Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Dorsal Short-Segment Fixation for Unstable Thoracolumbar Junction Fractures

  • Kim, Kwan-Sik (Department of Neurosurgery, Bundang Jesaeng General Hospital) ;
  • Oh, Sung-Han (Department of Neurosurgery, Bundang Jesaeng General Hospital) ;
  • Huh, Ji-Soon (Department of Neurosurgery, Bundang Jesaeng General Hospital) ;
  • Noh, Jae-Sub (Department of Neurosurgery, Bundang Jesaeng General Hospital) ;
  • Chung, Bong-Sub (Department of Neurosurgery, Bundang Jesaeng General Hospital)
  • Published : 2006.10.30
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Abstract

Objective : This study is to evaluate the efficacy of dorsal short-segment fixation in unstable thoracolumbar junction fractures. Methods : The cases of 20 patients who underwent dorsal short-segment fixation were reviewed retrospectively. Clinical outcomes were analysed using Sonntag's pain level, work status, and neurological scale according to the modified Frankel classification. Radiological outcomes were analysed using Mumford's anterior body compression[%], canal compromise ratio, and Cobb's kyphotic angle. Results : At the latest clinical follow-up [average=14.6 months]. there were 19 [95.0%] in group I and 1 patient [5.0%] in II in pain level. The postoperative work status were 17 [85.0%] in group I, 2 patients [10.0%] in II, and 1 patient [5.0%] in V. Surgery brought to improve the neurologic status. In success group [19 cases, 95%], the average canal compromise ratio was reduced from 0.57 [${\pm}0.07$] to 0.05 [${\pm}0.08$] [P<005], the average anterior body compression [%] was reduced from 41% [${\pm}17$] to 18% [${\pm}14$] [P<0.05], and the average preoperative kyphotic angle was $20.0^{\circ}$ [${\pm}9.0$], and corrected to $5.7^{\circ}$ [${\pm}7.1$] postoperatively, and progressed to $7.8^{\circ}$ [${\pm}6.2$] at the latest follow-up. There was a case of implantation failure in an elderly osteoporotic patient. Conclusion : Although there are limitations in the patient number and follow-up period, the present study favors dorsal short-segment fixation for selective cases in unstable thoracolumbar junction fractures.

