One-stage partial vertebrectomy, titanium mesh implantation and pedicle screw fixation in the treatment of thoracolumbar burst fractures through a posterior approach

Abstract

OBJECTIVE:To analyze the clinical results of a partial vertebrectomy with titanium mesh implantation and pedicle screw fixation using a posterior approach to reconstruct the spine in the treatment of thoracolumbar burst fractures.METHOD:From January 2006 to August 2008, 20 patients with severe thoracolumbar fractures were treated.For vertebral bodies associated with one injured intervertebral disk, subtotal vertebrectomy surgery and single-segment fusion were performed. For vertebral bodies with two injured adjacent intervertebral disks, partial vertebrectomy surgery and two-segment fusion were performed.RESULTS:All 20 patients were followed up for 12 to 24 months (average of 18 months). There were no complications such as wound infections, hemopneumothorax or abdominal infections in any of the patients. The neurological status of all of the patients was improved by at least one American Spinal Injury Association grade by the last follow-up. The anterior vertebral body height was an average of 50.77% before surgery, 88.51% after surgery and 87.86% at the last follow up; the sagittal Cobb angle was improved, on average, from 26.15° to 5.39° and was 5.90° at the last follow up. The percentage of spinal stenosis was improved, on average, from 26.07% to 4.93%° and was 6.15% at the last follow up. There were significant differences in the anterior vertebral body height pre- and post-surgery and in the sagittal Cobb angle and the percentage of spinal stenosis (p<0) in all patients.CONCLUSIONS:This surgical procedure is simple and can accomplish decompression, reduction, fixation and fusion of the spine in one stage. This approach could be widely used in orthopedics.

Evaluation of parallel endplate osteotomy for severe rigid spinal deformities: a retrospective analysis of 36 cases with a minimum 2-year follow-up

“…The surgical objective for severe (Cobb angle > 80°) kyphosis and rigid spinal kyphoscoliosis deformities is decompression of neurological elements and correction of the deformities, which have always been a great challenge for spine specialists [ 20 ]. The surgical treatment is highly demanding and risky for both the surgeon and the patient [ 21 ]. In severe rigid spinal deformities, conventional correction methods, including posterior instrumentation and fusion or combinations of anterior release and posterior instrumentation and fusion, are usually unsatisfactory [ 22 , 23 ].…”

Low Lumbar Fractures: Unique Biomechanics and Treatment Options

“…In lower lumbar burst fractures with excessive vertebral compression and neurologic damage, standard alternatives are open posterior decompression and stabilization with a pedicle screw system. The additional care might include bed rest or bracing to permit fracture union and this can ultimately prevent implant failure [3,44,45].…”

“…They obviate the need for an anterior approach to reconstruct the ver-tebral body. Meticulous care must be taken to reserve the spinal nerve roots [45,46] (Figure 3).…”

Clinical effect of limited posterior decompression and 13-mm titanium mesh implantation on severe thoracolumbar burst fractures: A case series

“…Many authors advocated a new surgical method for thoracolumbar burst fracture, namely the three-column reconstruction of the vertebral body with the implantation of titanium mesh for one-stage spinal canal decompression ( 9 , 10 ). In 2008, Huazi et al ( 11 ) described an innovative treatment method for thoracolumbar burst fractures through a posterior incision with 270° spinal canal decompression and reconstruction surgery.…”