 31-67) and almost all were males (n=128, 95.5%). Most respondents were orthopedists (n=85, 63.4%) or neurosurgeons (n=49, 36.9%). Most of the respondents (n=110, 82.1%) reported at least some difficulty using minimally invasive techniques for thoracolumbar fractures. It should be noted that there were significant regional differences between the surgeons' responses (P=0.017). Chilean surgeons reported better results than others. Spinal surgeons from Latin American centers have identified challenges and obstacles to performing minimally invasive surgery for thoracolumbar trauma. The survey found that a majority of respondents experienced some level of difficulty, with regional variations. The most frequently reported difficulties were the high cost of the procedure, patient insurance restrictions, and long insurance approval times.

Analysis of factors associated with the failure of treatment in thoracolumbar burst fractures treated with short-segment posterior spinal fixation

BackgroundThe treatment of thoracolumbar burst fractures continues to pose challenges. Although short-segment posterior spinal fixation (SSPSF) has shown satisfactory clinical outcomes, it is accompanied by a relatively high rate of treatment failure. This study aimed to assess factors associated with treatment failure in thoracolumbar burst fractures treated with SSPSF.MethodsThe clinical data of 241 consecutive patients with a traumatic thoracolumbar burst fracture who underwent SSPSF at our center between Apr 2016 and Apr 2021 were retrospectively reviewed. Patients were divided into two groups (failure of the treatment group and non-failure of the treatment group). We compared potential risk factors for the failure of treatment including age, gender, body mass index, smoking, diabetes, vertebral body compression rate, use of crosslinks, percentage of anterior height compression, presence of index level instrumentation, Cobb angle, interpedicular distance (IPD), canal compromise, Load Sharing Classification (LSC) score, use of posterolateral fusion, and pain intensity between the two groups.ResultsA sum of 137 (56.8%) males and 104 (43.2%) females were enrolled where the mean age and follow-up of the participants were 48.34 ± 10.23 years and 18.67 ± 5.23 months, respectively. Treatment failure was observed in 34 cases (14.1%). The results of the binary logistic regression analysis revealed that the lack of index level instrumentation (OR 2.21; 95% CI 1.78–3.04; P = 0.014), LSC score (odds ratio [OR] 2.64; 95% confidence interval [95% CI], 1.34–3.77; P = 0.007), and IPD (OR 1.77; 95% CI 1.51–2.67; P = 0.023) were independently associated with a higher rate of failure of treatment.ConclusionsThe findings of this study revealed that increased rates of treatment failure in thoracolumbar burst fractures treated with SSPSF were associated with factors such as the absence of index level instrumentation, higher LSC scores, and larger IPD. These findings could be helpful in the proper management of patients with unstable thoracolumbar burst fractures.

Outcome of Long Segment Posterior Spinal Stabilization Incorporating the Fractured Vertebra for Unstable Thoraco-Lumbar Junctional Brust Fracture

Objectives: To evaluate the outcome of long segment posterior spinal stabilization incorporating the fractured vertebra with posterolateral fusion for unstable thoraco-lumbar junctional brust fracture. Background: Thoracolumbar junction is the commonest site of traumatic spinal injury. Now a days, it is managed surgically most of the time because it is often associated with the spinal cord injury. Its mode of surgical management is a field of controversy. Huge debate is still going on between the superiority of long &amp; short segment stabilization. In this study, we evaluated the outcome of long segment posterior spinal stabilization incorporating the fractured vertebra Materials &amp; Method: This prospective interventonal study included 30 case of thoraco-lumbar junctional unstable brust fractures was carried out in the Spine unit of Orthopaedic surgery department of Bangabandhu Sheikh Mujib Medical University, Dhaka and other private hospital in Dhaka City, Bangladesh, from January 2016 to July 2022. All the patients with positive clinical findings, X-ray, MRI &amp; CT scan findings and underwent long segment posterior spinal stabilization incorporating the fractured vertevra with posterolateral fusion. Average follow-up period was 12 months. Pre &amp; Post-operatively, neurological assessment was done by the ASIA Impairment Score, improvement of pain control by VAS score, fusion rate by Bridwell’s criteria, Kyphotic angle was measured by Cobb’s angle measurement method &amp; Overall functional assessment by modified Odom’s score. Results: Total number of patients was 30. Average age was 34 years (range 21- 47). ASIA score improved from B to C in 5 patients, B to D in 5 patients, C to D in 8 patients , C to E in 3 patients, patients, D to E in 7 patients. 2 patient did not improved following surgery. Fusion was achieved in 29 patients &amp; 1 patient developed pseudoarthrosis. Pre &amp; Post- operative VAS score was 7.30±1.9 &amp; 3.3±1.8 respectively. The average kyphotic correction was 15 ∞. In our series, we have no bedridden patients after surgery. There was no radiographic progression after surgery. Conclusion: Early treatment within 21 days of injury with long segment posterior spinal stabilization incorporating the fractured vertevra with posterolateral fusion is a very effective surgical procedure with preservation of the motion segment to treat unstable thoracolumbar junctional brust fracture.

