Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Short-segment Pedicle Instrumentation of Thoracolumbar Burst-compression Fractures; Short Term Follow-up Results

  • Shin, Tae-Sob (Department of Neurosurgery Konyang University Hospital) ;
  • Kim, Hyun-Woo (Department of Neurosurgery Konyang University Hospital) ;
  • Park, Keung-Suk (Department of Neurosurgery Konyang University Hospital) ;
  • Kim, Jae-Myung (Department of Neurosurgery Konyang University Hospital) ;
  • Jung, Chul-Ku (Department of Neurosurgery Konyang University Hospital)
  • Published : 2007.10.31
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Abstract

Objective : The current literature implies that the use of short-segment pedicle screw fixation for spinal fractures is dangerous and inappropriate because of its high failure rate, but favorable results have been reported. The purpose of this study is to report the short term results of thoracolumbar burst and compression fractures treated with short-segment pedicle instrumentation. Methods : A retrospective review of all surgically managed thoracolumbar fractures during six years were performed. The 19 surgically managed patients were instrumented by the short-segment technique. Patients' charts, operation notes, preoperative and postoperative radiographs (sagittal index, sagittal plane kyphosis, anterior body compression, vertebral kyphosis, regional kyphosis), computed tomography scans, neurological findings (Frankel functional classification), and follow-up records up to 12-month follow-up were reviewed. Results : No patients showed an increase in neurological deficit. A statistically significant difference existed between the patients preoperative, postoperative and follow-up sagittal index, sagittal plane kyphosis, anterior body compression, vertebral kyphosis and regional kyphosis. One screw pullout resulted in kyphotic angulation, one screw was misplaced and one patient suffered angulation of the proximal segment on follow-up, but these findings were not related to the radiographic findings. Significant bending of screws or hardware breakage were not encountered. Conclusion : Although long term follow-up evaluation needs to verified, the short term follow-up results suggest a favorable outcome for short-segment instrumentation. When applied to patients with isolated spinal fractures who were cooperative with 3-4 months of spinal bracing, short-segment pedicle screw fixation using the posterior approach seems to provide satisfactory result.

