Objective To compare the effectiveness of long- and short-segment posterior pedicle screw fixation for thoracolumbar fracture. Methods Between January 2007 and December 2009, 58 patients with AO type B thoracolumbar fracture underwent posterior pedicle screw fixation. Of 58 patients, 36 received short-segment pedicle fixation (1 upper and 1 lower vertebral bodies of the fractured vertebral body) in group A, and 22 received long-segment pedicle fixation (2 upper and 2 lower vertebral bodies of the fractured vertebral body) in group B. There was no significant difference in age, gender, injury cause, fracture site, preoperative Frankel grade, and disease duration between 2 groups (P gt; 0.05). The operation time, blood loss, complication, anterior vertebra compression rate (AVCR), and Cobb angle were compared between 2 groups. Frankel grade was used to evaluate the neurological function. Results The operation time and blood loss of group B were significantly higher than those of group A (P lt; 0.05). All incisions obtained primary healing. The patients were followed up 17.2 months on average (range, 12-32 months). No complication occurred in the other patients except 1 case having internal fixation failure and 1 case having aggravated kyphosis deformity in group A. The neurological function recovered in a certain degree; Frankel grade at 3 months was significantly improved when compared with preoperative one (P lt; 0.05) in 2 groups, but no significant difference was found between 2 groups (Z=0.09, P=0.36). The AVCR and Cobb angle were significantly lower in 2 groups at immediately after operation and last follow-up than those before operation (P lt; 0.05). The correction rates of AVCR and Cobb angle in group B were significantly higher than those in group A (P lt; 0.05); whereas the correction losses of AVCR and Cobb angle in group B were significantly less than those in group A (P lt; 0.05). Conclusion Long-segment pedicle screw fixation is better than short-segment pedicle screw fixation in the correction of kyphosis and recovery of vertebra body height, especially in the prevention of correction loss in long-term follow-up although it will increase the blood loss and operation time.
Objective To investigate the influence of spinal cord decompression on posterior surgical treatment of thoracolumbar fracture, and to provide the practical basis for the indications of posterior spinal cord decompression Methods The cl inical data were retrospectively analyzed from 170 cases of thoracolumbar fracture treated with posterior surgical treatment between January 2005 and January 2009. There were 119 males and 51 females with an average age of42.7 years (range, 17-68 years). The fracture locations included T11 in 22 cases, T12 in 30 cases, L1 in 57 cases, and L2 in 61 cases. According to Denis classification system, there were 65 cases of compression fractures, 44 cases of burst fractures, 25 cases of flexion-distraction injuries, and 36 cases of fracture-dislocations. The time from injury to operation was 3-8 days (mean, 4.4 days). All the cases were divided into 4 groups according to space-occupying rates of spinal cord: group A, ≤20% (n=32); group B, 21%-40% (n=68); group C, 41%-60% (n=37); and group D, ≥ 61% (n=33). Through statistical analysis, the correlation between space-occupying rates and spinal cord function (Frankel grade) was evaluated, and the necessities of spinal cord decompression was studied in the patients who had neurological symptoms with space-occupying rates under 40%. Results There was no positive correlation between the degree of spinal cord injury and the space-occupying rates of bone fragments broken into the spinal canal. All patients were followed up 13-41 months (mean, 23.5 months). During the follow-up period, no secondary neurological damage occurred in the patients who were not given posterior spinal cord decompression with space-occupying rates under 40% (28 cases). And also in the cohort of patients with neurological symptoms whose space-occupying rates were under 40%, the posterior spinal cord decompression (65 cases) could improve the spinal cord function significantly when compared with no decompression cohort (7 cases), (P lt; 0.05). Conclusion The relative indications of posterior spinal cord decompression for thoracolumbar fracture are as follows: the cases having neurological symptoms with space-occupying rates under 40% and the ones having the neurological symptoms or not with space-occupying rates above 40%.
