Thoracolumbar burst fractures requiring instrumented fusion: Should reducted bone fragments be removed? A retrospective study

Yaldız, Can; Asil, Kıyasettin; Özkal, Birol; Ceylan, Davut; Kacira, Tibet

doi:10.1016/j.pjnns.2015.08.005

Cited by 3 publications

(2 citation statements)

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“…Thoracolumbar fractures account for approximately 90% of spinal injuries, [ 1 ] of which 10% to 20% are burst fractures. [ 2 , 3 ] Because burst fractures often involve damage to the column and posterior structures of the spine, the fracture block may invade the spinal canal and compress the spinal cord or the cauda equina, causing corresponding neurological dysfunction. [ 4 ] Because of the difference in the degree of fracture and the degree of completeness of neurological function, there are many controversies in the treatment of thoracolumbar burst fractures.…”

Section: Introductionmentioning

confidence: 99%

Finite element analysis of the indirect reduction of posterior pedicle screw fixation for a thoracolumbar burst fracture

2022

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Because burst fractures often involve damage to the column and posterior structures of the spine, the fracture block may invade the spinal canal and compress the spinal cord or the cauda equina, causing corresponding neurological dysfunction. When a thoracolumbar burst fracture is accompanied by the presence of bone in the spinal canal, whether posterior surgery requires spinal canal incision decompression is still controversial. Computed tomography images of the thoracolumbar spine of a 31-year-old male with an L1 burst fracture and Mimics 10.0 were used to establish a three-dimensional fracture model for simulating the indirect reduction process. The model was imported into Ansys 10.0 (ANSYS, Inc., Canonsburg, PA), and a 1 to 10 mm displacement was loaded 10° behind the Z-axis on the upper endplate of the L1 vertebral body to simulate position reduction and open reduction. The displacement and stress changes in the intervertebral disc, fractured vertebral body and posterior longitudinal ligament were observed during reduction. Under a displacement loaded 10° behind the Z-axis, the maximum stress in the vertebral body was concentrated on the upper disc of the injured vertebrae. The maximum displacement was in the anterior edge of the vertebral body of the injured vertebrae, and the vertebral body height and the anterior lobes were essentially restored. When the displacement load was applied in the positive Z-axis direction, the maximum displacement was in the posterior longitudinal ligament behind the injured vertebrae. Under a 6 mm load, the posterior longitudinal ligament displacement was 11.3 mm. Under an 8 mm load, this displacement significantly increased to 15.0 mm, and the vertebral stress was not concentrated on the intervertebral disc. A reduction in the thoracolumbar burst fractures by positioning and distraction allowed the injured vertebrae to be restored to normal height and kyphosis. The reduction in the posterior longitudinal ligament can push the bone block in the spinal canal into the reset space and achieve a good reset.

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Section: Introductionmentioning

confidence: 99%

Finite element analysis of the indirect reduction of posterior pedicle screw fixation for a thoracolumbar burst fracture

2022

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“…Spinal fractures commonly occur in the thoracolumbar region, of which burst fractures accounting for 10-20% of all spinal fractures [1][2][3]. It was always attributed to biomechanical and anatomical features in thoracolumbar junction, which is the most important biomechanical transition zone between rigid thoracic kyphosis and flexible lumbar lordosis.…”

Section: Introductionmentioning

confidence: 99%

Posterior monoaxial screw fixation combined with distraction-compression technology assisted endplate reduction for thoracolumbar burst fractures: a retrospective study

Xue

Zhao

2020

BMC Musculoskelet Disord

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Background: The management of thoracolumbar burst fractures traditionally involves posterior pedicle screw fixation, but it has some drawbacks. The aim of this study is to evaluate the clinical and radiological outcomes of patients with thoracolumbar burst fractures. They were treated by a modified technique that monoaxial pedicle screws instrumentation and distraction-compression technology assisted end plate reduction. Methods: From March 2014 to February 2016, a retrospective study including 42 consecutive patients with thoracolumbar burst fractures was performed. The patients had undergone posterior reduction and instrumentation with monoaxial pedicle screws. The fractured vertebrae were also inserted screws as a push point. The distraction-compression technology was used as assisting end plate reduction. All patients were followed up at a minimum of 2 years. These parameters including segmental kyphosis, severity of fracture, neurological function, canal compromise and back pain were evaluated in preoperatively, postoperatively and at the final follow-up. Results: The average follow-up period was 28.9 ± 4.3 months (range, 24-39mo). No patients had postoperative implant failure at recent follow-up. The mean Cobb angle of the kyphosis was improved from 14.2°to 1.1°(correction rate 92.1%). At final follow-up there was 1.5% loss of correction. The mean preoperative wedge angle was improved from 17.1 ± 7.9°to 4.4 ± 3.7°(correction rate 74.3%). The mean anterior and posterior vertebral height also showed significant improvements postoperatively, which were maintained at the final follow-up(P < 0.05). The mean visual analogue scale (VAS) scores was 8 and 1.6 in preoperation and at the last follow-up, and there was significant difference (p < 0.05). Conclusion: Based on our experience, distraction-compression technology can assist reduction of collapsed endplate directly. Satisfactory fracture reduction and correction of segmental kyphosis can be achieved and maintained with the use of monoaxial pedicle screw fixation including the fractured vertebra. It may be a good treatment approach for thoracolumbar burst fractures.

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Surgical treatment of traumatic fractures of the thoracic and lumbar spine: A systematic review

Vercoulen,

Niemeyer,

Peuker

et al. 2024

Brain and Spine

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Thoracolumbar burst fractures requiring instrumented fusion: Should reducted bone fragments be removed? A retrospective study

Cited by 3 publications

References 40 publications

Finite element analysis of the indirect reduction of posterior pedicle screw fixation for a thoracolumbar burst fracture

Finite element analysis of the indirect reduction of posterior pedicle screw fixation for a thoracolumbar burst fracture

Posterior monoaxial screw fixation combined with distraction-compression technology assisted endplate reduction for thoracolumbar burst fractures: a retrospective study

Surgical treatment of traumatic fractures of the thoracic and lumbar spine: A systematic review

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