EFFECTIVENESS OF PEDICLE SCREW FIXATION COMBINED WITH NON-FUSION TECHNOLOGY FOR TREATMENT OF THORACOLUMBAR FRACTURE THROUGH Wiltse PARASPINAL APPROACH_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 MENGXiangyu ¹ , ZENGKaibin ² , Turghunjan·Abdurxit ¹ , XIEJiang ¹ , TIANHuizhong ¹ , MAYuan ¹

1. Department of Spinal Surgery, the Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830002, P. R. China;
2. Department of Spinal Surgery, Xiangtan Central Hospital;

Corresponding author：

MENGXiangyu, Email: mengxiangyu815@163.com

Keywords：

Thoracolumbar fracture; Wiltse paraspinal approach; Internal fixation; Non-fusion technology

DOI：

10.7507/1002-1892.20140241

Video：

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Objective To explore the effectiveness of pedicle screw fixation combined with non-fusion technology for the treatment of thoracolumbar fracture (AO type A) through Wiltse paraspinal approach. Methods Between March 2011 and December 2012, 35 cases of thoracolumbar fractures were treated with pedicle screw fixation combined with non-fusion technology by Wiltse paraspinal approach. There were 27 males and 8 females, aged from 19 to 51 years (mean, 39.7 years). The time from injury to operation varied from 3 to 15 days (mean, 5.9 days). The causes of injury were traffic accident in 17 cases, falling from height in 11 cases, and crush trauma in 7 cases. All fractures were single-segment fracture, including T₈ in 1 case, T₉ in 2 cases, T₁₀ in 2 cases, T₁₁ in 3 cases, T₁₂ in 12 cases, L₁ in 10 cases, L₂ in 4 cases, and L₃ in 1 case. According to AO classification, there were 17 type A1 fractures (compression fracture), 3 type A2 fractures (splitting fracture), and 15 type A3 fractures (burst fracture). Based on American Spinal Injury Association (ASIA) spinal cord injury grade, all cases were in grade E before operation. Perioperative parameters were recorded; the anterior vertebral height and kyphotic Cobb angle of vertebral bodies were measured before and after operation to evaluate the effect of correction. Results The mean operating time was 74 minutes; the mean blood loss was 125 mL; and the mean drainage volume was 51 mL. Skin necrosis of incision occurred in 2 cases and was cured after dressing change; primary healing of incision was obtained in the others. All patients were followed up 15-24 months (mean, 17.3 months). No loosening or breakage of internal fixation was found. The internal fixator was removed at 12-19 months after operation (mean, 15 months). There were significant differences in Cobb's angle and anterior vertebral body height between before operation and immediately after operation, before internal fixator removal as well as at last follow-up (P < 0.05). There was no significant difference in anterior vertebral body height among the postoperative time points (P > 0.05). There was significant difference in Cobb's angle between immediately after operation and before internal fixator removal as well as at last follow-up (P < 0.05), but the difference was not significant between before internal fixator removal and at last follow-up (P > 0.05). The motion of fixed segment was restored after internal fixator removal. Conclusion It is an effective method of pedicle screw fixation combined with non-fusion technology through Wiltse paraspinal approach for the treatment of thoracolumbar fracture (AO type A). The method has the advantages of simple operation and less trauma. It can effectively rebuild the height of vertebral body and correct kyphotic deformity.

Citation： MENGXiangyu, ZENGKaibin, Turghunjan·Abdurxit, XIEJiang, TIANHuizhong, MAYuan. EFFECTIVENESS OF PEDICLE SCREW FIXATION COMBINED WITH NON-FUSION TECHNOLOGY FOR TREATMENT OF THORACOLUMBAR FRACTURE THROUGH Wiltse PARASPINAL APPROACH. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(9): 1106-1109. doi: 10.7507/1002-1892.20140241 Copy

