Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Short Segment Screw Fixation without Fusion for Unstable Thoracolumbar and Lumbar Burst Fracture : A Prospective Study on Selective Consecutive Patients

  • Kim, Hee-Yul (Department of Neurosurgery, School of Medicine, Chosun University) ;
  • Kim, Hyeun-Sung (Department of Neurosurgery, Heori Sarang Hospital) ;
  • Kim, Seok-Won (Department of Neurosurgery, School of Medicine, Chosun University) ;
  • Ju, Chang-Il (Department of Neurosurgery, School of Medicine, Chosun University) ;
  • Lee, Sung-Myung (Department of Neurosurgery, School of Medicine, Chosun University) ;
  • Park, Hyun-Jong (Gyeryoung Orthopedic Surgery Clinic)
  • Received : 2011.11.17
  • Accepted : 2012.04.15
  • Published : 2012.04.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: The purpose of this prospective study was to evaluate the efficacy and safety of screw fixation without bone fusion for unstable thoracolumbar and lumbar burst fracture. Methods: Nine patients younger than 40 years underwent screw fixation without bone fusion, following postural reduction using a soft roll at the involved vertebra, in cases of burst fracture. Their motor power was intact in spite of severe canal compromise. The surgical procedure included postural reduction for 3 days and screw fixations at one level above, one level below and at the fractured level itself. The patients underwent removal of implants 12 months after the initial operation, due to possibility of implant failure. Imaging and clinical findings, including canal encroachment, vertebral height, clinical outcome, and complications were analyzed. Results: Prior to surgery, the mean pain score (visual analogue scale) was 8.2, which decreased to 2.2 at 12 months after screw fixation. None of the patients complained of worsening of pain during 6 months after implant removal. All patients were graded as having excellent or good outcomes at 6 months after implant removal. The proportion of canal compromise at the fractured level improved from 55% to 35% at 12 months after surgery. The mean preoperative vertebral height loss was 45.3%, which improved to 20.6% at 6 months after implant removal. There were no neurological deficits related to neural injury. The improved vertebral height and canal compromise were maintained at 6 months after implant removal. Conclusion: Short segment pedicle screw fixation, including fractured level itself, without bone fusion following postural reduction can be an effective and safe operative technique in the management of selected young patients suffering from unstable burst fracture.

Keywords

References

  1. Carl AL, Tromanhauser SG, Roger DJ : Pedicle screw instrumentation for thoracolumbar burst fractures and fracture-dislocations. Spine (Phila Pa 1976) 17 : S317-S324, 1992 https://doi.org/10.1097/00007632-199208001-00018
  2. Cho WS, Chung CK, Jahng TA, Kim HJ : Post-laminectomy kyphosis in patients with cervical ossification of the posterior longitudinal ligament : does it cause neurological deterioration? J Korean Neurosurg Soc 43 : 259-264, 2008 https://doi.org/10.3340/jkns.2008.43.6.259
  3. de Klerk LW, Fontijne WP, Stijnen T, Braakman R, Tanghe HL, van Linge B : Spontaneous remodeling of the spinal canal after conservative management of thoracolumbar burst fractures. Spine (Phila Pa 1976) 23 : 1057-1060, 1998 https://doi.org/10.1097/00007632-199805010-00018
  4. Jang KS, Ju CI, Kim SW, Lee SM : Screw fixation without fusion for low lumbar burst fracture : a severe canal compromise but neurologically intact case. J Korean Neurosurg Soc 49 : 128-130, 2011 https://doi.org/10.3340/jkns.2011.49.2.128
  5. Kostuik JP : Anterior fixation for burst fractures of the thoracic and lumbar spine with or without neurological involvement. Spine (Phila Pa 1976) 13 : 286-293, 1988 https://doi.org/10.1097/00007632-198803000-00011
  6. Lin HJ, Wang ST, Liu CL : Reduction fixation system in treating burst fractures of thoracolumbar spine. J Spine Surg ROC 2 : 102-111, 1996
  7. Liu CL, Dai LG, Wang ST : Surgical treatment of thoracic spine burst fractures. J Spine Surg ROC 2 : 92-101, 1996
  8. Liu CL, Wang ST, Lin HJ, Kao HC, Yu WK, Lo WH : Roy-Camille plating system in treating burst fractures of thoracolumbar spine. J Orthop Surg Roc 13 : 309-316, 1996
  9. Mueller LA, Mueller LP, Schmidt R, Forst R, Rudig L : The phenomenon and efficiency of ligamentotaxis after dorsal stabilization of thoracolumbar burst fractures. Arch Orthop Trauma Surg 126 : 364-368, 2006 https://doi.org/10.1007/s00402-005-0065-6
  10. 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 https://doi.org/10.1097/00007632-199306150-00003
  11. Sanderson PL, Fraser RD, Hall DJ, Cain CM, 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
  12. Scapinelli R, Candiotto S : Spontaneous remodeling of the spinal canal after burst fractures of the low thoracic and lumbar region. J Spinal Disord 8 : 486-493, 1995
  13. Sjostrom L, Karlstrom G, Pech P, Rauschning W : Indirect spinal canal decompression in burst fractures treated with pedicle screw instrumentation. Spine (Phila Pa 1976) 21 : 113-123, 1996 https://doi.org/10.1097/00007632-199601010-00026
  14. Shen WJ, Shen YS : Nonsurgical treatment of three-column thoracolumbar junction burst fractures without neurologic deficit. Spine (Phila Pa 1976) 24 : 412-415, 1999 https://doi.org/10.1097/00007632-199902150-00024
  15. Siebenga J, Leferink VJ, Segers MJ, Elzinga MJ, Bakker FC, Haarman HJ, et al. : Treatment of traumatic thoracolumbar spine fractures : a multicenter prospective randomized study of operative versus nonsurgical treatment. Spine (Phila Pa 1976) 31 : 2881-2890, 2006 https://doi.org/10.1097/01.brs.0000247804.91869.1e
  16. Wang ST, Ma HL, Liu CL, Yu WK, Chang MC, Chen TH : 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 https://doi.org/10.1097/01.brs.0000244555.28310.40

