Posterior fixation of thoracolumbar burst fractures: Is it possible to protect one segment in the lumbar region?

Paudel

J Minim Invasive Spine Surg Tech

et al. 2017

Objective: The optimal treatment methods for thoracolumbar burst fracture with intact neurology are not established yet. Spinal canal integrity, sagittal balance and anterior column intactness are very important for successful outcome in this type of injury. There is no study analyzing restoration of these parameters by low pressure restoration using postural pillow reduction and lordotic posterior column compressive percutaneous transpedicular screw fixation and this study analyzes canal remodeling, spinal balance and anterior column intactness after this procedure. Methods: The surgical procedure included three different elements: (1) preoperative postural pillow reduction for 1-2 days, (2) augmentation of fractured vertebra by polymethylmethacrylate (PMMA) in osteoporotic bone or by non-PMMA materials in non-osteoporotic bone, and (3) lordotic, posterior column compressive, percutaneous transpedicular screw fixation. We measured anterior vertebral height, canal size and lordotic angle preoperatively, immediate postoperatively and after 6 months in 34 patients treated with this technique and were analyzed. Results: Of 34 patients 17 were male. The mean age was 52.03±12.51 years. They were followed for 30.68±11.67 months on average. At 6 months, preoperative canal stenosis of 44% remodeled to 12%, preoperative anterior vertebral height of 44% increased to 77% and preoperative average kyphosis of 14 degrees corrected to 3.4 degrees No neurological deterioration noted. Functionally all patients returned to their previous status. Conclusion: The postural pillow reduction and lordotic posterior column compressive percutaneous screw fixation in patients with neurologically intact thoracolumbar burst fracture is effective and safe.

Section: Discussionsupporting

confidence: 83%

Spontaneous Spinal Canal Remodeling after Postural Pillow Reduction and Lordotic Posterior Column Compressive Percutaneous Transpedicular Screw Fixation in Neurologically Intact Thoracolumbar Burst Fractures

Paudel

J Minim Invasive Spine Surg Tech

et al. 2017

“…The signs on radiography and axial-CT that are characteristic of burst-type fractures described by Denis [6] were found by other authors [1] [11]- [17] [22]- [25] in injuries with flexion and distraction, since the mechanism of injury in these cases can aggregate axial forces that result in compression injury of the posterior column (sub type B of Margerl et al) [8]. In burst fractures, injuries in the posterior capsular ligamentous complex may be suggested by the increase in the interspinous distance at the level of fracture in AP plain radiographs [18]- [20].…”

Section: Discussionsupporting

confidence: 55%

Can the Interspinous Distance Predict Kyphosis in Conservative Treatment in Thoracolumbar Burst Fracture? A Retrospective, Diagnostic Study

Meves¹,

Avanzi²

2016

OJO

Study Design: Retrospective, diagnostic study. Objective: To verify if the interspinous distance is able to predict the risk for kyphotic collapse in thoracolumbar burst fractures treated conservatively without neurological deficit. Summary of Background Data: In patients with thoracolumbar burst fractures, the association between the amount of comminution, by using load-sharing classification (LSC), and kyphotic collapse is presented in the literature. However, LSC does not include the interspinous distance as an indirect sign to suggest biomechanical instability due to posterior ligamentous disruption in these patients in order to predict kyphotic collapse. Methods: We added the interspinous distance to the load-sharing classification (MLSC) in 50 consecutive patients with thoracolumbar burst fractures (according to Denis criteria) treated conservatively. Results: The LSC score was correlated to kyphotic collapse in the patients treated with TLSO (r = 0.312, p = 0.027; Spearman test; A = 0.668). The MLSC was similarly correlated to kyphotic collapse among TLSO-treated patients (r = 0.295, p = 0.038; Spearman test; A = 0.652). Conclusions: The interspinous distance did not contribute to the identification of worse radiographic outcomes, represented by the kyphotic collapse. This may suggest that the amount of comminution pointed out by the LSC is enough and more important than the interspinous opening in order to predict kyphotic collapse in thoracolumbar burst fractures. Possibly, the interspinous distance is much too heterogenous and multifactorial to be useful, since it reflects vertebral body height, preinjury anatomy, as well as posterior element disruption.

“…No additional studies were obtained after reference review. Finally, nine trials including were selected and analyzed [ 9 13 19 20 21 22 23 25 ] ( Fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Six studies reported the final follow-up Cobb's angle in 154 patients (short segment group, 118; long segment group, 75) [ 1 20 21 22 23 25 ]. The fixed-effects model was applied to compare the follow up Cobb's angle between the two groups.…”

Section: Resultsmentioning

confidence: 99%

“…Several trials have been conducted comparing the clinical and radiological efficacy of posterior short segment fixation versus posterior long segment fixation [ 9 13 19 20 21 22 23 ]. The objective of this meta-analysis was to identify and summarize the evidence from randomized controlled trials on the effectiveness of number of fixed spine segments for thoracolumbar burst fractures.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Short Segment versus Long Segment Pedicle Screws Fixation in Management of Thoracolumbar Burst Fractures: Meta-Analysis

Aly

2017

Asian Spine J

Posterior pedicle screw fixation has become a popular method for treating thoracolumbar burst fractures. However, it remains unclear whether additional fixation of more segments could improve clinical and radiological outcomes. This meta-analysis was performed to evaluate the effectiveness of fixation levels with pedicle screw fixation for thoracolumbar burst fractures. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Springer, and Google Scholar were searched for relevant randomized and quasirandomized controlled trials that compared the clinical and radiological efficacy of short versus long segment for thoracolumbar burst fractures managed by posterior pedicle screw fixation. Risk of bias in included studies was assessed using the Cochrane Risk of Bias tool. Based on predefined inclusion criteria, Nine eligible trials with a total of 365 patients were included in this meta-analysis. Results were expressed as risk difference for dichotomous outcomes and standard mean difference for continuous outcomes with 95% confidence interval. Baseline characteristics were similar between the short and long segment fixation groups. No significant difference was identified between the two groups regarding radiological outcome, functional outcome, neurologic improvement, and implant failure rate. The results of this meta-analysis suggested that extension of fixation was not necessary when thoracolumbar burst fracture was treated by posterior pedicle screw fixation. More randomized controlled trials with high quality are still needed in the future.