Yonsei Med J.  2009 Aug;50(4):546-554. 10.3349/ymj.2009.50.4.546.

Comparison of Surgical Outcomes in Thoracolumbar Fractures Operated with Posterior Constructs Having Varying Fixation Length with Selective Anterior Fusion

• Kim HS
• Lee SY
• Nanda A
• Kim JY
• Park JO
• Moon SH
• Lee HM
• Kim HJ
• Wei H
• Moon ES

• KMID: 1758615
• DOI: http://doi.org/10.3349/ymj.2009.50.4.546

Abstract

PURPOSE
Surgical treatment in the case of thoracolumbar burst fractures is very controversial. Posterior instrumentation is most frequently used, however, but the number of levels to be instrumented still remains a matter of debate. MATERIALS AND METHODS: A total of 94 patients who had a single burst fracture between T11 and L2 were selected and were managed using posterior instrumentation with anterior fusion when necessary. They were divided into three groups as follows; Group I (n = 28) included patients who were operated by intermediate segment fixation, Group II (n = 32) included patients operated by long segment fixation, and Group III (n = 34) included those operated by intermediate segment fixation with a pair of additional screws in the fractured vertebra. The mean follow-up period was twenty one months. The outcomes were analyzed in terms of kyphosis angle (KA), regional kyphosis angle (RA), sagittal index (SI), anterior height compression rate, Frankel classification, and Oswestry Disability Index questionnaire. RESULTS: In Groups II and III, the correction values of KA, RA, and SI were much better than in Group I. At the final follow up, the correction values of KA (6.3 and 12.1, respectively) and SI (6.2 and 12.0, respectively) were in Groups II and III found to be better in the latter. CONCLUSION: The intermediate segment fixation with an additional pair of screws at the fracture level vertebra gives results that are comparable or even better than long segment fixation and gives an advantage of preserving an extra mobile segment.

Keyword

Thoracolumbar burst fracture; posterior instrumentation; intermediate segment fixation; fixation length; selective anterior fusion

MeSH Terms

Adolescent
Adult
Child
Female
Humans
Male
Spinal Fractures/radiography/*surgery
Thoracic Vertebrae/injuries/radiography/*surgery
Treatment Outcome
Young Adult

Figure

• 

  Fig. 1 Schematic figures of the operations performed in each group. (A) Group I, intermediate segment fixation without the fracture segment. (B) Group II, long segment fixation without the fracture segment. (C) Group III, intermediate fixation with the fracture segment.

• 

  Fig. 2 Kyphosis angle (KA), regional kyphosis angle (RA) and anterior body height loss (CR). Kyphosis angle (KA) = Angle between a and b, Regional kyphosis angle (RA) = Angle between c and d, Anterior body height Compression rate (AH) = 2e / (f + g) ×100.

• 

  Fig. 3 A 42-year-old man had fallen at a construction site. He visited the emergency room with back pain as his main complaint. (A) Preoperative plain radiographs showed a burst fracture at L1. Preoperative kyphosis angle, regional kyphosis angle, and sagittal index were 28 degrees, 28 degrees and 24 degrees, respectively. (B) Axial CT demonstrated 45% canal compromise.

• 

  Fig. 4 (A) The patient underwent posterior intermediate segment fixation with fracture segment fixation. Postoperative kyphosis angle, regional kyphosis angle, and sagittal index were 11 degrees, 8 degrees, and 4 degrees, respectively. (B) Postoperative radiograph at 15 months after the initial operation showed no significant changes from immediate postoperative results. (C) He underwent implant removal and the final follow-up kyphosis angle, regional kyphosis angle and sagittal index were 12 degrees, 13 degrees and 7 degrees, respectively. He was ambulating well at time of release but could not go back to work.

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