Posterior short-segment fixation including the fractured vertebra for severe unstable thoracolumbar fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Zhida , WU Jin , LIN Bin , WU Songsong ,  ZENG Wenrong

Department of Orthopaedics, the Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People’s Liberation Army, Fujian Zhangzhou, 363000, P.R.China;

Corresponding author：

ZENG Wenrong, Email: zengwenrong1112@163.com

Keywords：

Posterior; fractured vertebra; short-segment fixation; load sharing classification; thoracolumbar burst fracture

DOI：

10.7507/1002-1892.201708082

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Objective To discuss the effectiveness of posterior short-segment fixation including the fractured vertebra for severe unstable thoracolumbar fractures using pedicle screw fixation. Methods Between May 2008 and July 2013, 52 patients of severe unstable thoracolumbar fractures were treated through posterior short-segment fixation including the fractured vertebra using pedicle screw fixation. There were 33 males and 19 females with an age of 21-56 years (mean, 37.9 years). The causes of thoracolumbar burst fractures included fall from height in 32 cases, traffic accidents in 16 cases, and others in 4 cases. The load sharing classification (LSC) score was 7-9 (mean, 7.85). The levels involved included T₁₁ in 4 cases, T₁₂ in 19 cases, L₁ in 25 cases, and L₂ in 4 cases. According to Frankel classification, there were 2 cases of grade A, 4 cases of grade B, 8 cases of grade C, 11 cases of grade D, and 27 cases of grade E. The rate of spinal canal occupying was 24.2%-76.7% (mean, 47.1%). The time from injury to operation was 3-5 days (mean, 3.6 days). The effectiveness was assessed by the changes of injured vertebral Cobb angle, anterior vertebral height, and the Frankel grading at pre- and post-operation. Results The operation time was 85-127 minutes (mean, 106.5 minutes). The intraoperative blood loss was 90-155 mL (mean, 137.6 mL). All the incision healed at first intension. Forty-seven patients were followed up 19-27 months (mean, 23.2 months), and no incision infection, screw loosening, or other internal fixation failures was found during follow-up. The injured vertebral Cobb angle and anterior vertebral height at immediate after operation or at last follow-up were significantly improved when compared with preoperative values (P<0.001). There was a loss of injured vertebral Cobb angle and anterior vertebral height at last follow-up, but no significant difference was found between at immediate after operation and at last follow-up (P>0.05). The Frankel grade improved by 0-2 grades at last follow-up, showing significant difference when compared with preoperative grades (Z=15.980, P=0.003). Conclusion Posterior short-segment fixation including the fractured vertebra for severe unstable thoracolumbar fractures (LSC≥7) using pedicle screw fixation can correct the kyphosis deformity, restore vertebral body height, and aviod the need of anterior reconstruction.

Citation： CHEN Zhida, WU Jin, LIN Bin, WU Songsong, ZENG Wenrong. Posterior short-segment fixation including the fractured vertebra for severe unstable thoracolumbar fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(1): 59-63. doi: 10.7507/1002-1892.201708082 Copy

1.	Dai LY, Yao WF, Cui YM, et al. Thoracolumbar fractures in patients with multiple injuries: diagnosis and treatment-a review of 147 cases. J Trauma, 2004, 56(2): 348-355.
2.	Gertzbein SD. Scoliosis Research Society. Multicenter spine fracture study. Spine (Phila Pa 1976), 1992, 17(5): 528-540.
3.	McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine (Phila Pa 1976), 1994, 19(15): 1741-1744.
4.	Guven O, Kocaoglu B, Bezer M, et al. The use of screw at the fracture level in the treatment of thoracolumbar burst fractures. J Spinal Disord Tech, 2009, 22(6): 417-421.
5.	Kanna RM, Shetty AP, Rajasekaran S. Posterior fixation including the fractured vertebra for severe unstable thoracolumbar fractures. Spine J, 2015, 15(2): 256-264.
6.	Farrokhi MR, Razmkon A, Maghami Z, et al. Inclusion of the fracture level in short segment fixation of thoracolumbar fractures. Eur Spine J, 2010, 19(10): 1651-1656.
7.	张振武, 饶小华, 田纪青, 等. 脊柱载荷分享评分的改良及临床分析. 中华骨科杂志, 2010, 30(3): 237-243.
8.	Dai LY, Jiang LS, Jiang SD. Conservative treatment of thoracolumbar burst fractures: a long-term follow-up results with special reference to the load sharing classification. Spine (Phila Pa 1976), 2008, 33(23): 2536-2544.
9.	Elzinga M, Segers M, Siebenga J, et al. Inter- and intraobserver agreement on the Load Sharing Classification of thoracolumbar spine fractures. Injury, 2012, 43(4): 416-422.
10.	Parker JW, Lane JR, Karaikovic EE, et al. Successful short-segment instrumentation and fusion for thoracolumbar spine fractures: a consecutive 41/2-year series. Spine (Phila Pa 1976), 2000, 25(9): 1157-1170.
11.	Marco RA, Kushwaha VP. Thoracolumbar burst fractures treated with posterior decompression and pedicle screw instrumentation supplemented with balloon-assisted vertebroplasty and calcium phosphate reconstruction. J Bone Joint Surg (Am), 2009, 91(1): 20-28.
12.	Chen JF, Lee ST. Percutaneous vertebroplasty for treatment of thoracolumbar spine bursting fracture. Surg Neurol, 2004, 62(6): 494-500.
13.	Klezl Z, Majeed H, Bommireddy R, et al. Early results after vertebral body stenting for fractures of the anterior column of the thoracolumbar spine. Injury, 2011, 42(10): 1038-1042.
14.	Dick JC, Jones MP, Zdeblick TA, et al. A biomechanical comparison evaluating the use of intermediate screws and cross-linkage in lumbar pedicle fixation. J Spinal Disord, 1994, 7(5): 402-407.
15.	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.
16.	McLain RF. The biomechanics of long versus short fixation for thoracolumbar spine fractures. Spine (Phila Pa 1976), 2006, 31(11 Suppl): S70-79, 104.
17.	Meves R, Avanzi O. Correlation between neurological deficit and spinal canal compromise in 198 patients with thoracolumbar and lumbar fractures. Spine (Phila Pa 1976), 2005, 30(7): 787-791.
18.	Wood K, Buttermann G, Mehbod A, et al. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomized study. J Bone Joint Surg (Am), 2003, 85-A(5): 773-781.
19.	Miyashita T, Ataka H, Tanno T. Clinical results of posterior stabilization without decompression for thoracolumbar burst fractures: is decompression necessary?. Neurosurg Rev, 2012, 35(3): 447-455.

