Monosegmental Transpedicular Fixation for Selected Patients With Thoracolumbar Burst Fractures

Spinal Surgery Department, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Journal of spinal disorders & techniques (Impact Factor: 2.2). 03/2009; 22(1):38-44. DOI: 10.1097/BSD.0b013e3181679ba3
Source: PubMed


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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    • "Neurological outcome was assessed after doing a neurological examination on each follow-up as per ASIA score. Functional outcomes were assessed according to Denis Pain Index [14], Denis Work Scale index [15], and Quality of life index (WHOQOL-BREF as defined by World Health Organization) [16]. "
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    ABSTRACT: Prospective clinical study.
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    ABSTRACT: To study the outcome of patients with thoracolumbar fracture treated surgically or conservatively at the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia, between the year 1989 through to 1999. The medical and surgical record of all patients diagnosed as having thoracolumbar fracture (thoracic 10-lumbar 12) between the years 1989 to 1999 were reviewed. The parameter studies included the personal patient data, type of fracture, mechanism and cause of injury and neurological affection. For the outcome, the method of treatment and recovery from neurological deficit, return to pre-injury activity and work as well as complications were noted. One hundred patients were treated for thoracolumbar fracture. Seventy two percent were related to motor vehicle accident, 37% had neurological deficit, 19 of them had complete lesion. Thoracic 12 Lumbar 1 constituted 63% of injury level. Forty-four patients were treated surgically whereas 56 had conservative treatment. At follow up, 17 patients had complete recovery from neurological deficit while 6 had partial recovery and 14 had no recovery at all. No major complication has occurred due to method of treatment in both groups. Treatment of thoracolumbar fracture was carried out using both surgical and conservative methods. In our view, surgical treatment is indicated in cases of instability or removal of retropulsive fragment if there is neurological deficit or to correct deformity. For other cases conservative treatment was selected and gave satisfactory results.
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