Biomechanical analysis of the effect of ‘intermediate screws’ in short segment posterior fixation of unstable burst fractures of thoracolumbar spine in calf spine model

Background: Efforts in preserving motion levels in unstable thoracolumbar burst fractures steered to short segment fixation. However, short segment spanning fixation in clinical scenario reported high failure rates. Augmentation of spanning fixation by inserting intermediate screws into the fracture level is proposed to enhance stability. An experimental comparative study was performed to assess the biomechanical role of the ‘intermediate screws.’ Methods: Five calf spine specimens were freshly prepared to record the biomechanical characteristics, range of motion (ROM), and stiffness. CT scan confirmed an unstable burst fracture in each specimen. Each specimen was instrumented with short-segment posterior fixation with an intermediate screw. The same test protocols were repeated with and without intermediate screws. Results: Intermediate screws contribute to 20.2%, 16.5%, 14.5% and 23% decrease in ROM and 15.4%, 25.6%, 48.3%, and 160.2% increase in construct stiffness. Conclusions: Intermediate screws significantly increase the construct stiffness and decrease the ROM.

Long-Segment Versus Short-Segment Pedicle Screw Fixation Including Fractured Vertebrae for the Management of Unstable Thoracolumbar Burst Fractures.

Background For the treatment of unstable thoracolumbar fractures, this study compared the results of short-segment fixation with fracture level inclusion (SSFIFL) with long-segment pedicle fixation (LSPF). Methodology In this prospective case series study conducted from January 2015 to January 2019, 80 patients with partial spinal cord lesions were investigated. For the comparison, two groups of 40 patients each were chosen and treated with SSFIFL and LSPF. The outcomes were measured using pre and postoperative radiological parameters and clinical parameters. The radiographic variables included the kyphotic angle with loss of correction, kyphotic deformation, and the Beck index. Mean blood loss, operative time, and cost-effectiveness were also examined for clinical indicators such as the American Spinal Injury Association Impairment Scale, Visual Analog Scale (VAS), and Oswestry Disability Index (ODI). Results There were no substantial variations between the groups regarding age or gender, trauma etiology, fracture level, or fracture pattern. Between the two categories, there appeared to be no notable change in radiological indicators such as kyphotic angle, kyphotic deformation, and Beck index at the end of follow-up (p = 0.120, 0.360, and 0.776, respectively). Both groups had similar neurological outcomes (p = 0.781). In terms of ODI and VAS, statistically, there was no discernible difference (p = 0.567 and 0.161, respectively). In this study, however, there was less surgical time, blood loss, and implant cost (p = 0.05). Conclusions When fracture level is included in a short-segment fixation, the radiological and clinical results are comparable to long-segment posterior fixation. Ultimately, this treatment has proven to be not only a motion segment-saving procedure but also cost-effective.

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

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

Analysis of a Hybrid Spine Fixation Approach for the Treatment of Unstable Thoracolumbar Fractures.

