Is posterior fixation alone effective to prevent the late kyphosis after T-L fracture?

Martiniani, Monia; Vanacore, Felice; Meco, Leonard; Specchia, Nicola

doi:10.1007/s00586-013-3008-x

Cited by 14 publications

(14 citation statements)

References 22 publications

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“…However, the center of the end plate is in a compression state and develops a cup-like deformity because it is not attached by the annulus fibrosus. Under such conditions, the protruded intervertebral disc tissues result in a great loss of intervertebral space height - 16 . In our study, if their conditions permitted, combined anterior and posterior surgeries were performed for patients suffering from incomplete neurological damage caused by anterior vertebral elements (e.g., compressions) and severe intervertebral disc injuries.…”

Section: Discussionmentioning

confidence: 99%

A retrospective study evaluating the correlation between the severity of intervertebral disc injury and the anteroposterior type of thoracolumbar vertebral fractures

Su¹,

Ren²,

Zou³

et al. 2016

Clinics

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OBJECTIVE:To evaluate the correlation between the severity of intervertebral disc injury and the anteroposterior type of thoracolumbar vertebral fractures.METHODS:Fifty-six cases of thoracolumbar vertebral fractures treated in our trauma center from October 2012 to October 2013 were included in this study. The fractures were classified by the anteroposterior classification, whereas the severity of intervertebral disc injury was evaluated using magnetic resonance imaging. The Spearman correlation coefficient was used to analyze the correlation between the severity of intervertebral disc injury and the anteroposterior type of thoracolumbar fractures, whereas a χ2 test was adopted to measure the variability between different fracture types and upper and lower adjacent disc injuries.RESULTS:The Spearman correlation coefficients between fracture types and the severity of the upper and lower adjacent disc injuries were 0.739 (PU<0.001) and 0.368 (PL=0.005), respectively. It means that the more complex Arbeitsgemeinschaft für Osteosynthesefragen (AO) classifications are the disc injury is more severe. There was also a significant difference in the severity of injury between the upper and lower adjacent discs near the fractured vertebrae (p<0.001).CONCLUSIONS:In thoracolumbar spinal fractures, the severity of the adjacent intervertebral disc injury is positively correlated with the anteroposterior fracture type. The injury primarily involves intervertebral discs near the fractured end plate, with more frequent and severe injuries observed in the upper than in the lower discs. The presence of intervertebral disc injury, along with its severity, may provide useful information during the clinical decision-making process.

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Section: Discussionmentioning

confidence: 99%

A retrospective study evaluating the correlation between the severity of intervertebral disc injury and the anteroposterior type of thoracolumbar vertebral fractures

Su¹,

Ren²,

Zou³

et al. 2016

Clinics

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“…With single posterior instrumentation, an average loss of correction of 6.25° was found [1]. Further studies support these finding going along with a high failure rate of the implants [20][21][22][23]. A combined posterior-anterior procedure provided a better maintenance of the correction compared to the posterior only group [9]; however, even after this more complex surgical procedure there was a marked loss of correction of average 3.6° [1].…”

Section: Discussionmentioning

confidence: 77%

The effect of posterior compression of the facet joints for initial stability and sagittal profile in the treatment of thoracolumbar fractures: a biomechanical study

et al. 2021

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Purpose Surgical treatment of thoracolumbar A3-fractures usually comprises posterior fixation—in neutral position or distraction—potentially followed by subsequent anterior support. We hypothesized that additional posterior compression in circumferential stabilization may increase stability by locking the facets, and better restore the sagittal profile. Methods Burst fractures Type A3 were created in six fresh frozen cadaver spine segments (T12–L2). Testing was performed in a custom-made spinal loading simulator. Loads were applied as pure bending moments of ± 3.75 Nm in all six movement axes. We checked range of motion, neutral zone and Cobb’s angle over the injured/treated segment within the following conditions: Intact, fractured, instrumented in neutral alignment, instrumented in distraction, with cage left in posterior distraction, with cage with posterior compression. Results We found that both types of instrumentation with cage stabilized the segment compared to the fractured state in all motion planes. For flexion/extension and lateral bending, flexibility was decreased even compared to the intact state, however, not in axial rotation, being the most critical movement axis. Additional posterior compression in the presence of a cage significantly decreased flexibility in axial rotation, thus achieving stability comparable to the intact state even in this movement axis. In addition, posterior compression with cage significantly increased lordosis compared to the distracted state. Conclusion Among different surgical modifications tested, circumferential fixation with final posterior compression as the last step resulted in superior stability and improved sagittal alignment. Thus, posterior compression as the last step is recommended in these pathologies.

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“…However, the long-term results showed cases of progressive disc collapse. 22 It is a frequently observed complication. (Figure 8) The possibility of positioning convergent screws in the ends of the fixation is suggested.…”

Section: Discussionmentioning

confidence: 99%

Correction of the Spinal Sagittal Plane: The Application of Convergent or Divergent Screws

Garcia

Júnior³

et al. 2020

Coluna/Columna

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Objective To present a new principle for correction of the sagittal plane of the spine through the convergent or divergent placement of monoaxial pedicle screws in this plane, associated with compression or distraction, to provide lordotizing or kyphotizing leverage force. Method A statistical mechanical study of twenty-eight fixations in synthetic spine segments was performed. In fifteen pieces, pedicle screws were applied to the ends of the segments with positioning convergent to the center of the fixation. They were attached to the straight rods and subjected to compression force. The other thirteen segments were fixed with pedicle screws in a direction divergent to the center of the fixation, attached to the straight rods, and subjected to distraction force. Results To create kyphosis in the 15 synthetic segments of the spine, the mean pre-fixation Cobb angle was - 0.7° and the mean post-fixation angle was +15°. To create lordosis in the 13 segments, the mean pre-fixation Cobb angle was +1° and the mean post-fixation angle was +18°. The difference was confirmed by statistical mechanical tests and considered significant. However, there is no relevant difference between the mean angles for lordosis and kyphosis formation. Conclusions It was concluded that the correction of the sagittal plane of the spine by applying the new instrumentation method is efficient. A statistical mechanical test confirmed that the difference in Cobb degrees between pre- and post-fixation of the synthetic spine segments was considered significant in the creation of both kyphosis and lordosis. Level of evidence II C; Statistical mechanical study of synthetic spine segments.

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Is posterior fixation alone effective to prevent the late kyphosis after T-L fracture?

Cited by 14 publications

References 22 publications

A retrospective study evaluating the correlation between the severity of intervertebral disc injury and the anteroposterior type of thoracolumbar vertebral fractures

A retrospective study evaluating the correlation between the severity of intervertebral disc injury and the anteroposterior type of thoracolumbar vertebral fractures

The effect of posterior compression of the facet joints for initial stability and sagittal profile in the treatment of thoracolumbar fractures: a biomechanical study

Correction of the Spinal Sagittal Plane: The Application of Convergent or Divergent Screws

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