1. Dai LY, Yao WF, Cui YM, et al. Thoracolumbar fractures in patients with multiple injuries: diagnosis and treatment-a review of 147 cases. J Trauma, 2004, 56(2): 348-355.
2. Gertzbein SD. Scoliosis Research Society. Multicenter spine fracture study. Spine (Phila Pa 1976), 1992, 17(5): 528-540.
3. McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine (Phila Pa 1976), 1994, 19(15): 1741-1744.
4. Guven O, Kocaoglu B, Bezer M, et al. The use of screw at the fracture level in the treatment of thoracolumbar burst fractures. J Spinal Disord Tech, 2009, 22(6): 417-421.
5. Kanna RM, Shetty AP, Rajasekaran S. Posterior fixation including the fractured vertebra for severe unstable thoracolumbar fractures. Spine J, 2015, 15(2): 256-264.
6. Farrokhi MR, Razmkon A, Maghami Z, et al. Inclusion of the fracture level in short segment fixation of thoracolumbar fractures. Eur Spine J, 2010, 19(10): 1651-1656.
7. 张振武, 饶小华, 田纪青, 等. 脊柱载荷分享评分的改良及临床分析. 中华骨科杂志, 2010, 30(3): 237-243.
8. Dai LY, Jiang LS, Jiang SD. Conservative treatment of thoracolumbar burst fractures: a long-term follow-up results with special reference to the load sharing classification. Spine (Phila Pa 1976), 2008, 33(23): 2536-2544.
9. Elzinga M, Segers M, Siebenga J, et al. Inter- and intraobserver agreement on the Load Sharing Classification of thoracolumbar spine fractures. Injury, 2012, 43(4): 416-422.
10. Parker JW, Lane JR, Karaikovic EE, et al. Successful short-segment instrumentation and fusion for thoracolumbar spine fractures: a consecutive 41/2-year series. Spine (Phila Pa 1976), 2000, 25(9): 1157-1170.
11. Marco RA, Kushwaha VP. Thoracolumbar burst fractures treated with posterior decompression and pedicle screw instrumentation supplemented with balloon-assisted vertebroplasty and calcium phosphate reconstruction. J Bone Joint Surg (Am), 2009, 91(1): 20-28.
12. Chen JF, Lee ST. Percutaneous vertebroplasty for treatment of thoracolumbar spine bursting fracture. Surg Neurol, 2004, 62(6): 494-500.
13. Klezl Z, Majeed H, Bommireddy R, et al. Early results after vertebral body stenting for fractures of the anterior column of the thoracolumbar spine. Injury, 2011, 42(10): 1038-1042.
14. Dick JC, Jones MP, Zdeblick TA, et al. A biomechanical comparison evaluating the use of intermediate screws and cross-linkage in lumbar pedicle fixation. J Spinal Disord, 1994, 7(5): 402-407.
15. 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.
16. McLain RF. The biomechanics of long versus short fixation for thoracolumbar spine fractures. Spine (Phila Pa 1976), 2006, 31(11 Suppl): S70-79, 104.
17. Meves R, Avanzi O. Correlation between neurological deficit and spinal canal compromise in 198 patients with thoracolumbar and lumbar fractures. Spine (Phila Pa 1976), 2005, 30(7): 787-791.
18. Wood K, Buttermann G, Mehbod A, et al. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomized study. J Bone Joint Surg (Am), 2003, 85-A(5): 773-781.
19. Miyashita T, Ataka H, Tanno T. Clinical results of posterior stabilization without decompression for thoracolumbar burst fractures: is decompression necessary?. Neurosurg Rev, 2012, 35(3): 447-455.

Chinese Journal of Reparative and Reconstructive Surgery

Posterior short-segment fixation including the fractured vertebra for severe unstable thoracolumbar fractures

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