EFFECTS OF ANTERIOR SINGLE SEGMENT FIXATION ON SPINAL STABILITY IN TREATMENT OF THORACOLUMBAR BURST FRACTURE OF Denis TYPE B WITH PEDICLE INJURY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YUZhenxing ,  DINGZhenqi , SHAMo , KANGLiangqi , LIANGBowei

Department of Orthopaedics, the 175th Hospital of Chinese PLA, Zhangzhou Fujian, 363000, P. R. China;

Corresponding author：

DINGZhenqi, Email: dzqi@xmu.edu.cn

Keywords：

Thoracolumbar burst fracture; Anterior approach; Single segment fixation; Pedicle injury; Biomechanics

DOI：

10.7507/1002-1892.20150276

Video：

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Objective To investigate the effects of anterior single segment fixation on the spinal biomechanical stabilization in the treatment of thoracolumbar burst fracture of Denis type B with pedicle injury. Methods Six fresh human cadaveric spine specimens (T₁₁-L₃) were harvested as normal control (group A). Then the L₁ Denis type B fracture model was created by the hemi-corpectomy method. Each specimen was tested in 3 different scenarios: anterior single segment (T₁₂, L₁) fixation with the integrity of the pedicle (group B), anterior single segment fixation with the resection of the unilateral pedicle (group C), and anterior single segment fixation with the resection of the bilateral pedicles (group D). Range of motion (ROM) in flexion/extension, bilateral bending, and bilateral axial rotation was measured by spinal three-dimensional measuring system under pure moments of 8.0 N·m. Results The ROM values of T₁₂, L₁ in flexion, extension, and right/left lateral bending of groups B, C, and D were significantly lower than those of group A (P<0.05); group D was significantly higher than groups B and C (P<0.05); but groups B and C showed no significant difference (P>0.05). The ROM values of T₁₂, L₁ in right/left axial rotation of groups B and C were significantly lower than those of groups A and D (P<0.05), but there was no significant difference (P>0.05) between groups B and C and between groups A and D. The ROM values of L₁, 2 in flexion, extension, right/left lateral bending, and right/left axial rotation showed no significant difference between groups (P>0.05). Conclusion Resection of the unilateral pedicle has litter effects on the spine biomechanical stabilization of the anterior single segment fixation in the 6 degrees of freedom. However, the bilateral resection results show significant decrease in flexion, extension, lateral bending, and rotation motion stability by the single segment fixation devices, especially in the axial rotation aspect.

Citation： YUZhenxing, DINGZhenqi, SHAMo, KANGLiangqi, LIANGBowei. EFFECTS OF ANTERIOR SINGLE SEGMENT FIXATION ON SPINAL STABILITY IN TREATMENT OF THORACOLUMBAR BURST FRACTURE OF Denis TYPE B WITH PEDICLE INJURY. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(10): 1275-1278. doi: 10.7507/1002-1892.20150276 Copy

1.	Miyakoshi N, Abe E, Shimada Y, et al. Outcome of one-level posterior lumbar interbody fusion for spondylolisthesis and postoperative intervertebral disc degeneration adjacent to the fusion. Spine (Phila Pa 1976), 2000, 25(14):1837-1842.
2.	An HS, Lim TH, You JW, et al. Biomechanical evaluation of anterior thoracolumbar spinal instrumentation. Spine (Phila Pa 1976), 1995, 20(18):1979-1983.
3.	Zdeblick TA, Warden KE, Zou D, et al. Anterior spinal fixators. A biomechanical in vitro study. Spine (Phila Pa 1976), 1993, 18(4): 513-517.
4.	Langrana NA, Harten RD, Lin DC, et al. Acute thoracolumbar burst fractures:a new view of loading mechanisms. Spine (Phila Pa 1976), 2002, 27(5):498-508.
5.	Shi R, Liu H, Zhao X, et al. Anterior single segmental decompression and fixation for Denis B type thoracolumbar burst fracture with neurological deficiency:thirty-four cases with average twenty-six month follow-up. Spine (Phila Pa 1976), 2011, 36(9):E598-605.
6.	欧云生, 权正学, 蒋电明, 等. 前路有限减压单节段植骨内固定治疗Denis B型胸腰椎爆裂骨折. 中华创伤杂志, 2008, 24(3):208-211.
7.	张亮. 前路单节段融合双节段固定治疗Denis B型胸腰椎爆裂性骨折的研究. 广州:南方医科大学, 2010.
8.	Zou D, Yoo JU, Edwards WT, et al. Mechanics of anatomic reduction of thoracolumbar burst fractures. Comparison of distraction versus distraction plus lordosis, in the anatomic reduction of the thoracolumbar burst fracture. Spine (Phila Pa 1976), 1993, 18(2):195-203.
9.	Wang XY, Dai LY, Xu HZ, et al. Biomechanical effect of the extent of vertebral body fracture on the thoracolumbar spine with pedicle screw fixation:an in vitro study. J Clin Neurosci, 2008, 15(3):286-290.
10.	Schultheiss M, Hartwig E, Sarkar M, et al. Biomechanical in vitro comparison of different mono- and bisegmental anterior procedures with regard to the strategy for fracture stabilisation using minimally invasive techniques. Eur Spine J, 2006, 15(1):82-89.
11.	Crawford NR, Brantley AG, Dickman CA, et al. An apparatus for applying pure nonconstraining moments to spine segments in vitro. Spine (Phila Pa 1976), 1995, 20(19):2097-2100.
12.	Wilke HJ, Wenger K, Claes L. Testing criteria for spinal implants: recommendations for the standardization of in vitro stability testing of spinal implants. Eur Spine J, 1998, 7(2):148-154.
13.	Inceoglu S, Burghardt A, Akbay A, et al. Trabecular architecture of lumbar vertebral pedicle. Spine (Phila Pa 1976), 2005, 30(13):1485-1490.
14.	Kothe R, Panjabi MM, Liu W. Multidirectional instability of the thoracic spine due to iatrogenic pedicle injuries during transpedicular fixation. A biomechanical investigation. Spine (Phila Pa 1976), 1997, 22(16):1836-1842.
15.	O'Shaughnessy BA, Ondra SL, Ganju A, et al. Anterior thoracic spine reconstruction using a titanium mesh cage and pedicled rib flap. Spine (Phila Pa 1976), 2006, 31(16):1820-1827.
16.	Hitchon PW, Torner J, Eichholz KM, et al. Comparison of anterolateral and posterior approaches in the management of thoracolumbar burst fractures. J Neurosurg Spine, 2006, 5(2):117-125.
17.	Sasso RC, Renkens K, Hanson D, et al. Unstable thoracolumbar burst fractures:anterior-only versus short-segment posterior fixation. J Spinal Disord Tech, 2006, 19(4):242-248.

