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ABSTRACT: Indirect reduction and fixation is not a new method in the treatment of thoracolumbar burst fractures but the indications and efficacy are controversial. The current study was designed to evaluate the efficacy of indirect reduction without fusion. Sixty-four patients with single-level thoracolumbar burst fractures were identified and treated by this method. The outcome was analyzed by the Frankel method, radiographic measurements, and at the latest follow-up the Denis Pain Scale and Oswestry disability index (ODI) were used to assess back pain and functional outcome. The average follow-up period was 40.1 months. The anterior vertebral height (AVH) was corrected from 55.2 to 97.2% post-operatively and decreased to 88.9% after hardware removal. The posterior vertebral height (PVH) increased from 88.9 to 99.1% post-operatively and decreased slightly after implant removal to 93.7%. The average pre-operative canal compromise was 41.4%, which decreased to 13.7% at last follow-up. Except for three paraplegic patients, neurological status significantly improved or stayed normal in the study's remaining 61 patients. Fifty-two of sixty-four patients had excellent or good function. At latest follow-up the average ODI score was 16.7 and the Denis pain score improved in all patients but one. Indirect reduction and fixation can not only restore vertebral column structure but also, more importantly, patients' functional outcome.
European Spine Journal 03/2011; 20(3):380-6. · 1.97 Impact Factor
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International Orthopaedics 02/2010; · 2.03 Impact Factor
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ABSTRACT: This article presents an evaluation of fluoroscopy for indirect, posterior reduction and fixation of thoracolumbar burst fractures. A prospective study of 25 patients with thoracolumbar burst fractures who underwent C-arm machine-guided posterior indirect reduction and short segment fixation without fusion is described. No laminotomies were performed. All patients had a mean follow-up of 30.4 months. At postoperative review, the average anterior and posterior vertebral heights were corrected from 57.9% to 99.0% and 89.0% to 99.5%, respectively. The Cobb angle was corrected from 18.4 degrees to 0.17 degrees . The canal compromise ratio was improved from 35.2% to 8.6%. In all 25 cases, neurological status was intact at last follow-up. Fluoroscopy guidance is an effective method to accomplish indirect reduction and fixation. Reduction was confirmed on lateral fluoroscopic views by looking for a "one-line sign," which is the reconstitution of the posterior border of the vertebral body.
International Orthopaedics 10/2009; 33(5):1329-34. · 2.03 Impact Factor
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ABSTRACT: To explore the diagnosis of Chance fractures of thoracolumbar spine and the clinical efficacy of segmental pedicle screw instrumentation in the treatment.
The clinical data of 16 patients with Chance fractures from January 2000 to January 2007 were retrospectively analyzed. All patients were treated with segmental pedicle screw instrumentation. Radiology and the Oswestry Disability Index (ODI) were used to evaluate the efficacy.
One case associated with open dislocation of ankle and craniocerebral injury, 3 cases with calcaneus fracture and 1 with kidney contusion. All cases were followed up from 7 months to 6 years, with a mean of 2.6 years. There were no operation complications. The anterior vertebral body height of fracture vertebra was restored from preoperative (63.3 +/- 6.8)% to postoperative (92.1 +/- 4.0)%, at the follow-up (90.7 +/- 3.6)%. There was a significant improvement between preoperative and postoperative values (P < 0.01) and no difference between initial postoperative and final follow-up (P > 0.05). The mean ODI was 4.9.
The injuries associated with Chance fracture caused by a fall and its mechanism are different from those with the safety belt injury. The segmental pedicle screw instrumentation can rebuild spinal stabilization and restore spinal alignment in treatment of Chance fractures.
Zhonghua wai ke za zhi [Chinese journal of surgery] 05/2008; 46(10):741-4.
