In-Fracture Pedicular Screw Placement During Ligamentotaxis Following Traumatic Spine Injuries, a Randomized Clinical Trial on Outcomes

Abstract

Objective To investigate the efficacy and safety of two different techniques for spinal ligamentotaxis. Spine ligamentotaxis reduces the number of retropulsed bone fragments in the fractured vertebrae. Two different ligamentotaxis techniques require clinical evaluation. Methods This was a randomized clinical trial. The case group was defined as one pedicular screw insertion into a fractured vertebra, and the control group as a no-pedicular screw in the index vertebra. Spine biomechanical values were defined as primary outcomes and complications as secondary outcomes. Results A total of 105 patients were enrolled; 23 were excluded for multiple reasons, and the remaining were randomly allocated into the case (n=40) and control (n=42) groups. The patients were followed up and analyzed (n=56). The postoperative mid-sagittal diameter of the vertebral canal (MSD), kyphotic deformity correction, and restoration of the anterior height of the fractured vertebrae showed equal results in both groups. Postoperative retropulsion percentage and pain were significantly lower in the case group than in the control group ( p =0.003 and p =0.004, respectively). There were no group preferences for early or long-term postoperative complications. Conclusions Regarding clinical and imaging properties, inserting one extra pedicular screw in a fractured vertebra during ligamentotaxis results in better retropulsion reduction and lower postoperative pain.

Letter to the Editor: Commentary on In-Fracture Pedicular Screw Placement During Ligamentotaxis Following Traumatic Spine Injuries, a Randomized Clinical Trial on Outcomes (Korean J Neurotrauma 2023;19:90–102)

“…Thank you for the opportunity to review the paper “In-Fracture Pedicular Screw Placement During Ligamentotaxis Following Traumatic Spine Injuries, a Randomized Clinical Trial on Outcomes.” 8) …”

Authors’ Reply to Letter to the Editor: Commentary on In-Fracture Pedicular Screw Placement During Ligamentotaxis Following Traumatic Spine Injuries, a Randomized Clinical Trial on Outcomes (Korean J Neurotrauma 2023;19:90–102)

“…We have read the letter to the editor note that was previously published in your journal. 3 5) We would like to thank the author who have read our paper and evaluated it scientifically.…”

“… 3) We have discussed our possible explanations to support this incidental finding as you can see in the discussion section. 5) To our knowledge, there is no well-delineated evidence explaining this finding, but the authors hypothesize that stronger solid fixation via 1-extra pedicle screw (PS), further reduction, neural decompression, and nociceptive-ablative procedures during PS placement at the fracture site could be explanations. However, cannot disagree with the Lee’s hypothesis and the authors would like to encourage further research from this perspective in future studies.…”