1. Miyakoshi N, Abe E, Shimada Y, et al. Outcome of one-level posterior lumbar interbody fusion for spondylolisthesis and postoperative intervertebral disc degeneration adjacent to the fusion. Spine (Phila Pa 1976), 2000, 25(14):1837-1842.
2. An HS, Lim TH, You JW, et al. Biomechanical evaluation of anterior thoracolumbar spinal instrumentation. Spine (Phila Pa 1976), 1995, 20(18):1979-1983.
3. Zdeblick TA, Warden KE, Zou D, et al. Anterior spinal fixators. A biomechanical in vitro study. Spine (Phila Pa 1976), 1993, 18(4): 513-517.
4. Langrana NA, Harten RD, Lin DC, et al. Acute thoracolumbar burst fractures:a new view of loading mechanisms. Spine (Phila Pa 1976), 2002, 27(5):498-508.
5. Shi R, Liu H, Zhao X, et al. Anterior single segmental decompression and fixation for Denis B type thoracolumbar burst fracture with neurological deficiency:thirty-four cases with average twenty-six month follow-up. Spine (Phila Pa 1976), 2011, 36(9):E598-605.
6. 欧云生, 权正学, 蒋电明, 等. 前路有限减压单节段植骨内固定治疗Denis B型胸腰椎爆裂骨折. 中华创伤杂志, 2008, 24(3):208-211.
7. 张亮. 前路单节段融合双节段固定治疗Denis B型胸腰椎爆裂性骨折的研究. 广州:南方医科大学, 2010.
8. Zou D, Yoo JU, Edwards WT, et al. Mechanics of anatomic reduction of thoracolumbar burst fractures. Comparison of distraction versus distraction plus lordosis, in the anatomic reduction of the thoracolumbar burst fracture. Spine (Phila Pa 1976), 1993, 18(2):195-203.
9. Wang XY, Dai LY, Xu HZ, et al. Biomechanical effect of the extent of vertebral body fracture on the thoracolumbar spine with pedicle screw fixation:an in vitro study. J Clin Neurosci, 2008, 15(3):286-290.
10. Schultheiss M, Hartwig E, Sarkar M, et al. Biomechanical in vitro comparison of different mono- and bisegmental anterior procedures with regard to the strategy for fracture stabilisation using minimally invasive techniques. Eur Spine J, 2006, 15(1):82-89.
11. Crawford NR, Brantley AG, Dickman CA, et al. An apparatus for applying pure nonconstraining moments to spine segments in vitro. Spine (Phila Pa 1976), 1995, 20(19):2097-2100.
12. Wilke HJ, Wenger K, Claes L. Testing criteria for spinal implants: recommendations for the standardization of in vitro stability testing of spinal implants. Eur Spine J, 1998, 7(2):148-154.
13. Inceoglu S, Burghardt A, Akbay A, et al. Trabecular architecture of lumbar vertebral pedicle. Spine (Phila Pa 1976), 2005, 30(13):1485-1490.
14. Kothe R, Panjabi MM, Liu W. Multidirectional instability of the thoracic spine due to iatrogenic pedicle injuries during transpedicular fixation. A biomechanical investigation. Spine (Phila Pa 1976), 1997, 22(16):1836-1842.
15. O'Shaughnessy BA, Ondra SL, Ganju A, et al. Anterior thoracic spine reconstruction using a titanium mesh cage and pedicled rib flap. Spine (Phila Pa 1976), 2006, 31(16):1820-1827.
16. Hitchon PW, Torner J, Eichholz KM, et al. Comparison of anterolateral and posterior approaches in the management of thoracolumbar burst fractures. J Neurosurg Spine, 2006, 5(2):117-125.
17. Sasso RC, Renkens K, Hanson D, et al. Unstable thoracolumbar burst fractures:anterior-only versus short-segment posterior fixation. J Spinal Disord Tech, 2006, 19(4):242-248.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTS OF ANTERIOR SINGLE SEGMENT FIXATION ON SPINAL STABILITY IN TREATMENT OF THORACOLUMBAR BURST FRACTURE OF Denis TYPE B WITH PEDICLE INJURY

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