Effectiveness of injured vertebra fixation with inclined-long pedicle screws combined with interbody fusion for thoracolumbar fracture dislocation with disc injury_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HAN Yaozheng ¹ , MA Jun ² , HUANG Liangliang ² , SU Lintao ² , LEI Changyu ² , JIANG Jianfeng ² ,  KANG Hui ² , HAN Yaozheng ¹ , MA Jun ² , HUANG Liangliang ² , SU Lintao ² , LEI Changyu ² , JIANG Jianfeng ² ,  KANG Hui ²

1. Medical College, Wuhan University of Science and Technology, Wuhan Hubei, 430065, P. R. China;
2. Department of Orthopaedics, General Hospital of Central Theater Command of Chinese PLA, Wuhan Hubei, 430070, P. R. China;

Corresponding author：

KANG Hui, Email: kanghuicss@163.com; KANG Hui, Email: kanghuicss@163.com

Keywords：

Thoracolumbar fracture dislocation; disc injury; injured vertebra fixation with inclined-long pedicle screws; interbody fusion

DOI：

10.7507/1002-1892.202310042

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Objective To investigate the effectiveness of injured vertebra fixation with inclined-long pedicle screws combined with interbody fusion for thoracolumbar fracture dislocation with disc injury. Methods Between January 2017 and June 2022, 28 patients with thoracolumbar fracture dislocation with disc injury were underwent posterior depression, the injured vertebra fixation with inclined-long pedicle screws, and interbody fusion. There were 22 males and 6 females, with a mean age of 41.4 years (range, 22-58 years). The causes of injury included falling from height in 18 cases, traffic accident in 5 cases, and bruise in 5 cases. Fracture segment included 1 case of T₁₁, 7 cases of T₁₂, 9 cases of L₁, and 11 cases of L₂. According to the American Spinal Injury Association (ASIA) scale, the spinal injuries were graded as grade A in 4 cases, grade B in 2 cases, grade C in 11 cases, and grade D in 11 cases. Preoperative spinal canal encroachment ratio was 17.7%-75.3% (mean, 44.0%); the thoracolumbar injury classification and severity score (TLICS) ranged from 9 to 10 (mean, 9.9). Seventeen patients were associated with other injuries. The time from injury to operation ranged from 1 to 4 days (mean, 2.3 days). The perioperative indicators (operation time, intraoperative blood loss, and the occurrence of complications), clinical evaluation indicators [visual analogue scale (VAS) score and Oswestry Disability Index (ODI)], radiologic evaluation indicators [anterior vertebral height ratio (AVHR), kyphosis Cobb angle (KCA), intervertebral space height (ISH), vertebral wedge angle (VWA), displacement angle (DA), and percent fracture dislocation displacement (PFDD)], neurological function, and interbody fusion were recorded. Results The operation time was 110-159 minutes (mean, 130.2 minutes). The intraoperative blood loss was 200-510 mL (mean, 354.3 mL). All incisions healed by first intention, and no surgical complications such as wound infection or hematoma occurred. All patients were followed up 12-15 months (mean, 12.7 months). The chest and lumbar pain significantly relieved, VAS scores and ODI after operation were significantly lower than those before operation, and further decreased with the extension of postoperative time, with significant differences (P<0.05). At last follow-up, the ASIA classification of neurological function of the patients was grade A in 3 cases, grade B in 1 case, grade C in 1 case, grade D in 10 cases, and grade E in 13 cases, which was significantly different from preoperative one (Z=−4.772, P<0.001). Imaging review showed that AVHR, KCA, ISH, VWA, DA, and PFDD significantly improved at 1 week, 3 months and last follow-up (P<0.05). There was no significant difference between different time points after operation (P>0.05). At last follow-up, according to the modified Brantigan score, all patients achieved good intervertebral bone fusion, including 22 complete fusion and 6 good intervertebral fusion with a few clear lines. No complications such as internal fixation failure or kyphosis occurred during follow-up.Conclusion The injured vertebra fixation with inclined-long pedicle screws combined with interbody fusion is an effective treatment for thoracolumbar fracture dislocation with disc injury, which can correct the fracture dislocation, release the nerve compression, restore the injured vertebral height, and reconstruct spinal stabilization.