Introduction The treatment of unstable thoracolumbar burst fractures and fracture dislocations of the thoracolumbar spine remains ever evolving. Anterior or posterior approaches both have equal efficacy, but the posterior approach has been preferred in our study due to its ease of application, less extensile nature, and reduced intra-operative bleeding. Posterior approaches can employ short-segment fixation or long-segment fixation techniques. Long segment fixation may need implant removal later to increase mobility in nonfusion surgeries. The thoracolumbar segment is a transition zone where the thoracic spine is a less flexible zone, and the lumbar spine is a more flexible zone. Lumbar motion is important to preserve. Hence, we proposed to study spinal fixation two levels above and one level below the fracture for stabilization. This may provide increased stability along with preservation of the motion segment at the lumbar level. Methods We retro-prospectively reviewed the results ofunstable thoracolumbar junction fractures with incomplete or intact neurology in 34 consecutive cases operated with alternate two above and one below fixation approach between June 2018 and June 2019 at our institute. Five cases were excluded due to incomplete follow up and the remaining 29 patients were included in the study. Regular follow-up in the postoperative period at three, six, and 12 months was conducted. Data analysis was done by SPSS software version 22 (IBM Corp., Armonk, NY). Results Twenty-nine patients were included in the study out of which 16 were males and 13 were females. The average age was 36.31±1.46 years (range, 14-60 years). The average follow-up duration was 14.31 months. The average injury to surgery interval was 7.17±7.31 days (range, 1-30 days). On analysis via paired t-test, pre-operative kyphotic angle (mean=20.06±8.34º) improved to immediate post-operative (mean=8.44±5.76º, p=0.0001). The postoperative kyphotic angle at 12 months follow-up showed significant stability (Mean=14.13±5.27º, p=0.0001). A median average pre-operative neurological compromise was ASIA score C and Frankel Grade C and the median average disability was an ODI score of 61%-80%. At the end of 12 months of follow-up the median average neurological compromise improved to ASIA Score D and Frankel Grade D and the median average disability improved to an ODI score of 21%-40%. Conclusion Two levels above and one level below hybrid pedicle screw fixation with decompression for the treatment of unstable thoracolumbar fractures with partial and intact neurology was successful within the limited time frame we had for follow-up in preserving progressive post-operative kyphosis, preserving one-motion segment, improving the neurological outcome and disability of the patients without any major complications.

Treatment of Unstable Thoracolumbar Burst Fractures with Single-Stage Posterior Subtotal Corpectomy and Circumferential Reconstruction: A Prospective Observational Study in Jammu

Background: The term thoracolumbar fracture essentially refers to the fact that the bone is broken in the thoracic (middle) or lumbar (lower back) region of the spine. The present prospective study has been objectively conducted to evaluate the clinical and radiological outcome of single stage subtotal corpectomy and circumferential reconstruction of unstable thoracolumbar burst fracture. Methods: This prospective study was carried out in GMC Jammu from October 2017 to December 2018. A total 20 patients with acute traumatic unstable burst fractures at thoracolumbar junctions were included in this prospective study who qualified the defined inclusion criteria.Results: The mean sagittal plane kyphosis pre operatively was 24.845.220 which reduced to 13.155.30at post-operative day 1. At final follow up, sagittal plane kyphosis was 15.105.650. The mean Anterior Body Compression was 33.646.79% which decreased to 22.3 % at post-operative day 1. At final follow up, mean ABC was 24.264.95%. VAS score reduced from mean value of 6.85 to 2.2 at final follow up which is slightly less compared to what others reported. Conclusion: The present study revealed that indirect decompression and posterior subtotal corpectomy and circumferential reconstruction fulfill all the aims of surgical treatment of fractures and fracture dislocations of thoracolumbar spine. We recommend longer follow up to assess the degree of correction of kyphosis and re-collapse and neural recovery with single stage posterior subtotal corpectomy and circumferential reconstruction

The Efficiency and Reliability of Minimally Invasive Anterior Corpectomy and Percutaneous Posterior Stabilization for the Treatment of Unstable Thoracolumbar Burst Fractures

The purpose of this study was to evaluate the radiological and clinical outcomes of minimally invasive anterior corpectomy and percutaneous posterior stabilization for treating unstable thoracolumbar burst fractures. Patients with unstable thoracolumbar burst fractures who underwent minimally invasive anterior corpectomy and percutaneous posterior stabilization between 2012 and 2019 at a tertiary hospital were enrolled. Radiological outcomes such as endplate subsidence and fusion status were identified on preoperative and postoperative plain radiographs and computed tomography images. Preoperative and postoperative neurological statuses were evaluated using the American Spinal Injury Association impairment scale. Furthermore, operation-related parameters were analyzed. In total, 21 patients (mean follow-up period, 21.7months) were included in this study. Of them, 17 (80.95%) patients exhibited complete fusion according to the Bridwell's criteria at the final follow-up, and only 1 patient exhibited nonunion at the surgical level. Endplate subsidence was observed in 6 (28.57%) patients; however, there were no definite symptoms that would have necessitated a revision surgery. Of 15 patients with preoperative neurological impairment, 7 exhibited neurological improvement during follow-up. None of the patients experienced postoperative neurological deterioration. Regarding operation-related parameters, the mean operative time and intraoperative blood loss were 266.19±51.54min and 520.71±190.86ml, respectively. The mean length of hospital stays and days to postoperative ambulation were 12.14 and 4.20days, respectively. Minimally invasive anterolateral corpectomy with percutaneous pedicle screw fixation is a reliable surgical treatment option for unstable thoracolumbar burst fractures.

