Radiological study on disc degeneration of thoracolumbar burst fractures treated by percutaneous pedicle screw fixation

Abstract

Objective To examine disc degeneration at levels adjacent and next adjacent to the fractured vertebra and to analyses, if the disc degeneration is determined by the endplate fracture. Summary of background data Thoracolumbar burst fracture is one of the most common spinal injuries. The diagnostic (clinical and imaging) approach and treatment of a fractured vertebra is well established; however, some controversy remains. The associated disc degeneration is less well known after 9-12 months of the short segment pedicle screw fixations. There is a major controversy whether spinal trauma with vertebral endplate fractures can result in posttraumatic disc degeneration. No study to date, however, has assessed disc degeneration of the AO type A3 thoracolumbar fractures without neurologic deficits after pedicle screw fixations. Methods Twenty-six patients with single-level AO type A3 thoracolumbar fractures and no neurological deficit were treated by using postural reduction and short segment percutaneous pedicle screw fixation. No laminectomy and fusion were performed. Implants were removed 9-12 months after the first operation. The thoracolumbar magnetic resonance imaging (MRI) was used to assess disc degeneration at levels adjacent and next adjacent to the fractured vertebra before the first operation and after the second operation in a retrospective study.Results After the instrumentation removal, new disc degeneration was usually found at level adjacent to the cranial endplate of fractured vertebra by MRI examination in 24 patients. The average Pfirrmann grade of degenerative discs adjacent to the cranial fractured endplates deteriorated from 2.1 pre-operatively to 3.4 after the second operation. No change of disc degeneration was seen at the caudal disc space adjacent to the fractured vertebra and the levels next adjacent to the fractured vertebra. The discs next adjacent to the fractured vertebra were showed to be relatively normal without changes of degeneration during the study period. Conclusions Disc degeneration usually occurs at level adjacent to the fractured endplate of thoracolumbar burst fractures. Endplate fracture is strongly associated with disc degeneration. No correlation between fixation level and disc degeneration is seen in this study.

Enhancement of Lumbar Fusion and Alleviation of Adjacent Segment Disc Degeneration by Intermittent PTH(1-34) in Ovariectomized Rats

“…Thus, altered nutrition supply of the endplate may be a causative factor in osteoporotic ASDD . Additionally, endplate damage, such as microfractures, creates abnormal stress distributions in the adjacent intervertebral disc, increasing the risk of internal disruption and disc degeneration . The current study showed a significant increase in endplate thickness and rate of calcification and significantly decreased in MVD and relative area of vascular buds in the Sham+PLF+V group.…”

“…(54,55) Additionally, endplate damage, such as microfractures, creates abnormal stress distributions in the adjacent intervertebral disc, increasing the risk of internal disruption and disc degeneration. (56)(57)(58) The current study showed a significant increase in endplate thickness and rate of calcification and significantly decreased in MVD and relative area of vascular buds in the ShamþPLFþV group. In addition, the parameters of the ASDD extent was significantly increased by addition of OVX.…”

Surgical outcomes of temporary short-segment instrumentation without augmentation for thoracolumbar burst fractures

“…Concerning the loss of adjacent disc height and disc degeneration after surgery, Wang et al [19] reported that disc degeneration usually occurs at the level adjacent to the fractured endplate of thoracolumbar burst fractures after implant removal in shortsegment pedicle screw fixation without augmentation. They also concluded that endplate fracture is strongly associated with disc degeneration.…”

Morphological similarities after compression trauma of bovine and human intervertebral discs. Do disc cells have a chance of surviving?

“…This group showed vertebral endplate lesions to be associated with disc degeneration, with larger lesions being associated with more severe disc degeneration . Furthermore, Wang et al found an increase in Pfirrmann degeneration grades in discs adjacent to the cranial fractured endplate 12 months post‐trauma (A3‐fractures), after removal of the pedicle screw instrumentation. No change was found in the caudal disc space or the levels next to the fractured vertebrae …”

“…Furthermore, Wang et al found an increase in Pfirrmann degeneration grades in discs adjacent to the cranial fractured endplate 12 months post‐trauma (A3‐fractures), after removal of the pedicle screw instrumentation. No change was found in the caudal disc space or the levels next to the fractured vertebrae …”