Intermediate Screws in Short Segment Pedicular Fixation for Thoracic and Lumbar Fractures

Anekstein, Yoram; Brosh, Tamar; Mirovsky, Yigal

doi:10.1097/01.bsd.0000211240.98963.f6

Cited by 82 publications

(71 citation statements)

References 19 publications

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“…Another mid-term clinical study demonstrated superior results with the fracture-level screw combination, supporting the evidence of other reports 22. Interestingly, in most of these studies, the pedicle screws used were monoaxial, despite the current trend toward using polyaxial screws in short-segment fracture fixation 10–1221. On review of the literature, we found that there was a paucity of data, both clinical and biomechanical, on the use of polyaxial screw as an intermediate in unstable burst fractures, and thus this biomechanical study was instituted.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, the pattern and nature of a spinal burst fracture in clinic is more variable and unpredictable. Anekstein et al 12. hypothesized that the true mechanical effect of the intermediate screws is less predictable in in vivo settings.…”

Section: Discussionmentioning

confidence: 99%

“…According to several biomechanical and clinical studies, monoaxial or polyaxial pedicle screws inserted at the level of fractured vertebrae, along with the segmental fixation of burst fractures, improved biomechanical stability of the construct 10–12. In the past 20 years, the design and implantation techniques of the pedicle screw systems have been modified to reduce the rate of pedicle screw breakage and to facilitate easy application of the connecting rod without undue stress on the construct 13–16.…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical efficacy of monoaxial or polyaxial pedicle screw and additional screw insertion at the level of fracture, in lumbar burst fracture: An experimental study

Wang

Liu

et al. 2012

IJOO

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Background:Use of a pedicle screw at the level of fracture, also known as an intermediate screw, has been shown to improve clinical results in managing lumbar fracture, but there is a paucity of biomechanical studies to support the claim. The aim of this study was to evaluate the effect of adding intermediate pedicle screws at the level of a fracture on the stiffness of a short-segment pedicle fixation using monoaxial or polyaxial screws and to compare the strength of monoaxial and polyaxial screws in the calf spine fracture model.Materials and Methods:Flexibility of 12 fresh-frozen calf lumbar spine specimens was evaluated in all planes. An unstable burst fracture model was created at the level of L3 by the pre-injury and dropped-mass technique. The specimens were randomly divided into monoaxial pedicle screw (MPS) and polyaxial pedicle screw (PPS) groups. Flexibility was retested without and with intermediate screws (MPSi and PPSi) placed at the level of fracture in addition to standard screws placed at L2 and L4.Results:The addition of intermediate screws significantly increased the stability of the constructs, as measured by a decreased range of motion (ROM) in flexion, extension, and lateral bending in both MPS and PPS groups (P < 0.05). There was neither any significant difference in the ROM in the spines of the two groups before injury, nor a difference in the ROM between the MPSi and PPSi groups (P > 0.05), but there was a significant difference between MPS and PPS in flexion and extension in the short-segment fixation group (P < 0.05).Conclusions:The addition of intermediate screws at the level of a burst fracture significantly increased the stability of short-segment pedicle screw fixation in both the MPS and PPS groups. However, in short-segment fixation group, monoaxial pedicle screw exhibited more stability in flexion and extension than the polyaxial pedicle screw.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Biomechanical efficacy of monoaxial or polyaxial pedicle screw and additional screw insertion at the level of fracture, in lumbar burst fracture: An experimental study

Wang

Liu

et al. 2012

IJOO

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“…However, compared to Wiltse approach, percutaneous techniques are associated with higher doses of radiation exposure without better therapeutic outcomes [8].…”

Section: Introductionmentioning

confidence: 99%

“…The advantages of this approach are; minimal tissue trauma [6], significant reduction of intraoperative muscle retraction [7], marked reduction of operative time, protection of integrity, vascularity, nerve supply and strength of paraspinal muscles, shortening of hospitalization and minimizing development of chronic postoperative back pain [8]. There are two disadvantages of this approach.…”

Section: Introductionmentioning

confidence: 99%

Utilizing Wiltse Approach for Minimal Access Posterolateral Lumbar Stabilization

Behairy¹

2018

OJMN

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An aggressive separation and prolonged overstretching of the paraspinal muscles in the posterior midline approach during lumbar non fusion dynamic stabilization in cases of spondylolisthesis resulting from pars interarticularis fracture may result in postoperative flat back deformity and intractable chronic pain. It is hypothesized that utilizing Wiltse paraspinal inter-muscular approach for this purpose may result in reduction of operative time, protection of integrity, vascularity, nerve supply and strength of paraspinal muscles, shortening of hospitalization and minimizing development of chronic postoperative back pain. So, I have performed this prospective descriptive study that involved 24 patients having single level lumbar instability at L4-5 or L5-S1 levels. All patients were operated upon using Wiltse minimal access posterolateral surgical technique for non-fusion dynamic stabilization. The final results revealed that males were 66%, females were 33% and ages were 42 ± 6 years. Trauma was reported in 12%. Low back pain and tenderness were reported in 100% and root affection reported in 25%. Plain X-ray and MRI were done in 100% and C.T. was done in 8% of cases. Level L4-5 was affected in 17% while level L5-S1 was affected in 83%. Anterolisthesis "grades 0" was found in 8%, grades 1 in 88% and retrolisthesis in 4% of cases. Operative time was 1 hour ± 10 min., blood loss was 60 ± 20 ml., patients ambulation was after 6 -8 hours, hospital stay was 12 -24 hours. None of cases were complicated with infection, screw loosening, or fixation system break. Back pain VAS diminished from 7 preoperative to 5 in 2 nd day, then became 4 by 1 week, 3 by 1 month and 0 by 6 months. It was concluded that utilizing Wiltse approach for posterolateral lumbar stabilization minimizes tissue damage and improves the speed of recovery and outcome.

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Thoracolumbar Fractures

Bransford,

Kark

2024

Orthopaedics and Trauma

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Intermediate Screws in Short Segment Pedicular Fixation for Thoracic and Lumbar Fractures

Cited by 82 publications

References 19 publications

Biomechanical efficacy of monoaxial or polyaxial pedicle screw and additional screw insertion at the level of fracture, in lumbar burst fracture: An experimental study

Biomechanical efficacy of monoaxial or polyaxial pedicle screw and additional screw insertion at the level of fracture, in lumbar burst fracture: An experimental study

Utilizing Wiltse Approach for Minimal Access Posterolateral Lumbar Stabilization

Thoracolumbar Fractures

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