Keywords

References

  1. Alanay A, Acaroglu E, Yazici M, Oznur A, Surat A : Short-segment pedicle instrumentation of thoracolumbar burst fractures : does transpedicular intracorporeal grafting prevent early failure? Spine 26 : 213-217, 2001 https://doi.org/10.1097/00007632-200101150-00017
  2. 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 (Suppl) 79B : 306, 1997
  3. Bradford DS, McBride GG : Surgical management of thoracolumbar spine fractures with incomplete neurologic deficits. Clin Orthop 218 : 201-216, 1987
  4. Daniaux H : Transpedicular repositioning and spongioplasty in fractures of the vertebral bodies of the lower thoracic and lumbar spine. Unfallchirurg 89 : 197-213, 1986
  5. Daniaux H, Seykora P, Genelin A, Lang T, Kathrein A : Application of posterior plating and modifications in thoracolumbar spine injuries. Indication, techniques, and results. Spine (Suppl 3) 16 : S125-133, 1991 https://doi.org/10.1097/00007632-199103001-00018
  6. Danisa OA, Shaffrey CI, Jane JA, Whitehill R, Wang Gj, Szabo TA, et al : Surgical approaches for the correction of unstable thoracolumbar burst fractures : a retrospective analysis of treatment outcomes. J Neurosurg 83 : 977-983, 1995 https://doi.org/10.3171/jns.1995.83.6.0977
  7. Ferguson RL, Allen BL Jr : A mechanistic classification of thoracolumbar spine fractures. Spine 15 : 667-673, 1990 https://doi.org/10.1097/00007632-199007000-00010
  8. Fredrickson B, Mann K, Yuan H, Lubicky JP : Reduction of the intracanal fragment in experimental burst fractures. Spine 13 : 267-271, 1988 https://doi.org/10.1097/00007632-198803000-00008
  9. Hahn KH, Lee SG, Jeong JH, Yoo CJ, Kim WK, Kim YB : One Stage Decompression and Circumferential Stabilization by Posterior approach in the Unstable Burst Fracture of Thoracolumbar and Lumbar Spine. J Korean Neurosurg Soc 32 : 112-117, 2002
  10. Hitchon PW, Torner JC : Recumbency in thoracolumbar fractures. Neurosurg Clin North 8A : 509-517, 1997
  11. Hu, Serena S : Internal Fixation in the Osteoporotic Spine. Spine 22 : 43S-48S, 1997 https://doi.org/10.1097/00007632-199712151-00008
  12. Kaya RA, Aydin Y : Modified transpedicular approach for the surgical treatment of severe thoracolumbar or lumbar burst fractures. Spine 4 : 208-217, 2004 https://doi.org/10.1016/j.spinee.2003.07.005
  13. Kim SH : Surgical approach of thoracolumbar or lumbar burst fracture with associated laminar fracture. J Korean Neurosurg Soc 25 : 2455-2464, 1996
  14. Kim YS, Cho YW : One Stage Three Column Fixation by Posterior Approach in Thoracolumbar Junction Lesion. J Korean Neurosurg Soc 27 : 222-228, 1998
  15. Kim YW, Oh SH, Yoon DH, Chin DG, Cho YE, Kim YS : Short segment pedicle screw fixation with augmented intraoperative vertebroplasty in unstable thoracolumbar fracture. J Korean Neurosurg Soc 30 : 1271-1277, 2001
  16. Knop C, Fabian HF, Bastian L, Blauth M : Late results of thoracolumbar fractures after posterior instrumentation and transpedicular bone grafting. Spine 26 : 88-99, 2001 https://doi.org/10.1097/00007632-200101010-00016
  17. 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
  18. Lee YS, Sung JK : Long-term follow-up results of short segment pedicle screw fixation for thoracolumbar burst fractures. J Korean Neurosurg Soc 37 : 416-421, 2005
  19. Leferink VJ, Zimmerman KW, Veldhuis EF, ten Vergert EM, ten Duis HJ : Thoracolumbar spinal fractures : radiological results of transpedicular fixation combined with transpedicular cancellous bone graft and posterior fusion in 183 patients. Euro Spine J 10 : 517-523, 2001 https://doi.org/10.1007/s005860100319
  20. Maiman DJ, Pintar F, Yoganandan N, Reinartz J : Effects of anterior vertebral grafting on the traumatized lumbar spine after pedicle screw-fixation. Spine 18 : 2423-2430, 1993 https://doi.org/10.1097/00007632-199312000-00010
  21. McAfee PC, Yuan HA, Fredrickson BE, Lubicky JP : The value of computed tomography in thoracolumbar fractures. J Bone Joint Surg 65A : 461-473, 1983
  22. McCormack T, Karaikovic E, Gaines RW : The load-shearing classification of spine fractures. Spine 19 : 1741-1744, 1994 https://doi.org/10.1097/00007632-199408000-00014
  23. McLain RF, Sparling E, Benson DR : Early failure of short segment pedicle instrumentation for thoracolumbar fractures. J Bone Joint Surg 73A : 162-167, 1993
  24. Mermelstein LE, McLain RF, Yerby SA : Reinforcement of thoracolumbar burst fractures with calcium phosphate cement. Spine 23 : 664-671, 1998 https://doi.org/10.1097/00007632-199803150-00004
  25. Mumford J, Weinstein JN, Spratt KF : Thoracolumbar burst fractures : The clinical efficacy and outcome of nonoperative management. Spine 8 : 955-970, 1993
  26. Oertel J, Niendorf WR, Darwish N, Schroeder HWS, Gaab MR : Limitation of dorsal transpedicular stabilization in unstable fractures of the lower thoracic and lumbar spine : an analysis of 133 patients. Acta Neurochir (Wien) 146 : 771-777, 2004
  27. Oner FC, Dhert WJ, Verlann JJ : Less invasive anterior reconstruction in thoracolumbar fractures. Injury (Suppl 2) 36 : B82-89, 2005 https://doi.org/10.1016/j.injury.2005.06.018
  28. Parker JW, Lane JR, Karaikovic E, Gaines RW : Successful short segment instrumentation and fusion for thoracolumbar spine fractures : A consecutive 4 1/2 year series. Spine 25 : 1157-1169, 2000 https://doi.org/10.1097/00007632-200005010-00018
  29. 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 (Suppl 1) 55 : 9-13, 2000
  30. Resnick DK, Benzel EC : Lateral extracavitary approach for thoracic and thoracolumbar spine trauma : operative complications. Neurosurgery 43 : 628-637, 1998
  31. 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
  32. Sasso RC, Cotler HB, Reuben JD : Posterior fixation of thoracic and lumbar spine fractures using DC plates and pedicle screws. Spine 16S : 134-139, 1996
  33. 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
  34. Shaw B, Mansfield FL, Borges L : One-stage posterolateral decompression and stabilization for primary and metastatic vertebral tumors in the thoracic and lumbar spine. J Neurosurg 70 : 405-410, 1989 https://doi.org/10.3171/jns.1989.70.3.0405
  35. Sonntag VHR, Hadley MN : Surgical approaches to the thoracolumbar spine. Clinc Neurosurg 36 : 168-185, 1988
  36. Soshi S, Shiba R, Kondo H : An experimental study on transpedicular spine using AO DC plate internal fixation. Spine 14 : 91, 1989
  37. Stephens GC, Devito DP, McNamara MJ : Segmental fixation of lumbar burst fratures with Cotrel-Dubousset instrumentation. J Spinal Disord 5 : 344-348, 1992 https://doi.org/10.1097/00002517-199209000-00013
  38. Verlaan JJ, Diekerson CH, Buskens E, van der Tweel I, Verbout AJ, Dhert WJ : Surgical treatment of traumatic fractures of the thoracic and lumbar spine : a systemic review of the literature on techniques, complications, and outcome. Spine 29 : 803-814, 2004 https://doi.org/10.1097/01.BRS.0000116990.31984.A9