Assessment of Instability in Thoracolumbar Burst Fractures Using a New Bone Scan Scoring System.

Background and Objectives: Unstable thoracolumbar burst fractures require surgical management as they can result in neurological deficits if left untreated. This study aimed to evaluate whether a new bone scan scoring system could accurately assess instability in thoracolumbar burst fractures. Materials and Methods: Fifty-two patients with thoracolumbar burst fractures who underwent bone scans and magnetic resonance imaging prior to surgery between January 2015 and August 2017 at Ulsan University Hospital were selected for inclusion. Instability was determined by clinical assessment and imaging, and the Thoracolumbar Injury Classification and Severity score was determined. Bone scans were visually evaluated using a new bone scan scoring system. Bone scan findings of vertebral body (BB) and posterior column (BP) were scored separately and were summed to produce BTS {BTS (total score) = BB (body score, 5 points) + BP (posterior score, 2 points)}. The diagnostic performance of the scoring system for identifying unstable then thoracolumbar burst fractures were assessed. Results: Of the 52 thoracolumbar burst fractures, 34 (65.4%) were unstable and 31 (59.6%) had a Thoracolumbar Injury Classification and Severity score ≥ 5. The diagnostic performance of using BTS ≥ 4 to identify unstable thoracolumbar burst fractures and those with a Thoracolumbar Injury Classification and Severity score ≥ 5 was as follows: sensitivity, 61.8% and 58.1%; specificity, 94.4% and 81.0%; positive predictive value, 95.5% and 81.8%; and negative predictive value, 56.7% and 56.7%, respectively. Conclusions: The proposed bone scan scoring system has a high specificity and positive predictive value for identifying thoracolumbar burst fractures that are unstable or have a Thoracolumbar Injury Classification and Severity score ≥ 5. This scoring system may help to inform decisions regarding surgical management.

Biomechanical Analysis of Different Internal Fixation Combined with Different Bone Grafting for Unstable Thoracolumbar Fractures in the Elderly.

This research was developed to accurately evaluate the unstable fractures of thoracolumbar before and after surgery and discuss the treatment timing and methods. Three-dimensional (3D) finite element method was adopted to construct the T12-L5 segment model of human body. The efficiency of percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP), two commonly used internal fixation procedures, was retrospectively compared. A total of 150 patients with chest fracture who received PKP or PVP surgery in our hospital, and 104 patients with the same symptoms who received conservative treatment were collected and randomly rolled into PVP group (75 cases), PKP group (75 cases), and control group (104 cases). Visual analog scale (VAS) score and Oswestry disability index (ODI) of patients were collected before and after surgery and 2, 12, and 24 months after surgery. Then, the anterior and central height of the patient's cone and the kyphosis angle were calculated by X-ray. Lumbar minimally invasive fusion system and lumbar pedicle screw rod system were established by computer-aided design (CAD), and the biomechanical characteristics were analyzed. The results showed that there was no substantial difference in VAS score and ODI score between PKP and PVP (P > 0.05), but they were higher than those of the control group (P < 0.05). The anterior edge and middle height of vertebra in the two groups were higher than those in control group (P < 0.05), and the increase in PKP group was more substantial (P < 0.05). The kyphosis of the two groups was smaller than that of the control group (P < 0.05), and the decrease of the kyphosis of the PKP group was more substantial (P < 0.05). In summary, the thoracolumbar segment model established by 3D finite element method was an effective model, and it was verified on patients that both PKP and PVP could achieve relatively satisfactory efficacy. The implantation of the new internal fixation system had no obvious effect on the lumbar movement. This work provided a novel idea and method for the treatment of senile thoracolumbar unstable fracture, as well as experimental data of biomechanics for the operation of senile unstable fracture.

