J Korean Neurosurg Soc.  2013 Jan;53(1):26-30. 10.3340/jkns.2013.53.1.26.

Short Segment Fixation for Thoracolumbar Burst Fracture Accompanying Osteopenia : A Comparative Study

• Kim HS
• Kim SW
• Ju CI
• Lee SM
• Shin H

• KMID: 2066981
• DOI: http://doi.org/10.3340/jkns.2013.53.1.26

Abstract

OBJECTIVE
The purpose of this study was to compare the results of three types of short segment screw fixation for thoracolumbar burst fracture accompanying osteopenia.
METHODS
The records of 70 patients who underwent short segment screw fixation for a thoracolumbar burst fracture accompanying osteopenia (-2.5< mean T score by bone mineral densitometry <-1.0) from January 2005 to January 2008 were reviewed. Patients were divided into three groups based on whether or not bone fusion and bone cement augmentation procedure 1) Group I (n=26) : short segment fixation with posterolateral bone fusion; 2) Group II (n=23) : bone cement augmented short segment fixation with posterolateral bone fusion; 3) Group III (n=21) : bone cement augmented, short segment percutaneous screw fixation without bone fusion. Clinical outcomes were assessed using a visual analogue scale and modified MacNab's criteria. Radiological findings, including kyphotic angle and vertebral height, and procedure-related complications, such as screw loosening or pull-out, were analyzed.
RESULTS
No significant difference in radiographic or clinical outcomes was noted between patients managed using the three different techniques at last follow up. However, Group I showed more correction loss of kyphotic deformities and vertebral height loss at final follow-up, and Group I had higher screw loosening and implant failure rates than Group II or III.
CONCLUSION
Bone cement augmented procedure can be an efficient and safe surgical techniques in terms of achieving better outcomes with minimal complications for thoracolumbar burst fracture accompanying osteopenia.

Keyword

Burst fracture; Osteopenia; Fusion

MeSH Terms

Bone Diseases, Metabolic
Congenital Abnormalities
Densitometry
Follow-Up Studies
Humans

Figure

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  Fig. 1 Three representative cases of each group. A and B : Short segment screw fixation with posterolateral bone fusioin (Group I). C and D : Bone cement augmented short segment fixation with posterolateral bone fusioin (Group II). E and F : Bone cement augmented short segment percutaneous screw fixation without bone fusioin (Group III).

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  Fig. 2 Longitudinal visual analogue scale (VAS) findings after short segment screw fixation. *p<0.01 compared to preoperative VAS.

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  Fig. 3 A case of screw loosening in 48-year-old male patient in Group I. A : Preoperative simple lateral radiograph shows an L1 burst fracture. B : Postoperative simple lateral radiograph shows correction of kyphosis and short segment screw fixation. C : Postoperative simple lateral radiograph obtained at 6 months after surgery reveals screw pull-out and aggravated kyphosis. A surgical treatment removing the screws was performed in this case.

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  Fig. 4 A case of asymptomatic screw loosening in 49-year male patient in Group III. A and B : Preoperative simple radiographs showing an L2 bursting fracture. C and D : Postoperative simple radiographs showing bone cement augmented short segment fixation using percutaneous screws. E and F : Postoperative simple radiographs obtained at 11 months showing loosening at the L1 level. A surgical treatment removing the screws was not performed in this case.

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