Screw Fixation without Fusion for Low Lumbar Burst Fracture : A Severe Canal Compromise But Neurologically Intact Case

et al. 2014

J Korean Neurosurg Soc

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ObjectiveThe purpose of this study was to evaluate the efficacy of implant removal of percutaneous short segment fixation after vertebral fracture consolidation in terms of motion preservation.MethodsBetween May 2007 and January 2011, 44 patients underwent percutaneous short segment screw fixation due to a thoracolumbar burst fracture. Sixteen of these patients, who underwent implant removal 12 months after screw fixation, were enrolled in this study. Motor power was intact in all patients, despite significant vertebral height loss and canal compromise. The patients were divided into two groups by degree of osteoporosis : Group A (n=8), the non-osteoporotic group, and Group B (n=8), the osteoporotic group. Imaging and clinical findings including vertebral height loss, kyphotic angle, range of motion (ROM), and complications were analyzed.ResultsSignificant pain relief was achieved in both groups at final follow-up versus preoperative values. In terms of vertebral height loss, both groups showed significant improvement at 12 months after screw fixation and restored vertebral height was maintained to final follow-up in spite of some correction loss. ROM (measured using Cobb's method) in flexion and extension in Group A was 10.5° (19.5/9.0°) at last follow-up, and in Group B was 10.2° (18.8/8.6°) at last follow-up. Both groups showed marked improvement in ROM as compared with the screw fixation state, which was considered motionless.ConclusionRemoval of percutaneous implants after vertebral fracture consolidation can be an effective treatment to preserve motion regardless of osteoporosis for thoracolumbar burst fractures.

Section: Introductionmentioning

confidence: 99%

Implant Removal after Percutaneous Short Segment Fixation for Thoracolumbar Burst Fracture : Does It Preserve Motion?

et al. 2014

J Korean Neurosurg Soc

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“…Most transpedicular screw instrumentation systems have been reported to provide satisfactory results in treating burst fractures of the thoracolumbar or lumbar spine with bone fusion 8) . Nowadays, however, some good clinical outcomes were also reported with short segment fixation, without bone fusion 4 , 11 , 16) . Theoretically, igamentotaxis allows posterior instrumentation to provide distractive forces, leading to fracture reduction and canal decompression.…”

Section: Discussionmentioning

confidence: 99%

Short Segment Screw Fixation without Fusion for Unstable Thoracolumbar and Lumbar Burst Fracture : A Prospective Study on Selective Consecutive Patients

et al. 2012

J Korean Neurosurg Soc

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ObjectiveThe purpose of this prospective study was to evaluate the efficacy and safety of screw fixation without bone fusion for unstable thoracolumbar and lumbar burst fracture.MethodsNine patients younger than 40 years underwent screw fixation without bone fusion, following postural reduction using a soft roll at the involved vertebra, in cases of burst fracture. Their motor power was intact in spite of severe canal compromise. The surgical procedure included postural reduction for 3 days and screw fixations at one level above, one level below and at the fractured level itself. The patients underwent removal of implants 12 months after the initial operation, due to possibility of implant failure. Imaging and clinical findings, including canal encroachment, vertebral height, clinical outcome, and complications were analyzed.ResultsPrior to surgery, the mean pain score (visual analogue scale) was 8.2, which decreased to 2.2 at 12 months after screw fixation. None of the patients complained of worsening of pain during 6 months after implant removal. All patients were graded as having excellent or good outcomes at 6 months after implant removal. The proportion of canal compromise at the fractured level improved from 55% to 35% at 12 months after surgery. The mean preoperative vertebral height loss was 45.3%, which improved to 20.6% at 6 months after implant removal. There were no neurological deficits related to neural injury. The improved vertebral height and canal compromise were maintained at 6 months after implant removal.ConclusionShort segment pedicle screw fixation, including fractured level itself, without bone fusion following postural reduction can be an effective and safe operative technique in the management of selected young patients suffering from unstable burst fracture.

“…6,9) Treatments for low lumbar burst fractures are conservative or surgical, that is, by posterior stabilization or by applying an anterior approach. 9,10) However, no accepted guidelines or consensus exists regarding the optimal approach for such lesions, and no universally accepted criterion is available for evaluating stability of the low lumbar spine.…”

Section: Discussionmentioning

confidence: 99%

“…Due to their rarity, most of the literature regarding the best treatment for burst fractures concerns the thoracolumbar junction, rather than the low lumbar region. 6) Fractures of these vertebrae have biomechanical and anatomic characteristics that distinguish them from thoracolumbar burst fractures. 7,11) In particular, the iliolumbar ligaments and a location below the pelvic brim with major muscle support are two stabilizing factors that are unique to these fractures.…”

Section: Introductionmentioning

confidence: 99%

Short Segment Screw Fixation without Fusion for Low Lumbar Burst Fracture: Severe Canal Compromise but Neurologically Intact Cases

Wang

et al. 2013

Korean J Neurotrauma

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Objective: The purpose of this study was to determine whether screw fixation without bone fusion in patients with a low lumbar burst fracture has satisfactory outcomes. Methods: Twelve patients that underwent screw fixation without bone fusion for a low lumbar burst fracture (L3-5) between 2006 and 2009, were included in this study. Motor power was intact despite severe canal compromise in all. Surgical procedures included postural reduction for 2 days and screw fixation without bone fusion. Imaging and clinical findings, including level of the involved vertebra, vertebral height, canal compromise, clinical outcomes, and related complications were analyzed. Results: Mean follow-up was 23.1±11.0 months. Mean pain score (visual analogue scale) prior to surgery was 7.8±2.0 and this decreased to 1.8±1.0 at final follow-up. In 5 patients, open screw fixation by midline skin incision was performed and 7 patients underwent percutaneous screw fixation at one level above, one level below the fractured vertebra and fractured level itself. The proportion of canal compromise at the fractured level improved significantly from 60% to 30% at final follow-up (p＜0.001). Mean preoperative vertebral height loss was 31.0%, and improved to 20.5% at final follow-up, though this improvement was not statistically significant (p＜0.001). No neurological aggravation related to neural injury was observed. Conclusion: Short segment pedicle screw fixation without bone fusion can be an effective and safe operative technique for the management of selected low lumbar burst fractures.