Short-Segment Instrumentation with Fractured Vertebrae Augmentation by Screws and Bone Substitute for Thoracolumbar Unstable Burst Fractures

Abstract

Background. For thoracolumbar burst fractures, traditional four-screw (one above and one below) short-segment instrumentation is popular and has a high failure rate. Additional augmentation at the fractured vertebrae is believed to reduce surgical failure. The purpose of this study was to examine the clinical and radiographic results of patients who underwent short-segment posterior instrumentation with augmentation by screws and bone substitutes at the fractured vertebrae and to compare these data to those of patients who underwent long-segment instrumentation for thoracolumbar burst fractures. Methods. The study group had twenty patients who underwent short-segment instrumentation with additional augmentation by two screws and bone substitutes at the fractured vertebrae. The control group contained twenty-two patients who underwent eight-screw long instrumentation without vertebra augmentation. Local kyphosis and the anterior body height of the fractured vertebrae were measured. The severity of the fractured vertebrae was evaluated with the load sharing classification (LSC). Any implant failure or loss of correction >10° at the final follow-up was defined as surgical failure. Results. Both groups had similar distributions in terms of age, sex, the injured level, and the mechanism of injury before operation. During the operation, the study group had significantly less blood loss (136.0 vs. 363.6 ml, p=0.001) and required shorter operating times (146.8 vs. 157.5 minutes, p=0.112) than the control group. Immediately after surgery, the study group had better correction of the local kyphosis angle (13.4° vs. 11.9°, p=0.212) and restoration of the anterior height (34.7% vs. 31.0%, p=0.326) than the control group. At the final follow-up, no patients in the study group and only one patient in the control group experienced surgical failure. Conclusions. Patients with thoracolumbar burst fractures who received six-screw short-segment posterior fixators with augmentation at the level of the fractured vertebrae via injectable artificial bone substitute achieved satisfactory clinical and radiographic results, and this method could replace long-segment instrumentation methods used in unstable thoracolumbar burst fractures.

A novel scoring system to predict the residual back pain after percutaneous kyphoplasty for osteoporotic vertebral compression fracture

“…It was found that compared with OF4 and 5 types fractures, OF1-3 types fractures had better pain relief after PVP (23,24), which was consistent with the findings of our present study. Therefore, we speculated that for patients with severe vertebral fractures (such as complete burst fractures), the addition of bone cement-assisted fixation on the basis of internal fixation may achieve better pain relief (25). Surgical factors are important factors affecting the postoperative pain.…”

Unilateral biportal endoscopic technique combined with percutaneous transpedicular screw fixation for thoracolumbar burst fractures with neurological symptoms: technical note and preliminary report

“…Short-segment transpedicular screw fixation has been shown to achieve similar results in kyphosis correction and biomechanical stability maintenance to long-segment transpedicular screw fixation, and the screw placement of the fractured vertebra can better maintain the height of the fractured vertebra [ 19 ]. In addition, short-segment fixation can preserve more moving segments and reduce the incidence of adjacent segment degeneration [ 20 ]. Generally, the accepted standard treatment for thoracolumbar fractures with neurological deficit is decompression (anterior or posterior) with fusion.…”

Effectiveness of the Endplate Reduction Technique Combined With Bone Grafting for the Treatment of Thoracolumbar Fractures by Using Posterior Short-Segment Fixation

“…Posterior fixation is divided into single-segment fixation, short-segment fixation, and long-segment fixation. 7 Short-segment fixation is simple, less invasive, and more reliable. [8][9][10] However, since the anterior column of the thoracolumbar instability fracture is severely damaged, the use of short-segment fixation causes concentrated stress, thus easily resulting in failure of reduction and implant breakage, resulting in surgical failure.…”