Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지

Long-term Follow-up Results of Short-segment Posterior Screw Fixation for Thoracolumbar Burst Fractures

  • Lee, Yoon-Soo (Department of Neurosurgery, School of Medicine, Kyungpook National University) ;
  • Sung, Joo-Kyung (Department of Neurosurgery, School of Medicine, Kyungpook National University)
  • Published : 2005.06.28
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Abstract

Objective: Despite general agreement on the goals of surgical treatment in thoracolumbar burst fractures, considerable controversy exists regarding the choice of operative techniques. This study is to evaluate the efficacy of short-segment fixation for thoracolumbar burst fractures after long-term follow-up and to analyze the causes of treatment failures. Methods: 48 out of 60 patients who underwent short-segment fixation for thoracolumbar burst fractures between January 1999 and October 2002 were enrolled in this study. Their neurological status, radiological images, and hospital records were retrospectively reviewed. Simple radiographs were evaluated to calculate kyphotic angles and percentages of anterior body compression (%ABC). Results: The average kyphotic angles were $20.0^{\circ}$ preoperatively, $9.6^{\circ}$ postoperatively, and $13.1^{\circ}$ at the latest follow-up. The average %ABC were 47.3% preoperatively, 31.2% postoperatively, and 33.3% at the latest follow-up. The treatment failure, defined as correction loss by $10^{\circ}$ or more or implant failure, was detected in 6 patients (12.5%). 5 out of 6 patients had implant failures. 2 out of 5 patients were related with osteoporosis, and the other 2 were related with poor compliance of spinal bracing. 3 patients with poor initial postoperative alignment had implant failure. 4 patients with screws only on the adjacent vertebrae and not on the injured vertebra itself showed poor initial and overall correction. Conclusion: With proper patient selection, adequate intraoperative reduction with screw fixation involving the injured vertebra, and strict postoperative spinal bracing, the short-segment fixation is an efficient and safe method in the treatment of thoracolumbar burst fracture.

