A Comparative Analysis of the Efficacy of Short-Segment Pedicle Screw Fixation with that of Long-Segment Pedicle Screw Fixation for Unstable Thoracolumbar Spinal Burst Fractures
Clinical Medicine Research
Volume 4, Issue 1, January 2015, Pages: 1-5
Received: Dec. 22, 2014; Accepted: Jan. 6, 2015; Published: Jan. 14, 2015
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Authors
Jin-Woo Hur, Department of Neurosurgery, Cheongju Saint Mary’s Hospital, Cheongju, Korea
Jong-Joo Rhee, Department of Neurosurgery, Cheongju Saint Mary’s Hospital, Cheongju, Korea
Jong-Won Lee, Department of Neurosurgery, Cheongju Saint Mary’s Hospital, Cheongju, Korea
Hyun-Koo Lee, Department of Neurosurgery, Cheongju Saint Mary’s Hospital, Cheongju, Korea
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Abstract
The indications for operative treatment and type of stabilization procedures for the treatment of thoracolumbar burst fracture remain controversial. As surgical reconstruction for the thoracolumbar burst fracture, both long-segment pedicle screw fixation and short-segment pedicle screw fixation including fractured vertebral body have been used widely. The present study evaluated the efficacy of short-segment fixation compared with that of long-segment fixation in terms of the radiological and clinical outcomes in unstable thoracolumbar burst fractures. From January 2007 to December 2012, 76 patients with thoracolumbar burst fracture underwent posterior pedicle screw fixation consecutively in our hospital. These patients were divided into two groups: the short-segment group, which included patients who underwent short-segment pedicle screw fixation including the fractured vertebral body, and the long-segment group, which included patients who underwent long-segment pedicle screw fixation (2 levels above and 1 level below the fractured vertebral body). There were 44 and 32 patients in the long-segment and short-segment group, respectively. Radiological assessment of the kyphotic angle was performed using the Cobb method immediately after the operation and at 3, 6, and 12 months postoperatively. The clinical outcomes were evaluated using the modified Mcnab criteria at the last follow-up. The sex ratio, mean age of patients, and composition of the fractured vertebral body were similar in both groups. In the long-segment and short-segment group, 37 (84.1%) and 26 (81.3%) cases showed excellent or good outcomes, respectively. The mean kyphotic angle at the immediate postoperative period was 7.3° ± 5.8° and 0.6° ± 11.9° in the long-segment and short-segment group, respectively. The average loss of kyphosis correction was 5.4° ± 4.4°, 8.6° ± 6.2°, and 10.5° ± 4.8° in the long-segment group and 4.1° ± 3.6°, 6.2° ± 5.2°, and 7.5° ± 4.4° in the short-segment group at 3, 6, and 12 months postoperatively, respectively. There was no statistically significant difference in the average loss of kyphosis correction between the two groups (p > 0.05). In conclusion, short-segment pedicle screw fixation including the fractured vertebral body might be as effective as long-segment pedicle screw fixation for the treatment of unstable thoracolumbar spinal burst fracture.
Keywords
Loss of Kyphosis Correction, Long-Segment Pedicle Screw Fixation, Short-Segment Pedicle Screw Fixation, Thoracolumbar Burst Fracture
To cite this article
Jin-Woo Hur, Jong-Joo Rhee, Jong-Won Lee, Hyun-Koo Lee, A Comparative Analysis of the Efficacy of Short-Segment Pedicle Screw Fixation with that of Long-Segment Pedicle Screw Fixation for Unstable Thoracolumbar Spinal Burst Fractures, Clinical Medicine Research. Vol. 4, No. 1, 2015, pp. 1-5. doi: 10.11648/j.cmr.20150401.11
References
[1]
Bohlman HH. Treatment of fractures and dislocations of the thoracic and lumbar spine. J. Bone. Joint. Surg. Am. 67: 165-169, 1985.
[2]
Ferguson RL, Allen BL Jr. An algorithm for the treatment of unstable thoracolumbar fractures. Orthop. Clin. North. Am. 17: 105-112, 1986.
[3]
Meves R, Avanzi O. Correlation between neurological deficit and spinal canal compromise in 198 patients with thoracolumbar and lumbar fractures. Spine. (Phila Pa 1976) 30: 787-791, 2005.