Radiological comparison of the biomechanical characteristics of short segment posterior instrumentation (Moss- Miami system), with and without transverse connector, in unstable thoraco-lumbar fracture

Introduction: Wedge compression fracture was most common type of fracture (66.6 %) and first Lumbar vertebra (L1) was the most common fracture site (38 %). The choice of surgical approach and instrumentation depends on fracture type, injury level and degree of neural injury. This paper evaluated efficacy of transpedicular screw fixation by Moss Miami instrumentation with transverse connector for surgical treatment in traumatic unstable thoraco-lumbar fractures.&#x0D; Materials and Method: Fifty-five cases were prospectively studied over three years. Comparison was done between two groups- Group 1 without transverse connector and Group 2 with transverse connector. Radiologically evaluation was done in both groups pre-operatively, tenth day, six weeks and six months interval. All X-rays were assessed by lateral and dynamic antero- posterior views for measuring kyphotic (cobb’s) angle and inter-rod angle.&#x0D; Results: In both groups post-operative Mean Cobb’s angle level were increased and remained same until 6months. Variation in Group 2 with transverse connector was slightly higher in initial period (i.e.) after 10 days and then it remains minimal from 6 weeks to 6 months. But in Group 1 without transverse connector the change in angle variation was minimal which worsen over 6 weeks and it continues to remain worse at 6 months, suggestive of parallelogram effect.&#x0D; Conclusion: Transverse connector does play role in preventing parallelogram effect of implants and provides additional stability to the construct. This is first study done in vivo which is done to study the role of transverse connector and evaluate any parallelogram effect in spinal instrumentation.&#x0D; Key words&#x0D; Transverse connector, Thoraco-lumbar fracture, parallelogram effect

Wiltse Approach Versus Conventional Transforaminal Interbody Fusion for Unstable Thoracolumbar Fracture with Intervertebral Disc Lesions.

ObjectiveTo compare the clinical results of two surgical techniques, Wiltse approach and conventional transforaminal interbody fusion, for the treatment of unstable thoracolumbar fracture associated with traumatic intervertebral disc lesion (TIDL).MethodsA total of 76 patients with unstable thoracolumbar fracture associated with TIDL treated by posterior pedicle screw fixation and transforaminal thoracolumbar interbody fusion from June 2010 and July 2016 were reviewed retrospectively. These patients including 48 male and 28 female patients were divided into Wiltse approach transforaminal thoracolumbar interbody fusion (W‐TLIF) group (n = 38) and conventional transforaminal thoracolumbar interbody fusion (C‐TLIF) group (n = 38). Patients were followed up for about 33 months. Clinical and radiological records, kyphotic angle, fractured vertebral body height, visual analogue score (VAS), Oswestry Disability Index (ODI), complications, neurological improvement and fusion rate were compared between two groups.ResultsAll patients underwent posterior surgery successfully. Blood loss, operation time and hospital stay in the W‐TLIF group was 437.84 ± 143.98 ml, 118.64 ± 20.55 min and 12.32 ± 2.87 days, respectively. While those parameters in the C‐TLIF group was 862.70 ± 300.24 ml, 141.35 ± 31.72 min and 15.51 ± 2.08 days, respectively. Average operation time and hospital stay time were significantly shorter, and blood loss was significantly less in the W‐TLIF group than in the C‐TLIF group (P < 0.05). VAS and ODI in the W‐TLIF group were significantly less than those in the C‐TLIF group at 1 week after operation and final follow‐up. The kyphotic angle and vertebral body height were improved. There was 1–2 grade improvement in patients with neurological deficit. Thirty‐three patients in the W‐TLIF group and 32 patients in the C‐TLIF group had achieved fusion during follow‐up. No internal fixation failure was observed in two groups.ConclusionsThe both techniques of W‐TLIF and C‐TLIF were feasible and effective for unstable thoracolumbar fracture with TIDL. Compare to C‐TLIF, The technique of W‐TLIF was a relatively less invasive way to decompress the neural elements and an easy method to reconstruct the anterior column using the same posterior approach.

Posterior instrumented stabilization in the management of unstable thoracolumbar spine fractures with minimum 2 years follow-up