Keywords

References

  1. Aebi M, Etter C, Kehl T, Thalgott J : Stabilization of the lower thoracic and lumbar spine with the internal spinal skeletal fixation system : Indications, techniques, and first results of treatment. Spine 12 : 544-551, 1987 https://doi.org/10.1097/00007632-198707000-00007
  2. Alanay A, Acaroglu E, Yazici M, Oznur A, Surat A : Short-segment pedicle instrumentation of thoracolumbar burst fractures. Spine 26 : 213-217, 2001 https://doi.org/10.1097/00007632-200101150-00017
  3. Alvine GF, Swain JM, Asher MA : The safety and efficacy of variable screw placement(VSP) and Isola spinal implant systems for the surgical treatment of thoracolumbar burst fractures. J Bone Joint Surg 79B(Suppl) : 306, 1997
  4. Benzel EC, Larson SJ : Functional recovery after decompressive operation for thoracic and lumbar spine fractures. Neurosurgery 19 : 772-778, 1986 https://doi.org/10.1227/00006123-198611000-00009
  5. Bradford DS, Akbarnia BA, Winter RB : Surgical stabilization of fractures and fracture-dislocations of the thoracic spine. Spine 2 : 185-196, 1977 https://doi.org/10.1097/00007632-197709000-00004
  6. Cantor JB, Labwohl NH, Garvey T : Nonoperative management of stable thoracolumbar burst fractures with early ambulation and bracing. Spine 18 : 971-976, 1993 https://doi.org/10.1097/00007632-199306150-00004
  7. Carl AL, Tromanhauser SG, Roger DJ : Pedicle screw instrumentation for thoracolumbar burst fractures and fracture-dislocations. Spine 17 : 317-324, 1992 https://doi.org/10.1097/00007632-199208001-00018
  8. Chun SW, Hwang JH, Sung JK, Hwang SK, Hamm IS, Park YM, et al : Pedicle screw fixation and posterolateral fusion for thoracolumbar spine fracture. J Korean Neurosurg Soc 28 : 644-648, 1999
  9. Csecsei GI, Klekner AP, Dobai J, Lajgut A, Sikula J : Posterior interbody fusion using laminectomy bone and transpedicular screw fixation in the treatment of lumbar spondylolisthesis. Surg Neurol 53 : 2-7, 2000 https://doi.org/10.1016/S0090-3019(99)00198-6
  10. Daniaux H, Seykora P, Genelin A, Lang T, Kathrein A : Application of posterior plating and modifications in thoracolumbar spine injuries : Indications, techniques and results. Spine 16 : 125-133, 1991 https://doi.org/10.1097/00007632-199103001-00018
  11. Devito DP, Tsahakis PJ : Cotrel-Dubousset instrumentation in traumatic spine injuries. Proceedings of the Sixth International Congress on Cotrel-Dubousset Instrumentation. Montpellier : Sauramps Medical, 1989, pp41-46
  12. Dick W, Kluger P, Magerl F : A new device for internal fixation of thoracolumbar and lumbar spine fractures : the 'Fixateur Interne'. Paraplegia 23 : 225-232, 1985 https://doi.org/10.1038/sc.1985.38
  13. Dickson JH, Harrington PR, Erwin WE : Results of reduction and stabilization of the severely fractured thoracic and lumbar spine. J Bone Joint Surg 60A : 799-805, 1978
  14. Ebelke DK, Asher MA, Neff JR, Krake DP : Survivorship analysis of VSP spine instrumentation in the treatment of thoracolumbar and lumbar burst fractures. Spine 16 : 428-492, 1991 https://doi.org/10.1097/00007632-199108001-00023
  15. Esses SI, Botsford DJ, Wright T, Bednar D, Bailey S : Operative treatment of spinal fractures with the AO internal fixator. Spine 16 : S146-S150, 1991 https://doi.org/10.1097/00007632-199103001-00021
  16. Frankel H, Hancock DO, Hyslop G : The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Paraplegia 7 : 179-192, 1969 https://doi.org/10.1038/sc.1969.30
  17. Gillet P, Meyer R, Fatemi F, Lemaire R : Short-segment internal fixation using CD instrumentation with pedicular screws : Biomechanical Testing. Proceedings of the Sixth International Congress on Cotrel-Dubousset Instrumentation. Montpellier : Sauramps Medical, 1989, pp19-24
  18. Gurwitz GS, Dawson J, McNamara MJ : Biomechanical analysis of three surgical approaches for lumbar burst fractures using short segment instrumentation. Spine 18 : 977-982, 1993 https://doi.org/10.1097/00007632-199306150-00005
  19. Hirunyachote P, Adulkasem W : Posterolateral fusion with autogenous laminospinous process bone graft. J Med Assoc Thai 85 : 1105-1112, 2002
  20. Holt BT, McCormack T, Gaines RW : Short segment fusion-anterior or posterior approach-The load-sharing classification of spine fractures. Spine 7 : 189-197, 1993
  21. Kai Y, Oyama M, Morooka M : Posterior lumbar interbody fusion using local facet joint autograft and pedicle screw fixation. Spine 29 : 41-46, 2003
  22. Kasai Y, Takegami K, Uchida A : Mixture ratios of local bone to artificial bone in lumbar posterolateral fusion. J Spinal Disord Tech 16 : 31-37, 2003 https://doi.org/10.1097/00024720-200302000-00006
  23. Kramer DI, Rodgers WB, Mansfield FL : Transpedicular instrumentation and short-segment fusion of thoracolumbar fractures. J Orthop Trauma 9 : 499-506, 1995 https://doi.org/10.1097/00005131-199509060-00007
  24. Lindsey RW, Dick W : The Fixateur Interne in reduction and stabilization of thoracolumbar spine fractures in patients with neurologic deficit. Spine 16 : 140-145, 1991 https://doi.org/10.1097/00007632-199103001-00020
  25. Louis CA, Gauthier VY, Louis RP : Posterior approach with Louis plates for fractures of the thoracolumbar and lumbar spine with and without neurologic deficits. Spine 23 : 2030-2039, 1998 https://doi.org/10.1097/00007632-199809150-00022
  26. McAfee PC, Yuan HA, Fredrickson BE, Lubicky JP : The value of computed tomography in thoracolumbar fractures. J Bone Joint Surg 65A : 641-473, 1983
  27. McCormack T, Kariokovic E, Gaines RW : The load sharing classification of spine fractures. Spine 19 : 1741-1744, 1994 https://doi.org/10.1097/00007632-199408000-00014
  28. McLain FR, Sparling E, Benson RD : Early failure of short-segment pedicle instrumentation for thoracolumbar burst fractures : A preliminary report. J Bone Joint Surg 75A : 162-167, 1993
  29. Miura Y, Imagama S, Yoda M, Mitsuguchi H, Kachi H : Is local bone viable as a source of bone graft in posterior lumbar interbody fusion. Spine 28 : 2386-2389, 2003 https://doi.org/10.1097/01.BRS.0000085326.73430.68
  30. Mumford J, Weinstein JN, Spratt KF : Thoracolumbar burst fractures : The clinical efficacy and outcome of nonoperative management. Spine 8 : 955-970, 1993
  31. Parker JW, Lane JR, Karaikovic E, Gaines RW : Successful short-segment instrumentation and fusion for thoracolumbar spine fractures : A consecutive 4$\frac{1}{2}$ year series. Spine 25 : 1157-1169, 2000 https://doi.org/10.1097/00007632-200005010-00018
  32. Razak M, Mahmud MM, Hyzan MY, Omar A : Short segment posterior instrumentation, reduction and fusion of unstable thoracolumbar burst fractures-A review of 26 cases. Med J Malaysia 55 (Suppl) : 9-13, 2000
  33. Roy-Camille R, Saillant G, Mazel C : Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop 203 : 7-17, 1986
  34. Sanderson PL, Fraser RD, Hall DJ, Cain CMJ, Osti OL, Potter GR : Short segment fixation of thoracolumbar burst fractures without fusion. Eur Spine J 8 : 495-500, 1999 https://doi.org/10.1007/s005860050212
  35. Sasso RC, Cotler HB : Posterior instrumentation and fusion for unstable fractures and fracture-dislocations of the thoracic and lumbar spine. Spine 18 : 450-460, 1993 https://doi.org/10.1097/00007632-199303010-00008
  36. Sasso RC, Cotler HB, Reuben JD : Posterior fixation of thoracic and lumbar spine fractures using DC plates and screws. Spine 16 : 134-139, 1981
  37. Schnee CL, Ansell LV : Selection criteria and outcome of operative approaches for thoracolumbar burst fractures with and without neurological deficit. J Neurosurg 86 : 48-55, 1997 https://doi.org/10.3171/jns.1997.86.1.0048
  38. Steffee AD, Biscup RS, Sitkowski DJ : Segmental spine plates with pedicle screw fixation : A new internal fixation device for disorders of the lumbar and thoracolumbar spine. Clin Orthop 203 : 45-53, 1986
  39. Willen JAG, Lindahl S, Nordwall A : Unstable thoracolumbar fracutres : A comparative study of conservative treatment and Harrington instrumentation. Spine 10 : 111-122, 1985 https://doi.org/10.1097/00007632-198503000-00001