1.	Post RB, Keizer HJ, Leferink VJ, et al.Functional outcome 5 years after non-operative treatment of type A spinal fractures.Eur Spine J, 2006, 15(4):472-478.
2.	Siebenga J, Leferink VJ, Segers MJ, et al.Treatment of traumatic thoracolumbar spine fractures:a multicenter prospective randomized study of operative versus nonsurgical treatment.Spine (Phila Pa 1976), 2006, 31(25):2881-2890.
3.	Wild MH, Glees M, Plieschnegger C, et al.Five-year follow-up examination after purely minimally invasive posterior stabilization of thoracolumbar fractures:a comparison of minimally invasive percutaneously and conventionally open treated patients.Arch Orthop Trauma Surg, 2007, 127(5):335-343.
4.	Grass R, Biewener A, Dickopf A, et al.Percutaneous dorsal versus open instrumentation for fractures of the thoracolumbar border.A comparative, prospective study.Unfallchirurg, 2006, 109(4):297-305.
5.	池永龙, 徐华梓, 林焱, 等.微创经皮椎弓根螺钉内固定治疗胸腰椎骨折的初步探讨.中华外科杂志, 2004, 42(21):1307-1311.
6.	Mahar A, Kim C, Wedemeyer M, et al.Short segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture.Spine (Phila Pa 1976), 2007, 32(14):1503-1507.
7.	Kim KT, Lee SH, Suk KS, et al.The quantitative analysis of tissue injury markers after mini-open lumbar fusion.Spine (Phila Pa 1976), 2006, 31(6):712-716.
8.	Stevens KJ, Spenciner DB, Griffiths KL, et al.Comparison of minimally invasive and conventional open posterolateral lumbar fusion using magnetic resonance imaging and retraction pressure studies.J Spinal Disord Tech, 2006, 19(2):77-86.
9.	Kawaguchi Y, Matsui H, Jsuji H.Back muscle injury after posterior lumbar spine surgery.A histologicand enzymatic analysis.Spine (Phila Pa 1976), 1996, 21(8):941-944.
10.	Wiltse LL, Bateman JG, Hutchinson RH, et al.The paraspinal sacrospinalis-splitting approach to the lumbar spine.J Bone Joint Surg (Am), 1968, 50(5):919-926.
11.	印飞, 孙振中, 殷渠东, 等.伤椎植骨植钉与跨节段椎弓根螺钉内固定术治疗胸腰椎骨折的比较研究.中国修复重建外科杂志, 2014, 28(2):227-232.
12.	Lee JK, Jang JW, Kim TW, et al.Percutaneous short-segment pedicle screw placement without fusion in the treatment of thoracolumbar burst fractures:is it effective?:comparative study with open short-segment pedicle screw fixation with posterolateral fusion.Acta Neurochir (Wien), 2013, 155(12):2305-2312.
13.	Grossbach AJ, Dahdaleh NS, Abel TJ, et al.Flexion-distraction injuries of the thoracolumbar spine:open fusion versus percutaneous pedicle screw fixation.Neurosurg Focus, 2013, 35(2):E2.
14.	Kim YM, Kim DS, Choi ES, et al.Nonfusion method in thoracolumbar and lumbar spinal fractures.Spine (Phila Pa 1976), 2011, 36(2):170-176.
15.	Shin BJ, Kim DS, Choi CU.Analysis of loss of correction in spinal fractures treated by pedicle screw system.J Korean Spine Surg, 1994, 1(2):223-232.
16.	李钦亮, 刘艺, 储照明, 等.经伤椎椎弓根椎体内植骨并植钉治疗胸腰椎骨折.中国修复重建外科杂志, 2011, 25(8):956-959.
17.	Olivier E, Beldame J, Ould Slimana M, et al.Comparison between one midline cutaneous incision and two lateral incisions in the lumbar paraspinal approach by Wiltse:a cadaver study.Surg Radiol Anat, 2006, 28(5):494-497.
18.	Palmer DK, Allen JL, Williams PA, et al.Multilevel MRI analysis of multifidus longissimus cleavage planes in the lumbar spine and potential clinical applications to Wiltse's paraspinal approach.Spine (Phila Pa 1976), 2011, 36(16):1263-1267.