BACKGROUND: Thoracolumbar region (T11–L2) involvement is most common among the spinal injuries often associated with catastrophic neurodeficits. There are many classification systems to describe thoracolumbar fractures, but few have been useful in recommending surgical decision. The treatment of thoracolumbar fracture has been debated extensively. Optimal surgical approach to be used to treat thoracolumbar fractures remains controversial. MATERIALS AND METHODS: Thirty-four patients with thoracolumbar injury classification and severity score ≥5, who underwent posterior instrumentation, were studied prospectively between August 2018 and July 2021. Follow-up assessment was done using x-ray, American Spinal Injury Association (ASIA) impairment scale, Denis pain and work scale, and Oswestry disability index. RESULTS: Most of the patients were belonged to age group 31–40 years (44.1%, n = 15); L1 was the most common vertebra injured (61.8%, n = 21). Average kyphosis correction obtained by surgery was 10.53°, and the average loss of kyphosis correction at 2 years was 2.94°. Surgery duration and blood loss when compared between short-segment fixation (SSF) and long-segment fixation (LSF) showed a statistical significance (P < 0.0001). Associated injuries were seen in 11.76% (n = 4) of patients. At final follow-up, 85.71% (n = 24) of patients showed improvement to one higher ASIA grade; 82.4% (n = 28) of patients reported to have no pain or occasional minimal pain. CONCLUSIONS: Posterior pedicle screw-rod fixation is relatively safe, more familiar, and associated with less morbidity. Most of the fractures can be treated by SSF, but in patients with severe vertebral body comminution (AOtype A3) and AO type C fractures, LSF can be done.

The radiological outcomes of short-segment pedicle screw fixation combined with transforaminal interbody fusion for treatment of thoracolumbar burst fracture

Objective: This study aims to evaluate radiological outcomes of short-segment pedicle screw fixation with transforaminal interbody fusion (TIF) using bone chip graft for treatment of unstable thoracolumbar burst fracture, Denis type IIB. Subject and method: The data in this study were retrospectively collected from all patients with isolated unstable thoracolumbar burst fractures treated by posterior short segment pedicle screw fixation and TIF from January 2013 to January 2017. All patients were followed up for a minimum time interval of 1 year. For radiologic outcome evaluation, a loss percentage of anterior vertebral body heights (%ABC), vertebral kyphotic angle (VKA) and regional kyphotic angle (RKA) were collected preoperatively, postoperatively and at final follow-up. Result: There were 36 patients who met the inclusion criteria with a mean follow-up duration of 53 months (range, 17-73 months). The mean % ABC, VKA and, RKA at the time of admission were 49.9%, 24.6o and 19.7o, respectively. These values were 17.6%, 11.5o, 8.5o postoperatively, and 27.5%, 14.4° and 14.1° at final follow-up, respe­ctively. Fusion rate at final follow-up was 91.7% based on Bridwell’s criteria. There were 6 patients (16.7%) with hardware failure at final follow-up. Conclusion: Short-segment pedicle screw fixation with TIF using bone chip graft is an effective surgical management for unstable thoracolumbar burst fracture with the acceptable radiological outcomes in Vietnamese patients.

COMPARISON OF PERCUTANEOUS PEDICLE SCREW FIXATION AND PEDICAL SCREW FIXATION IN CONVENTIONAL INCISION IN THORACOLUMBAR FRACTURE

Background: Originally, patients with unstable thoracolumbar spine fracture were treated using pedicle screw fixation, a conventional incision. However, the small incision percutaneous pedicle screw fixation (PPSF), a new device, has been recently introduced which could save surgery time, reduce blood loss and improve clinical recovery.&#x0D; Objective: This study aimed to evaluate postoperative outcomes of the PPSF, compared with the open pedicle screw fixation (OPSF) in conventional incision among patients with thoracolumbar fracture.&#x0D; Methods: A retrospective study of 54 cases of patients with thoracolumbar spine fracture without neurological deficit was included in the study. The data were collected from medical records of patients admitted to Rayong Hospital from January 2017-December 2019. Results: Patients aged from 18-46 years (32.35+ 8.52) were mostly males (59.2%). Types of fracture included burst (72.22%). The most common level of thoracolumbar spine fracture was L1 (37.04%). Mostly, the cause of injury was fall from height (53.70%). The mean postoperative stays in the PPSF and OPSF groups were significant, 3.09±.59 and 6.16±1.003 days, respectively (p&lt;0.05). The mean intraoperative blood losses of the PPSF and OPSF groups significantly differed, 44.35±15.02 and 466.13±87.92 mL, respectively (p &lt; 0.01). However, the mean kyphotic angle reduction of the PPSF (24.43±2.74 degrees) and OPSF (24.87±2.55 degrees) groups did not significantly differ (p &gt; 0.1). The mean postoperative pain score (VAS) at the first day in the PPSF and OPSF groups were 6.43±.94 and 6.61±.98, respectively, which did not significantly differ (p &gt; 0.1).&#x0D; Conclusion: PPSF spinal fracture treatment could reduce the amount of bleeding during surgery and reduce the length of hospital stay. However, the results of both types of surgery did not differ regarding postoperative pain, decreased kyphotic angle and surgical time.