J Korean Neurosurg Soc.  2014 Feb;55(2):73-77. 10.3340/jkns.2014.55.2.73.

Implant Removal after Percutaneous Short Segment Fixation for Thoracolumbar Burst Fracture : Does It Preserve Motion?

• Kim HS
• Kim SW
• Ju CI
• Wang HS
• Lee SM
• Kim DM

• KMID: 2191048
• DOI: http://doi.org/10.3340/jkns.2014.55.2.73

Abstract

OBJECTIVE
The purpose of this study was to evaluate the efficacy of implant removal of percutaneous short segment fixation after vertebral fracture consolidation in terms of motion preservation.
METHODS
Between May 2007 and January 2011, 44 patients underwent percutaneous short segment screw fixation due to a thoracolumbar burst fracture. Sixteen of these patients, who underwent implant removal 12 months after screw fixation, were enrolled in this study. Motor power was intact in all patients, despite significant vertebral height loss and canal compromise. The patients were divided into two groups by degree of osteoporosis : Group A (n=8), the non-osteoporotic group, and Group B (n=8), the osteoporotic group. Imaging and clinical findings including vertebral height loss, kyphotic angle, range of motion (ROM), and complications were analyzed.
RESULTS
Significant pain relief was achieved in both groups at final follow-up versus preoperative values. In terms of vertebral height loss, both groups showed significant improvement at 12 months after screw fixation and restored vertebral height was maintained to final follow-up in spite of some correction loss. ROM (measured using Cobb's method) in flexion and extension in Group A was 10.5degrees (19.5/9.0degrees) at last follow-up, and in Group B was 10.2degrees (18.8/8.6degrees) at last follow-up. Both groups showed marked improvement in ROM as compared with the screw fixation state, which was considered motionless.
CONCLUSION
Removal of percutaneous implants after vertebral fracture consolidation can be an effective treatment to preserve motion regardless of osteoporosis for thoracolumbar burst fractures.

Keyword

Fusion; Percutaneous; Removal

MeSH Terms

Follow-Up Studies
Humans
Methods
Osteoporosis
Range of Motion, Articular

Figure

• 

  Fig. 1 Restoration of vertebral height.

• 

  Fig. 2 A case of a neurologically intact 29-year-old woman with a L1 burst fracture (Group A). A, B, and C : Preoperative simple radiograph and computed tomography images showing about 40% height loss and 50% canal compromise. D, E, and F : Simple radiographs and a computed tomography image taken at 12 months after percutaneous screw fixation showing consolidation of the fractured body and improved kyphosis. G and H : Simple flexion and extension radiographs taken at 11 months after screws removal revealing well-maintained range of motion, which coincided with a completely pain free status.

• 

  Fig. 3 A case of a neurologically intact 72-year-old woman with a L1 burst fracture (Group B). A and B : Preoperative simple radiograph and computed tomography image showing about 60% height loss. C, D, and E : Simple radiographs and a computed tomography image taken at 12 months after percutaneous screw fixation showing consolidation of the fractured body and restored vertebral height. F and G : Simple flexion and extension radiographs taken at 13 months after screw removal reveal a well-maintained range of motion, which coincided with a completely pain free status.

Reference

1. Chow GH, Nelson BJ, Gebhard JS, Brugman JL, Brown CW, Donaldson DH. Functional outcome of thoracolumbar burst fractures managed with hyperextension casting or bracing and early mobilization. Spine (Phila Pa 1976). 1996; 21:2170–2175. PMID: 8893445.

2. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976). 1983; 8:817–831. PMID: 6670016.

3. Gahr RH, Strasser S, Strasser E, Schmidt OI. Percutanous internal fixation of thoracolumbar spine fractures. Top Spinal Cord Inj Rehabil. 2006; 12:45–54.

4. Gertzbein SD. Scoliosis Research Society. Multicenter spine fracture study. Spine (Phila Pa 1976). 1992; 17:528–540. PMID: 1621152.

5. Huang QS, Chi YL, Wang XY, Mao FM, Lin Y, Ni WF, et al. [Comparative percutaneous with open pedicle screw fixation in the treatment of thoracolumbar burst fractures without neurological deficit]. Zhonghua Wai Ke Za Zhi. 2008; 46:112–114. PMID: 18509968.

6. 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. 2011; 49:128–130. PMID: 21519504.

7. Jung HJ, Kim SW, Ju CI, Kim SH, Kim HS. Bone cement-augmented short segment fixation with percutaneous screws for thoracolumbar burst fractures accompanied by severe osteoporosis. J Korean Neurosurg Soc. 2012; 52:353–358. PMID: 23133724.

8. Kim HS, Kim SW, Ju CI, Lee SM, Shin H. Short segment fixation for thoracolumbar burst fracture accompanying osteopenia : a comparative study. J Korean Neurosurg Soc. 2013; 53:26–30. PMID: 23440679.

9. Kim HY, Kim HS, Kim SW, Ju CI, Lee SM, Park HJ. Short segment screw fixation without fusion for unstable thoracolumbar and lumbar burst fracture : a prospective study on selective consecutive patients. J Korean Neurosurg Soc. 2012; 51:203–207. PMID: 22737299.

10. Korovessis P, Repantis T, George P. Treatment of acute thoracolumbar burst fractures with kyphoplasty and short pedicle screw fixation : transpedicular intracorporeal grafting with calcium phosphate : a prospective study. Indian J Orthop. 2007; 41:354–361. PMID: 21139791.

11. Liao JC, Fan KF, Chen WJ, Chen LH. Posterior instrumentation with transpedicular calcium sulphate graft for thoracolumbar burst fracture. Int Orthop. 2009; 33:1669–1675. PMID: 18985350.

12. Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J. 1994; 3:184–201. PMID: 7866834.

13. Mahar A, Kim C, Wedemeyer M, Mitsunaga L, Odell T, Johnson B, et al. Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Spine (Phila Pa 1976). 2007; 32:1503–1507. PMID: 17572619.

14. 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. 2006; 126:364–368. PMID: 16721620.

15. Mumford J, Weinstein JN, Spratt KF, Goel VK. Thoracolumbar burst fractures. The clinical efficacy and outcome of nonoperative management. Spine (Phila Pa 1976). 1993; 18:955–970. PMID: 8367783.

16. Wang ST, 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). 2006; 31:2646–2652. discussion 2653. PMID: 17077731.

17. Weinstein JN, Collalto P, Lehmann TR. Thoracolumbar "burst" fractures treated conservatively : a long-term follow-up. Spine (Phila Pa 1976). 1988; 13:33–38. PMID: 3381135.