Cited by

  1. Short Segment Fixation for Thoracolumbar Burst Fracture Accompanying Osteopenia : A Comparative Study vol.53, pp.1, 2013, https://doi.org/10.3340/jkns.2013.53.1.26
  2. Anterior decompression with single segmental spinal interbody fusion for Denis type B thoracolumbar burst fracture: a midterm follow-up study vol.37, pp.11, 2012, https://doi.org/10.1007/s00264-013-2095-y
  3. The Retrospective Analysis of Posterior Short-Segment Pedicle Instrumentation without Fusion for Thoracolumbar Burst Fracture with Neurological Deficit vol.2014, pp.None, 2012, https://doi.org/10.1155/2014/457634
  4. Implant Removal after Percutaneous Short Segment Fixation for Thoracolumbar Burst Fracture : Does It Preserve Motion? vol.55, pp.2, 2012, https://doi.org/10.3340/jkns.2014.55.2.73
  5. Biomechanical comparison of mono-segment transpedicular fixation with short-segment fixation for treatment of thoracolumbar fractures: A finite element analysis vol.228, pp.10, 2014, https://doi.org/10.1177/0954411914552308
  6. Comparison of Surgical Outcomes Between Short-Segment Open and Percutaneous Pedicle Screw Fixation Techniques for Thoracolumbar Fractures vol.22, pp.None, 2012, https://doi.org/10.12659/msm.896882
  7. Factors predicting long-term outcome after short-segment posterior fixation for traumatic thoracolumbar fractures vol.8, pp.1, 2017, https://doi.org/10.4103/sni.sni_244_17
  8. Short versus long-segment posterior fixation in the treatment of thoracolumbar junction fractures: a comparison of outcomes vol.31, pp.1, 2017, https://doi.org/10.1080/02688697.2016.1206185
  9. Biomechanical effects of posterior pedicle fixation techniques on the adjacent segment for the treatment of thoracolumbar burst fractures: a biomechanical analysis vol.22, pp.13, 2019, https://doi.org/10.1080/10255842.2019.1631286
  10. Clinical Effects of Posterior Limited Long-Segment Pedicle Instrumentation for the Treatment of Thoracolumbar Fractures vol.33, pp.1, 2012, https://doi.org/10.1080/08941939.2018.1474301
  11. Clinical efficacy and outcome of intelligently inflatable reduction in conjunction with percutaneous pedicle screw fixation for treating thoracolumbar burst fractures vol.48, pp.3, 2012, https://doi.org/10.1177/0300060520903658
  12. Outcomes in Thoracolumbar and Lumbar Traumatic Fractures: Does Restoration of Unfused Segmental Mobility Correlated to Implant Removal Time? vol.157, pp.None, 2012, https://doi.org/10.1016/j.wneu.2021.09.138