Citation： HAN Yaozheng, MA Jun, HUANG Liangliang, SU Lintao, LEI Changyu, JIANG Jianfeng, KANG Hui. Effectiveness of injured vertebra fixation with inclined-long pedicle screws combined with interbody fusion for thoracolumbar fracture dislocation with disc injury. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(4): 466-473. doi: 10.7507/1002-1892.202310042 Copy

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1. Katsuura Y, Osborn JM, Cason GW. The epidemiology of thoracolumbar trauma: A meta-analysis. J Orthop, 2016, 13(4): 383-388.
2. Katsuura Y, Osborn JM, Cason GW. The epidemiology of thoracolumbar trauma: A meta-analysis. J Orthop, 2016, 13(4): 383-388.
3. Reinhold M, Knop C, Beisse R, et al. Operative treatment of 733 patients with acute thoracolumbar spinal injuries: comprehensive results from the second, prospective, Internet-based multicenter study of the Spine Study Group of the German Association of Trauma Surgery. Eur Spine J, 2010, 19(10): 1657-1676.
4. Reinhold M, Knop C, Beisse R, et al. Operative treatment of 733 patients with acute thoracolumbar spinal injuries: comprehensive results from the second, prospective, Internet-based multicenter study of the Spine Study Group of the German Association of Trauma Surgery. Eur Spine J, 2010, 19(10): 1657-1676.
5. Rajasekaran S, Kanna RM, Shetty AP. Management of thoracolumbar spine trauma: An overview. Indian J Orthop, 2015, 49(1): 72-82.
6. Rajasekaran S, Kanna RM, Shetty AP. Management of thoracolumbar spine trauma: An overview. Indian J Orthop, 2015, 49(1): 72-82.
7. Sharif S, Shaikh Y, Yaman O, et al. Surgical techniques for thoracolumbar spine fractures: WFNS Spine Committee Recommendations. Neurospine, 2021, 18(4): 667-680.
8. Sharif S, Shaikh Y, Yaman O, et al. Surgical techniques for thoracolumbar spine fractures: WFNS Spine Committee Recommendations. Neurospine, 2021, 18(4): 667-680.
9. Farooque K, Sharma V, Kar S. Morcellized local grafts as cost effective option for interbody fusion in thoracolumbar fracture dislocation: Seven years follow up of 53 patients. J Orthop, 2022, 31: 33-39.
10. Farooque K, Sharma V, Kar S. Morcellized local grafts as cost effective option for interbody fusion in thoracolumbar fracture dislocation: Seven years follow up of 53 patients. J Orthop, 2022, 31: 33-39.
11. 王翔, 蔡毅, 郑明辉, 等. 胸腰椎骨折脱位经后路长节段内固定术后力线不良及其原因分析. 中国临床解剖学杂志, 2017, 35(1): 85-89.
12. 王翔, 蔡毅, 郑明辉, 等. 胸腰椎骨折脱位经后路长节段内固定术后力线不良及其原因分析. 中国临床解剖学杂志, 2017, 35(1): 85-89.
13. Chokshi JJ, Shah M. Outcomes of including fracture level in short-segment fixation for thoracolumbar fracture dislocation. Asian Spine J, 2019, 13(1): 56-60.
14. Chokshi JJ, Shah M. Outcomes of including fracture level in short-segment fixation for thoracolumbar fracture dislocation. Asian Spine J, 2019, 13(1): 56-60.
15. Zhang QS, Lü GH, Wang XB, et al. The significance of removing ruptured intervertebral discs for interbody fusion in treating thoracic or lumbar type B and C spinal injuries through a one-stage posterior approach. PLoS One, 2014, 9(5): e97275. doi: 10.1371/journal.pone.0097275.
16. Zhang QS, Lü GH, Wang XB, et al. The significance of removing ruptured intervertebral discs for interbody fusion in treating thoracic or lumbar type B and C spinal injuries through a one-stage posterior approach. PLoS One, 2014, 9(5): e97275. doi: 10.1371/journal.pone.0097275.
17. Hashimura T, Onishi E, Ota S, et al. Correction loss following short-segment posterior fixation for traumatic thoracolumbar burst fractures related to endplate and intervertebral disc destruction. BMC Musculoskelet Disord, 2023, 24(1): 174. doi: 10.1186/s12891-023-06288-y.
18. Hashimura T, Onishi E, Ota S, et al. Correction loss following short-segment posterior fixation for traumatic thoracolumbar burst fractures related to endplate and intervertebral disc destruction. BMC Musculoskelet Disord, 2023, 24(1): 174. doi: 10.1186/s12891-023-06288-y.
19. 魏晓东, 宋宏亮, 龚维明, 等. 椎间盘损伤的胸腰椎骨折患者修复后易出现严重后凸畸形. 中国组织工程研究, 2016, 20(17): 24441-24447.
20. 魏晓东, 宋宏亮, 龚维明, 等. 椎间盘损伤的胸腰椎骨折患者修复后易出现严重后凸畸形. 中国组织工程研究, 2016, 20(17): 24441-24447.
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Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of injured vertebra fixation with inclined-long pedicle screws combined with interbody fusion for thoracolumbar fracture dislocation with disc injury

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