Objective To study the effectiveness of transpedicular intervertebral bone graft and pedicle screws fixation in injured vertebrae for the treatment of thoracolumbar fractures. Methods Between February 2007 and January 2009, 25 patients with thoracolumbar fractures were treated by posterior short-segment fixation combined with transpedicular intervertabral bone graft and pedicle screw fixation in injured vertebrae. There were 18 males and 7 females with a mean ageof 46 years (range, 28-63 years). The injured vertebrae were located at T10 in 1 case, T11 in 2 cases, T12 in 8 cases, L1 in 6 cases, L2 in 6 cases, L3 in 1 case, and L4 in 1 case. According to Denis classification, there were 14 cases of burst fractures and 11 cases of compression fractures. Based on Frankel classifications, 2 cases were rated as grade A, 4 cases as grade B, 8 cases as grade C, 7 cases as grade D, and 4 cases as grade E. The time between injury and operation was 6 hours to 7 days (mean, 4.6 days). The X-ray film was taken to measure the relative height of fractured vertebrae and Cobb angle, and Frankel classification was conducted to evaluate the function recovery of the spinal cord. Results The operations were performed successfully, and incisions healed primarily. All the patients were followed up 12-25 months (mean, 16 months). CT and X-ray films showed good bone graft heal ing and no loosening or breakage of screws and rods. The relative height of fractured vertebrae were 56.8% ± 15.6% at preoperation, 91.2% ± 10.7% immediately after operation, and 89.6% ± 10.3% at 1 year after operation, showing significant differences between preoperation and postoperation (P lt; 0.01), while no significant difference between immediately after operation and 1 year after operation. The Cobb angles were (18.2 ± 2.6), (7.5 ± 1.4), and (8.7 ± 1.1)°, respectively, showing significant differences between preoperation and postoperation (P lt; 0.01), while no significant difference between immediately and 1 year after operation. At 1 year after operation, the neural function in 16 cases was improved 1-3 grades. ConclusionTreatment of thoracolumbar fractures with transpedicular intervertebral bone graft and pedicle screw fixation in injuredvertebrae has satisfactory effectiveness, which can reconstruct vertebral body height, increase the stabil ity of anterior and middle
Objective To study the feasibil ity and rel iabil ity of the multi-plannar reformation (MPR) of multispiral CT (MSCT) in measuring the kyphosis angle (KA) after thoracolumbar fracture. Methods From December 2007 to December 2009, 45 thoracolumbar fracture patients who underwent computed radiology (CR) and MSCT were recruited. There were 32 males and 13 females with a mean age of 48 years (range, 24-63 years), including 36 simple compression fractures and 9 burst fractures. The fracture locations were T11 in 6 cases , T12 in 11 cases, L1 in 20 cases, and L2 in 8 cases. Fracture was caused by trafffic accident in 25 cases, by fall ing from height in 12 cases, and by others in 8 cases. The imaging examination was performed after 2 hours to 7 days of injury in 22 cases and after more than 7 days in 23 cases. The KA was measured on the lateral X-ray films of CR and MPR by two observers, then the measurements were done again after three weeks. The data were statistically analyzed. Results The average KA values on CR by two observers were (20.75 ± 8.31)° and (22.49 ± 9.07)°, respectively; showing significant difference (P lt; 0.05), and the correlation was good (r=0.882, P lt; 0.05). The average KA values on MPR by two observers were (16.65 ± 8.62)° and (17.08 ± 7.88)°, respectively, showing no significant difference (P gt; 0.05), the correlation was excellent (r=0.976, P lt; 0.05). The average KA values on CR and MPR were (21.61 ± 8.43)° and (16.87 ± 8.20)°, respectively; showing significant difference (P lt; 0.05), the correlation was good (r=0.852, P lt; 0.05). Conclusion It is more feasible and rel iable in measuring the KA on MRP of MSCT than CR, but the value is larger on CR.
Objective To review the latest progress in classification system of thoracolumbar fractures and its surgical treatment with posterior approaches. Methods Recent l iterature about classification system of thoracolumbar fractures and its surgical treatment was reviewed. Results For the treatment of thoracolumbar fracture, the surgeon first should decide whether the surgical treatment was necessary. Recently, a new classification system had been developed to help the surgeon make the right decision. The surgical methods included short segment internal fixation and long segment internalfixation with or without fusion, and minimally invasive internal fixation. Conclusion The progress in the surgical treatmentof thoracolumbar fracture will help spinal surgeon decide the necessary surgery beneficial for the patients. The most appropriate and effective surgical method with the minimum damage should be used to treat the fracture. The advantages of non-fusion surgical treatment still need a further study.
A new method of anterior decompression for thoracolumbar fractures with paralysi s in six cases was reported. In a follw-up of one to five months, was shown that the neurological functions in all six cases has improved ⅡⅢ rank in Frankl classification. The author believe that the method has the following advantages, such as: less trauma from operation; the level and the limit of decompression could be made without Xray during the operation; usually only 1/5 to 1/4 of the vertebral body was excised so that the stability of the spine was not disturbed, and the obvious favourable results.
ObjectiveTo evaluate the clinical efficacy of domestic minimally-invasive percutaneous screw system for thoracolumbar fractures without neurological damage. MethodsSixty patients suffering from unstable thoracolumbar fractures without obvious neurologic deficits treated from January 2011 to April 2012 were studied retrospectively. The patients were divided into two groups:group A (domestic minimally-invasive percutaneous screw system) and group B (imported minimally-invasive percutaneous screw system). Perioperative parameter, pre-and post-operative imaging indexes, visual analog scale (VAS) and modified MacNab evaluation standard were studied for comparison. ResultsAll the patients were followed up from 6 to 18 months with an average of (12.2±3.0) months. The Cobb's angle and anterior height of the fracture vertebral body changed significantly in each group (P<0.05). There was no significant difference in incision size, surgical time, postoperative improvement of Cobb's angle, anterior height of the fracture vertebral body and accuracy of pedicle screw placement between the two groups (P>0.05). ConclusionDomestic minimally-invasive percutaneous screw system is reliable with minimal invasion, which is comparable to imported minimally-invasive percutaneous screw system.