Keywords

References

  1. Aebi M, Etter C, Kehl T : Stabilization of the lower thoracic and lumbar spine the internal spine skeletal fixation system. Indication, technique, and first results of treatment. Spine 12 : 544-551, 1987 https://doi.org/10.1097/00007632-198707000-00007
  2. Ahmet A, Emre A, Muharrem Y, Ali O, Adil S : Short-Segment Pedicle Instrumentation of Thoracolumbar Burst Fractures Does Transpedicular Intracorporeal Grafting Prevent Early Failure? Spine 26 : 213-217, 2001
  3. Aota Y, Kumano K, Hirabayashi S : Postfusion instability at the adjacent segments after rigid pedicle screw fixation for degenerative lumbar spinal disorders. J spine Disord 8 : 464-473, 1995
  4. Been HD, Bouma GJ : Comparison of two Types of Surgery for Thoraco-Lumbar Burst Fractures : Combined Anterior and Posterior Stabilization vs. Posterior Instrumentation Only. The Netherlands Acta Neurochir (Wien) 141 : 349-357, 1999 https://doi.org/10.1007/s007010050310
  5. Blauth M, Tscherne M : Theraputic concept and results of operative treatment in acute trauma of the thoracic and lumbar spine : The Hanover experience. J Orthop Trauma 1 : 240-252, 1987 https://doi.org/10.1097/00005131-198701030-00009
  6. Boucher HH : A method of spinal fusion. J Bone Joint Surg 41B : 248, 1959
  7. Bradford DS, Akbarnia BA, Winter RB : Surgical stabilization of fractures and fracture dislocation of the thoracic spine. Spine 2 : 185- 196, 1977 https://doi.org/10.1097/00007632-197709000-00004
  8. Cantor JB, Labwohl NH, Garvey T : Nonoperative management of stable thoracolumbar burst fractures with early ambulation and bracing. Spine 18 : 971-976, 1993 https://doi.org/10.1097/00007632-199306150-00004
  9. Chun SW, Hwang JH, Sung JK, Hwang SK, Hamm IS, Park YM, et al : Pedicle Screw Fixation and Posterolateral Fusion for Thoracolumbar Spine Fracture. J Korean Neurosurg Soc 28 : 644- 648, 1999
  10. Denis F, Armstrong GWD, Searis K : Acute thoracolumbar burst fractures in the absence of neurologic deficits. Clin Orthop Relat Res 189 : 142-149, 1984
  11. Dickson JH, Harrington PR, Erwin WD : Results of reduction and stabilization of the severely fractured thoracic and lumbar spine. J Bone Joint Surg 60A : 799-805, 1978
  12. Dorr LD, Harvey JP, Nickel VL : Clinical review of the early stability of spine injuries. Spine 7 : 545-553, 1882 https://doi.org/10.1097/00007632-198211000-00006
  13. Farcy JP, Veidenbaum M, Glassman S : Sagittal index in management of thoracolumbar burst fractures. Spine 15 : 958-965, 1990 https://doi.org/10.1097/00007632-199009000-00022
  14. Flasch JR, Leider LI, Ericks DL : Harrington instrumentation and spine fusion for unstable fractures and fracture dislocations of the thoracic and lumbar spine. J Bone Joint Surg 59A : 143-153, 1977
  15. Frankel H, Hancock DO, Hyslop G : The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Paraplegia 7 : 179-192, 1969 https://doi.org/10.1038/sc.1969.30
  16. Gertzbein SD, Court-Brown CM, Marks P : The neurologic outcome following surgery for spinal fractures. Spine 13 : 641-644, 1988 https://doi.org/10.1097/00007632-198813060-00007
  17. Guttman L : Spinal cord injuries : Comprehensive management and research. Oxford : Blackwell scientific Publication, 1976, pp152
  18. Han IH, Song GS : Thoracic Pedicle Screw Fixation and Fusion in Unstable Thoracic Spine Fractures. J Korean Neurosurg Soc 32 : 334-340, 2002
  19. Hu, Serena S : Internal fixation in the osteoporotic spine. Spine 22 : 43-48, 1997 https://doi.org/10.1097/00007632-199712151-00008
  20. Hyun SJ, Lim YB, Hong HJ, Kwon JT, Suk JS, Min BK : Predictable risk factors for adjacent segment degeneration after lumbar fusion. J Korean Neurosurg Soc 41 : 88-94, 2007
  21. Jacobs RR, Casey MP : Surgical management of thoracolumbar spinal injuries. Clin Orthop Relat Res 189 : 22-35, 1984
  22. Jeffrey WP, Joel RL, Eldin EK, Robert WG : Successful Short-Segment Instrumentation and Fusion for Thoracolumbar Spine Fractures A Consecutive 4 1/2-Year Series. Spine 25 : 1157-1169, 2000 https://doi.org/10.1097/00007632-200005010-00018
  23. James JY, Allen S, Christopher S, Lawrence S, Kenneth W, Mark T, et al : The Treatment of Unstable Thoracic Spine Fractures with Transpedicular Screw Instrumentation : A 3-Year Consecutive Series. Spine 27 : 2782-2787, 2002 https://doi.org/10.1097/00007632-200212150-00008
  24. Kim KS, Oh SH, Huh JS, Noh JS, Chung BS : Dorsal Short-Segment Fixation for Unstable Thoracolumbar Junction Fractures. J Korean Neurosurg Soc 40 : 249-255, 2006
  25. King D : Internal fixation for lumbosacral fusion. Am J Surg 66 : 357-367, 1944 https://doi.org/10.1016/S0002-9610(44)90201-1
  26. Kothe R, Panjabi MM, Liu W : Multidirectional instability of the thoracic spine due to iatrogenic pedicle injuries during transpedicular fixation. A biomechanical investigation. Spine 22 : 1836-1842, 1997 https://doi.org/10.1097/00007632-199708150-00008
  27. Lee YS, Sung JK : Long-term Follow-up Results of Short-segment Posterior Screw Fixation for Thoracolumbar Burst Fractures. J Korean Neurosurg Soc 37 : 416-421, 2005
  28. McAfee OC, Yuan HA, Fredrickson BE, Lubicky JP : The value of computed tomography in thoracolumbar fractures. J Bone Joint Surg 65 : 461-473, 1983 https://doi.org/10.2106/00004623-198365040-00006
  29. McCormack T, Karaikovic E, Gaines RW : The load-shearing classification of spine fractures. Spine 19 : 1741-1744, 1994 https://doi.org/10.1097/00007632-199408000-00014
  30. Mumford J, Weinstein JN, Spratt KF : Thoracolumbar burst fractures : The clinical efficacy and outcome of nonoperative management. Spine 18 : 955-970, 1993 https://doi.org/10.1097/00007632-199306150-00003
  31. Muller U, Berlemann U, Sledge J, Schwarzenbach O : Treatment of thoracolumbar burst fractures without neurologic deficit by indirect reduction and posterior instrumentation : bisegmental stabilization with monosegmental fusion. Eur Spine J 8 : 284-289, 1999 https://doi.org/10.1007/s005860050175
  32. Park P, Garton HJ, Gala VC, Hoff JT, McGillicuddy JE : Adjacent segment disease after lumbar ot lumbosacral fusion. Spine 29 : 1938- 1944, 2004 https://doi.org/10.1097/01.brs.0000137069.88904.03
  33. Patrick T, Russel CH, Christian AL, Dominique GP, Rene PL : Functional and radiologic outcome of thoracolumbar and burst fractures managed by closed orthopedic reduction and casting. Spine 28 : 2459-2465, 2003 https://doi.org/10.1097/01.BRS.0000090834.36061.DD
  34. Patrick WH, James CT, Souheil FH, Kenneth AF : Management options in thoracolumbar burst fractures. Surg Neurol 49 : 619-627, 1998 https://doi.org/10.1016/S0090-3019(97)00527-2
  35. Roy-Camille R, Saillant G, Mazel C : Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop 203 : 7-17, 1986
  36. Roy-Camille R, Saillant G, Salgado V : Osteogenesis of thoracolumbar spine fractures with metal plates screwed through the vertebral pedicle. Reconstr Surg Traumatol 15 : 2-16, 1976
  37. Sanderson PL, Fraser RD, Hall DJ, Cain CMJ, Osti OL, Potter GR : Short-segment fixation of thoracolumbar burst fractures without fusion. Eur Spine J 8 : 495-500, 1999 https://doi.org/10.1007/s005860050212
  38. Sasso RC, Costler HB : Posterior Instrumentation and fusion for unstable fractures and fracture-dislocations of the thoracic and lumbar spine. Spine 18 : 450-460, 1993 https://doi.org/10.1097/00007632-199318040-00008
  39. Lee YS, Sung JK : Long-term follow-up results of short-segment posterior screw fixation for thoracolumbar burst fractures. J Korean Neurosurg Soc 37 : 416-421, 2005