The Use of Screw at the Fracture Level in the Treatment of Thoracolumbar Burst Fractures

Güven, Osman; Kocaoğlu, Barış; Bezer, Murat; Aydın, Nuri; Nalbantoğlu, Ufuk

doi:10.1097/bsd.0b013e3181870385

Cited by 162 publications

(198 citation statements)

References 19 publications

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“…All of the above data, although not in favor of any of the two groups, introduce the ''including'' technique as relatively safe and without additional complications to the patient. In contrast to some other studies [9], we did not keep from inserting screws into fractured pedicles; and observed no related complications.…”

Section: Discussionmentioning

confidence: 74%

“…In a similar study conducted by Guven et al [9], the authors studied the inclusion of the fracture level in both short and long segment fixation. They observed that fracture level fixation had lowered the rates of correction failure which was most significant on short segment constructs.…”

Section: Discussionmentioning

confidence: 99%

“…Only two studies [8,9] have considered the inclusion of the fracture level in short segment fixation. In this study, we have tried to compare the one level above and one level below excluding the fracture level, and the one level above and one level below including the fracture level.…”

Section: Introductionmentioning

confidence: 99%

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Inclusion of the fracture level in short segment fixation of thoracolumbar fractures

et al. 2010

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Short segment posterior fixation is the preferred method for stabilizing thoracolumbar fractures. In case of significant disruption of the anterior column, the simple short segment construct does not ensure adequate stability. In this study, we tried to evaluate the effect of inclusion of the fractured vertebra in short segment fixation of thoracolumbar fractures. In a prospective randomized study, eighty patients with thoracolumbar fractures treated just with posterior pedicular fixation were randomized into two groups receiving either the one level above and one level below excluding the fracture level (bridging group), or including the fracture level (including group). Different clinical and radiological parameters were recorded and followed. A sum of 80 patients (42 patients in group 1 and 38 patients in group 2) were enrolled in the study. The patients in both the groups showed similar clinical outcome. There was a high rate of instrumentation failure in the ''bridging'' group. The ''bridging'' group showed a mean worsening (29%) in kyphosis, whereas the ''including'' group improved significantly by a mean of 6%. The significant effect of the ''including'' technique on the reduction of kyphotic deformity was most prominent in type C fractures. In conclusion, inclusion of the fracture level into the construct offers a better kyphosis correction, in addition to fewer instrument failures, without additional complications, and with a comparable-if not better-clinical and functional outcome. We recommend insertion of screws into pedicles of the fractured thoracolumbar vertebra when considering a short segment posterior fixation, especially in Magerl type C fractures.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

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Inclusion of the fracture level in short segment fixation of thoracolumbar fractures

et al. 2010

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“…Furthermore, this additional point of fixation allows for a 3-point reduction maneuver, analogous to that used for reduction of long bone fractures. In a recent prospective randomized study, the efficacy of the fracture-level screw combination in achieving and maintaining correction for the treatment of unstable thoracolumbar burst fractures was evaluated 21. The authors of that study concluded that reinforcement with a fracture-level screw could help provide and maintain improved kyphosis correction.…”

Section: Discussionmentioning

confidence: 99%

“…Another mid-term clinical study demonstrated superior results with the fracture-level screw combination, supporting the evidence of other reports 22. Interestingly, in most of these studies, the pedicle screws used were monoaxial, despite the current trend toward using polyaxial screws in short-segment fracture fixation 10–1221. On review of the literature, we found that there was a paucity of data, both clinical and biomechanical, on the use of polyaxial screw as an intermediate in unstable burst fractures, and thus this biomechanical study was instituted.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical efficacy of monoaxial or polyaxial pedicle screw and additional screw insertion at the level of fracture, in lumbar burst fracture: An experimental study

Wang

Liu

et al. 2012

IJOO

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Background:Use of a pedicle screw at the level of fracture, also known as an intermediate screw, has been shown to improve clinical results in managing lumbar fracture, but there is a paucity of biomechanical studies to support the claim. The aim of this study was to evaluate the effect of adding intermediate pedicle screws at the level of a fracture on the stiffness of a short-segment pedicle fixation using monoaxial or polyaxial screws and to compare the strength of monoaxial and polyaxial screws in the calf spine fracture model.Materials and Methods:Flexibility of 12 fresh-frozen calf lumbar spine specimens was evaluated in all planes. An unstable burst fracture model was created at the level of L3 by the pre-injury and dropped-mass technique. The specimens were randomly divided into monoaxial pedicle screw (MPS) and polyaxial pedicle screw (PPS) groups. Flexibility was retested without and with intermediate screws (MPSi and PPSi) placed at the level of fracture in addition to standard screws placed at L2 and L4.Results:The addition of intermediate screws significantly increased the stability of the constructs, as measured by a decreased range of motion (ROM) in flexion, extension, and lateral bending in both MPS and PPS groups (P < 0.05). There was neither any significant difference in the ROM in the spines of the two groups before injury, nor a difference in the ROM between the MPSi and PPSi groups (P > 0.05), but there was a significant difference between MPS and PPS in flexion and extension in the short-segment fixation group (P < 0.05).Conclusions:The addition of intermediate screws at the level of a burst fracture significantly increased the stability of short-segment pedicle screw fixation in both the MPS and PPS groups. However, in short-segment fixation group, monoaxial pedicle screw exhibited more stability in flexion and extension than the polyaxial pedicle screw.

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Pedicle screw fixation for traumatic fractures of the thoracic and lumbar spine

Wang

Zeng

et al. 2013

Cochrane Database of Systematic Reviews

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The Use of Screw at the Fracture Level in the Treatment of Thoracolumbar Burst Fractures

Abstract: Reinforcement with fracture level screw combination can help to provide better kyphosis correction and offers immediate spinal stability in patients with thoracolumbar burst fracture.

Cited by 162 publications

References 19 publications

Inclusion of the fracture level in short segment fixation of thoracolumbar fractures

Inclusion of the fracture level in short segment fixation of thoracolumbar fractures

Biomechanical efficacy of monoaxial or polyaxial pedicle screw and additional screw insertion at the level of fracture, in lumbar burst fracture: An experimental study

Pedicle screw fixation for traumatic fractures of the thoracic and lumbar spine

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