ObjectiveTo investigate the security of pedicle screw fixation in fractured vertebra in treatment of thoracolumbar fractures by comparing with routine fixation cross fractured vertebra. MethodsA total of 101 cases of single segmental thoracolumbar fracture were selected between June 2008 and June 2011. Of them, 56 cases underwent pedicle screw fixation in fractured vertebra (group A), and 45 cases received routine fixation cross fractured vertebra (group B). There was no significant difference in gender, age, causes of injury, fracture type, fracture segment, Frankel grading, time of injury to operation, and the preoperative anterior vertebral height compression ratio and the canal occupation rate between 2 groups (P>0.05). There were 34 cases of junction fracture of pedicle and vertebra (type I), 2 cases of pedicle waist fracture (type Ⅱ), and 20 cases of junction fracture of pedicle and lamina (type Ⅲ) in group A. The position of fractured vertebral pedicle screw was observed; the anterior vertebral height compression ratio, canal occupation rate, and surgical complications were compared between 2 groups. ResultsA total of 103 pedicle screws were placed in 54 patients of group A, except 2 patients of type Ⅱ fracture; 96 screws were placed in the bone cortex completely and 7 screws deviated. The operation time of group A was significantly longer than that of group B (t=4.339, P=0.000), but there was no significant difference in intraoperative blood loss between 2 groups (t=-0.089, P=0.929). All 101 patients were followed up 6-16 months (mean, 8.5 months). The patients of 2 groups achieved nerve functional recovery. Fixation-related complications occurred in 1 case of 2 groups respectively, showing no significant difference (P=1.000). At last follow-up, according to Denis lumbago classification, 51 cases were rated as P1 level and 5 cases as P2 level in group A; 35 cases were rated as P1 level, 8 cases as P2 level, and 2 cases as P3 level in group B; and there was no significant difference between 2 groups (Z=-1.836, P=0.066). There was no significant difference between 2 groups in canal occupation rate at immediate after operation and at last follow-up (P>0.05), and in the anterior vertebral height compression ratio at immediate after operation (P>0.05), but the anterior vertebral height compression ratio of group B was significantly higher that of group A at last follow-up (P<0.05). ConclusionSingle segmental thoracolumbar fracture treated by pedicle screw fixation in fractured vertebra through posterior approach is safe and feasible according to different pedicle fracture types to guide fixation.
ObjectiveTo 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. MethodsBetween 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. ResultsThe 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. ConclusionIt 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.
ObjectiveTo evaluate the clinical significance of individualized reference model of sagittal curves and navigation templates of pedicle screw by three-dimensional printing technique for thoracolumbar fracture with dislocation. MethodsBetween February 2011 and November 2013, 42 patients with thoracolumbar fracture and dislocation undergoing pedicle screw fixation were divided into 2 groups:traditional pedicle screw internal fixation by fluoroscopy assistant was used in 24 cases (control group), and individualized reference model of sagittal curves and navigation templates of pedicle screw were used in 18 cases (trial group). There was no significant difference in gender, age, injury causes, segment, degree of dislocation, and Frankel classification between 2 groups (P>0.05). The operation time, intraoperative blood loss, perspective times, and dislocation rate, sagittal angle recovery rate at different time were compared. The success rate of pedicle screw insertion, sagittal screw angle, and Frankel classification were compared. The angle between sagittal screws, difference of screw entry point at horizontal position, and difference of screw inclined angle were compared. ResultsThe operating time, intraoperative blood loss, and perspective times in trial group were significantly lower than those in control groups (P<0.05). All the patients were followed up 12-40 months (mean, 22 months). The dislocation rate at immediate after operation and last follow-up were significantly improved when compared with preoperative value in 2 groups (P<0.05). At immediate after operation and last follow-up, the dislocation rate and sagittal angle recover rate in trial group were significantly better than those in control group (P<0.05). There were significant differences in the one-time success rate, final success rate of pedicle screw insertion, and saggital screw angle between 2 groups (χ2=9.38, P=0.00; χ2=10.95, P=0.00; χ2=13.43, P=0.00). The angle between sagittal screws, difference of screw entry point at horizontal position, and difference of screw inclined angle in trail group were significantly less than those in control group (P<0.05). There was significant difference in the Frankel classification between 2 groups at last follow-up (Z=-1.99, P=0.04). ConclusionThe application of individualized reference model of sagittal curves and navigation templates of pedicle screw by three-dimensional printing technique for thoracolumbar fracture with dislocation has the advantages of shorter operation time, less intraoperative blood loss, better recovery of thoracolumbar dislocation, and better Frankel classification.