J Korean Soc Spine Surg.  2002 Mar;9(1):19-26. 10.4184/jkss.2002.9.1.19.

The Comparison of Loss of Reduction at the Thoracolumbar Fracture According to Insertion of Screw Including Fractured Vertebra or not in Short Segment Posterolat Fusion

• Min HJ
• Kim KW
• Kim YH
• Yoon US
• Hwang JS

• KMID: 1897086
• DOI: http://doi.org/10.4184/jkss.2002.9.1.19

Abstract

STUDY DESIGNS: Retrospective analysis of the surgical treatment in patients of thoracolumbar spine fractures.
OBJECTIVES
To measure by modified Cobb method the correction angle of thoracolumbar vertebral fractures and to comparison the difference between short segment pedicular fixation with fractured vertebra(group A) and without fractured vertebra (group B). SUMMARY OF LITERATURE REVIEW: The major treatment of thoracolumbar spine fractures is surgical correction of kyphotic angle by posterior decompression and posterolat. fusion at one level or more.
MATERIALS AND METHODS
The materials are the patients who visited due to trauma beween 1991.1 and 2000.12. and treated by post. decompression and short segment posterolat. fusion with iliac bone graft. The number were A group, 28 persons and B group, 15 persons. The method of radiologic measurement is done by the modified Cobb method. The follow up time is till 2001.7. and the duration are minimal 6 months and maximal 77 months. The age was between 17 old and 60 old. The neurologic abnormalities in patients are 12 persons. The fractures were classified by the Denis classification. There are compressive fracture are 3 persons and bursting fracture type A are 18 persons, type B are 22 persons. The materials were confirmed by radiologic union and excluded if more than one vertebra fusion is needed.
RESULTS
The most fractures were due to falldown injury. The most fracture site was T-L level (T12-L3). The one case was complicated by deep infection and treated and the other case was reduction loss due to metallic failure. The results of the loss of correction were A group, 5.3 degree and B group, 6.2 degree. (P>0.05). The relative correction loss were A group, 42%, and B group, 54%. (P<0.05).
CONCLUSION
The mean correction angle and loss of correction are more good results in the group of short segment pedicular fixation with fracture vertebra. But to get more good results, our study do more long term follow-up and rule out other statistical errors and consecutive radiologic follow-up.

Keyword

Cobb angle; Sup. and inf. endplate; Thoracolumbar vertebral fracture, posterolat. fusion

MeSH Terms

Classification
Decompression
Follow-Up Studies
Humans
Retrospective Studies
Spine*
Transplants

Figure

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  Fig. 1. Preoperative sagittal radiography of 51years old male and immediate postoperative sagittal radiography after short segment posterolat. fusion without fracture segment pedicular fixation, last follow up filim after 18months later. Fig. 1. The cobb angle was initial 37degree(A) and immediate post. op 15degree(B), last follow up was 22degree(C).

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  Fig. 2. Preoperative sagittal radiography of 25years old female and immediate postoperative sagittal radiography after short segment posterolat. fusion with fracture segment pedicular fixation, last follow up film after 52months later. Fig. 1. The cobb angle was initial 20degree(A) and immediate post. op 4degree(B), last follow up was 15degree(C).

Reference

1). American College of Radiology. Index for roentgen diagnoses. 3rd. Baltimore: Wavelrly;1975.

2). American JR.  . 134:979–983. May 1980.

3). Bosekar EH. .:. The determination of the normal thoracic kyphosis; a roentgenographic study of the spines of 121. Minn. 56:114–120. Med. 1973.

4). Keim H. .:. Kyphosis and lordosis in the adolescent spine. New York: Grune & Stratton;1976. 193-209.

5). Cobb RJ. .:. Outline for the study of scoliosis.Am Acad Orthop Surg. 5:261–275. 1948.

6). Aebi M, Etter C, Kehl T, et al. The internal skeletal fixation systems: A new treatment of thoracolumbar fractures and other spinal disorders. Clin Orthop. 227:30–43. 1988.

7). An HS. Vaccaro A, Cotler JM, et al. Low lumbar burst fractures; Comparison among body cast, Harrington rod, Luque rod, and Steffee plate. Spine. 16:S440–4. 1991.

8). Been HD. Anterior decompression and stabilization of thoracolumbar burst fractures by the use of the Slot-Zeilke device. Spine. 16:70–7. 1991.

9). Cantor JB, Lebwohl NH, Garvey T, et al. Nonoperative management of stable thoracolumbar burst fractures with early ambulation and bracing. Spine. 18:971–6. 1993.

10). Davies WF, Morris JH, Hill V. An analysis of conservetive (nonsurgical) management of thoracolumbar fractures and fracture dislocations with neural damage. J.Bone Joint Surg. (Am). 62:1324–8. 1980.

11). Esses SI, Botsford DJ, Wright T, et al. Operative treatment of spinal fractures with the AO internal fixator. Spine. 16:S146–50. 1990.

12). Hass N, Blauth M, Tscherne H. Anterior plating in thoracolumbar spine injuries; Indication, technique, and results. Spine. 16:S1000–11. 1991.

13). Jacobs RR, Asher MA, Snider RK. Tho r a columb a r spinal injuries; A comparative study of recumbent and operative treatment in 100 patients. Spine. 5:463–77. 1980.

14). Kaneda K, Taneichi H, Abumi K, et al. Anterior decom pression and stabilization with the Kaneda device for tho racolumbar burst fractures associated with neurologic deficit. J Bone Joint Surg(Am). 79:69–83. 1997.

15). Lewis J, McKibbin B. T he treatment of unstable fracture dislocations of the thoracolumbar spine accompanied by paraplegia. J Bone Joint Surg. 56:603–12. 1974.

16). Lindsey RW, Dick W. The fixateur interne in the reduction and stabilization of thoracolumbar spine fractures in patients with neurologic deficit. Spine. 16:S140–5. 1991.

17). Maiman DJ, Pintar F, Yoganandan N, et al. Effects of anterior vertebral grafting on the traumatized lumbar spine after pedicle screw plate fixation. Spine. 18:2423–30. 1993.

18). Miyakoshi N, Abe E, Shimada Y, et al. Anterior decom pression with single segmental spinal interbody fusion for lumbar burst fracture. Spine. 10:631–7. 1985.

19). Mumford J, Weinstein JN, Spratt KF, et al. Th ora -columbar burst fractures; The clinical efficacy and outcome of nonoperative management. Spine. 18:955–70. 1993.

20). Olerud S, Karlstrom G, Sjostrom L. Transpedicular fixation of thoracolumbar vertebral fractures. Clin Orthop. 277:44–51. 1988.

21). Reid DC, Hu R, Davis LA, et al. The nonoperative treatment of burst fractures of the thoracolumbar junction. J Trauma. 28:1188–94. 1988.

22). Soreff J, Axdorph G, Bylund P, et al. Treatment of patients with unstable fractures of the thoracic and lumbar spine, A followup study of surgical and conservative treatment. Acta Orthop Scand. 53:369–81. 1982.

23). Boucher HH. A Method of Spinal Fusion. J. Bone and joint Surg. 41-B:248. 1959.