1. Post RB, Keizer HJ, Leferink VJ, et al.Functional outcome 5 years after non-operative treatment of type A spinal fractures.Eur Spine J, 2006, 15(4):472-478.
2. Siebenga J, Leferink VJ, Segers MJ, et al.Treatment of traumatic thoracolumbar spine fractures:a multicenter prospective randomized study of operative versus nonsurgical treatment.Spine (Phila Pa 1976), 2006, 31(25):2881-2890.
3. Wild MH, Glees M, Plieschnegger C, et al.Five-year follow-up examination after purely minimally invasive posterior stabilization of thoracolumbar fractures:a comparison of minimally invasive percutaneously and conventionally open treated patients.Arch Orthop Trauma Surg, 2007, 127(5):335-343.
4. Grass R, Biewener A, Dickopf A, et al.Percutaneous dorsal versus open instrumentation for fractures of the thoracolumbar border.A comparative, prospective study.Unfallchirurg, 2006, 109(4):297-305.
5. 池永龙, 徐华梓, 林焱, 等.微创经皮椎弓根螺钉内固定治疗胸腰椎骨折的初步探讨.中华外科杂志, 2004, 42(21):1307-1311.
6. Mahar A, Kim C, Wedemeyer M, et al.Short segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture.Spine (Phila Pa 1976), 2007, 32(14):1503-1507.
7. Kim KT, Lee SH, Suk KS, et al.The quantitative analysis of tissue injury markers after mini-open lumbar fusion.Spine (Phila Pa 1976), 2006, 31(6):712-716.
8. Stevens KJ, Spenciner DB, Griffiths KL, et al.Comparison of minimally invasive and conventional open posterolateral lumbar fusion using magnetic resonance imaging and retraction pressure studies.J Spinal Disord Tech, 2006, 19(2):77-86.
9. Kawaguchi Y, Matsui H, Jsuji H.Back muscle injury after posterior lumbar spine surgery.A histologicand enzymatic analysis.Spine (Phila Pa 1976), 1996, 21(8):941-944.
10. Wiltse LL, Bateman JG, Hutchinson RH, et al.The paraspinal sacrospinalis-splitting approach to the lumbar spine.J Bone Joint Surg (Am), 1968, 50(5):919-926.
11. 印飞, 孙振中, 殷渠东, 等.伤椎植骨植钉与跨节段椎弓根螺钉内固定术治疗胸腰椎骨折的比较研究.中国修复重建外科杂志, 2014, 28(2):227-232.
12. Lee JK, Jang JW, Kim TW, et al.Percutaneous short-segment pedicle screw placement without fusion in the treatment of thoracolumbar burst fractures:is it effective?:comparative study with open short-segment pedicle screw fixation with posterolateral fusion.Acta Neurochir (Wien), 2013, 155(12):2305-2312.
13. Grossbach AJ, Dahdaleh NS, Abel TJ, et al.Flexion-distraction injuries of the thoracolumbar spine:open fusion versus percutaneous pedicle screw fixation.Neurosurg Focus, 2013, 35(2):E2.
14. Kim YM, Kim DS, Choi ES, et al.Nonfusion method in thoracolumbar and lumbar spinal fractures.Spine (Phila Pa 1976), 2011, 36(2):170-176.
15. Shin BJ, Kim DS, Choi CU.Analysis of loss of correction in spinal fractures treated by pedicle screw system.J Korean Spine Surg, 1994, 1(2):223-232.
16. 李钦亮, 刘艺, 储照明, 等.经伤椎椎弓根椎体内植骨并植钉治疗胸腰椎骨折.中国修复重建外科杂志, 2011, 25(8):956-959.
17. Olivier E, Beldame J, Ould Slimana M, et al.Comparison between one midline cutaneous incision and two lateral incisions in the lumbar paraspinal approach by Wiltse:a cadaver study.Surg Radiol Anat, 2006, 28(5):494-497.
18. Palmer DK, Allen JL, Williams PA, et al.Multilevel MRI analysis of multifidus longissimus cleavage planes in the lumbar spine and potential clinical applications to Wiltse's paraspinal approach.Spine (Phila Pa 1976), 2011, 36(16):1263-1267.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF PEDICLE SCREW FIXATION COMBINED WITH NON-FUSION TECHNOLOGY FOR TREATMENT OF THORACOLUMBAR FRACTURE THROUGH Wiltse PARASPINAL APPROACH

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