Monosegmental transpedicular fixation for selected patients with thoracolumbar burst fractures.
ABSTRACT A prospective cohort study on selected consecutive patients.
To evaluate the efficacy of an innovative operative technique called monosegmental transpedicular fixation for the treatment of some thoracolumbar burst fractures.
Short-segment pedicle screw instrumentation is accepted by many spinal surgeons as an acceptable technique for the treatment of thoracolumbar burst fractures. Preoperative evaluation using the spinal load-sharing makes this technique more reliable. To preserve more motion segments, some authors have advocated using monosegmental pedicle screw instrumentation (MSPI) to treat thoracolumbar fractures. However, up until now this kind of maneuver is only performed in cases of flexion distraction injuries.
A cohort of 20 patients with thoracolumbar burst fractures fulfilling the inclusion criteria were prospectively submitted to surgical treatment of monosegmental transpedicular fixation plus posterior fusion. All instrumentations were performed with pedicle screws inserted bilaterally into the fractured level and 1 adjacent level, either superior or inferior depending on the locating side of the intact endplate. All patients were followed up. The preoperative radiographs, the postoperative radiographs within 1 week of operation, and the radiographs of the most recent follow-up were evaluated for kyphosis correction recorded in the Sagittal Index and Load-Sharing Classification (LSC) index. The postoperative functional outcomes were evaluated using the Frankel Performance Scale together with the Denis Pain Scale.
Eighteen patients were followed up successfully with an average final follow-up of 24.7+/-8.0 months. The focal kyphotic angulations were corrected satisfactorily with the mean Sagittal Index of preoperative 16.5+/-6.6 degrees, initial postoperative 4.0+/-2.4 degrees, and latest follow-up 4.8+/-4.0 degrees. No obvious loss of correction occurred except for 2 patients who both scored 8 points on the LSC Score. Postoperatively, most patients attained both functional neurologic improvement and pain relief, and only a few complications were noted.
For selected thoracolumbar burst fractures, MSPI can provide the same or better fixation and preserve more motion segments than other methods of posterior pedicle instrumentation. With preoperative evaluation using the spinal LSC system, MSPI is effective and reliable for the treatment of thoracolumbar burst fractures when properly indicated.
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ABSTRACT: The routine surgical approach to posterior reconstruction in spinal tuberculosis is short- or long-segment fixation and/or fusion. This method sacrifices movement at more than one vertebral level, limits normal movement of the spinal column, and leads to degeneration of the small joints of the adjacent levels. Surgical techniques that reduce the number of fixed vertebral levels and maximize the retention of movement of the spinal column are of current interest in the treatment of spinal tuberculosis. A total of 106 patients with lumbosacral tuberculosis were randomly divided into two groups: a single-segment fixation group and a short-segment fixation group. After posterior correction and internal fixation, all patients underwent anterior radical debridement and interbody fusion with bone grafting. The mean postoperative follow-up period was 58.09 ± 17.01 months. The average bone graft healing time was 4.35 ± 1.04 months in the single-segment group and 4.47 ± 1.10 months in the short-segment group. In the single-segment group, correction of the Cobb angle was 14.47 ± 3.76° and the loss rate was 7.22 %, and in the short-segment group, correction of the Cobb angle was 16.20 ± 2.70° and the loss rate was 6.37 % (P < 0.05). Patients with operative time, blood loss, costs in the single-segment group were significantly reduced than the short-segment group (P < 0.05). Single-segment pedicle screw fixation and correction surgery can fix and fuse the diseased segment in lumbar and sacral tuberculosis, retain normal movement in the adjacent spinal column, and promote functional recovery of the spinal column postoperatively. It was be regarded as a cost-effective means of treatment with lumbar and sacral tuberculosis.Archives of Orthopaedic and Trauma Surgery 06/2012; 132(10):1429-35. · 1.36 Impact Factor
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ABSTRACT: To investigate the safety and therapeutic effects of mono-segmental pedicle instrumentation (MSPI) in treating thoracolumbar burst fracture (AO classification: A3.1 and A3.2). A retrospective analysis was conducted on 60 cases with thoracolumbar burst fracture (AO classification: A3.1 and A3.2) between April 2005 and February 2010. Half of the 60 inpatients were treated with MSPI, and the other half was treated with short-segment pedicle instrumentation (SSPI). The mean operation time, blood loss, visual analog scale (VAS) and vertebral kyphotic angle before and after surgery were compared. In the MSPI group, the mean operation time was 90 ± 25 min, and the blood loss at operation was 180 ± 62 ml. The vertebral kyphotic angles were 17.3° ± 9.3° before surgery, 6.5° ± 6.5° one week after surgery, and 9.5° ± 6.4° for the latest follow-up. The VAS scores were 7.5 ± 1.4 before surgery, 2.5 ± 0.7 one week after surgery, and 1.4 ± 0.8 for the latest follow-up. In the SSPI group, the mean operation time was 101 ± 28 min, and the blood loss at operation was 203 ± 88 ml. The follow-up duration was 12-64 months. The vertebral kyphotic angles were 16.5° ± 9.1° before surgery, 7.1° ± 6.9° one week after surgery, and 7.5° ± 5.2° for the latest follow-up. The VAS scores were 6.7 ± 1.5 before surgery, 3.0 ± 0.4 one week after surgery, and 1.1 ± 0.6 for the latest follow-up. There were no statistically significant differences between these two groups in the operation time, blood loss at operation, VAS score and vertebral kyphotic angle before and after surgery (p > 0.05). The post-surgical VAS scores and vertebral kyphotic angles were significantly decreased in both groups, compared to before surgery (p < 0.05). It is safe and effective to treat thoracolumbar burst fractures (AO 3.1 and AO 3.2) with MSPI. The mean operation time, blood loss at operation, post-surgical VAS and vertebral kyphotic angle of the MSPI group are similar, compared to the SSPI group. Further research is needed to find out whether therapeutic effects of MSPI are better than those of conservative treatment in these cases.European Spine Journal 03/2012; 21(10):2034-42. · 2.47 Impact Factor
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ABSTRACT: To compare the von Mises stresses of the internal fixation devices among different short segment pedicle screw fixation techniques to treat thoracic 12 vertebral fractures, especially the mono-segment pedicle screw fixation and intermediate unilateral pedicle screw fixation techniques.PLoS ONE 01/2014; 9(6):e99156. · 3.53 Impact Factor