[4]
Mohanty SP, Venkatram N. Does neurological recovery in thoracolumbar and lumbar burst fractures depend on the extent of canal compromise? Spinal. Cord. 40: 295-299, 2002.
[5]
Wilcox RK, Boerger TO, Allen DJ et al. A dynamic study of thoracolumbar burst fractures. J. Bone. Joint. Surg. Am. 85: 2184-2189, 2003.
[6]
McAfee PC, Yuan HA, Lasda NA. The unstable burst fracture. Spine. (Phila Pa 1976) 7: 365-373, 1982.
[7]
Baaj AA, Reyes PM, Yaqoobi AS et al. Biomechanical advantage of the index-level pedicle screw in unstable thoracolumbar junction fractures. J. Neurosurg. Spine. 14: 192-197, 2011.
[8]
Mahar A, Kim C, Wedemeyer M, et al. Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Spine. (Phila Pa 1976) 32: 1503-1507, 2007.
[9]
Parker JW, Lane JR, Karaikovic EE, Gaines RW. Successful short-segment instrumentation and fusion for thoracolumbar spine fractures: a consecutive 41/2-year series. Spine. (Phila Pa 1976) 25: 1157-1170, 2000.
[10]
Sanderson PL, Fraser RD, Hall DJ et al. Short segment fixation of thoracolumbar burst fractures without fusion. Eur. Spine. J. 8: 495-500, 1999.
[11]
Tezeren G, Kuru I. Posterior fixation of thoracolumbar burst fracture: short-segment pedicle fixation versus long-segment instrumentation. J. Spinal. Disord. Tech. 18: 485-488, 2005.
[12]
Wang ST, Ma HL, Liu CL et al. Is fusion necessary for surgically treated burst fractures of the thoracolumbar and lumbar spine?: a prospective, randomized study. Spine. (Phila Pa 1976) 31: 2646-2652; discussion 2653, 2006.
[13]
Kim GW, Jang JW, Hur H, et al. Predictive factors for a kyphosis recurrence following short-segment pedicle screw fixation including fractured vertebral body in unstable thoracolumbar burst fractures. J. Korean. Neurosurg. Soc. 56: 230-236, 2014.
[14]
Kanna RM, Shetty AP, Rajasekaran S. Posterior fixation including the fractured vertebra for severe unstable thoracolumbar fractures. Spine. J. Sep 22, 2014
[15]
Gurwitz GS, Dawson JM, McNamara MJ, Federspiel CF, Spengler DM. Biomechanical analysis of three surgical approaches for lumbar burst fractures using short-segment instrumentation. Spine. (Phila Pa 1976) 18: 977-982, 1993.
[16]
McLain RF, Sparling E, Benson DR. Early failure of short-segment pedicle instrumentation for thoracolumbar fractures. A preliminary report. J. Bone. Joint. Surg. Am. 75: 162-167, 1993.
[17]
Sasso RC, Cotler HB. Posterior instrumentation and fusion for unstable fractures and fracture-dislocations of the thoracic and lumbar spine. A comparative study of three fixation devices in 70 patients. Spine. (Phila Pa 1976) 18: 450-460, 1993.
[18]
Cantor JB, Lebwohl NH, Garvey T, Eismont FJ. Nonoperative management of stable thoracolumbar burst fractures with early ambulation and bracing. Spine. (Phila Pa 1976) 18: 971-976, 1993.
[19]
Mumford J, Weinstein JN, Spratt KF, Goel VK. Thoracolumbar burst fractures. The clinical efficacy and outcome of nonoperative management. Spine. (Phila Pa 1976) 18: 955-970, 1993.
[20]
Weinstein JN, Collalto P, Lehmann TR. Thoracolumbar “burst” fractures treated conservatively: a long-term follow-up. Spine. (Phila Pa 1976) 13: 33-38, 1988.
[21]
Kim HY, Kim HS, Kim SW et al. Short segment screw fixation without fusion for unstable thoracolumbar and lumbar burst Fracture: a prospective study on selective consecutive patients. J. Korean. Neurosurg. Soc. 51: 203-207, 2012.
[22]
Toyone T, Ozawa T, Inada K et al. Short-segment fixation without fusion for thoracolumbar burst fractures with neurological deficit can preserve thoracolumbar motion without resulting in post-traumatic disc degeneration: a 10-year follow-up study. Spine. (Phila Pa 1976) 38: 1482-1490, 2013.
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