J Korean Soc Spine Surg.  1997 Nov;4(2):223-231.

The Effect of Anterior Column Augmentation in Thoraco-lumbar Burst Fractures Treated with Pedicle Screw Instrumentation

• Shin BJ
• Kim BW
• Lee S

Abstract

STUDY DESIGN: Thirty-fiye thoracolumbar and lumbar burst fractures treated with pedicle screw instrumentation were assessed on loss reduction.
OBJECTIVE
To compare the mechanical results of simple posterior fixation and posterior fixation with anterior augmentation by anterior interbody fusion, disc space fusion or longer construct. SUMMARY OF BACKGROUND DATA: Althrough the pedicle screw instrumentation provides good mechanical stability, two segment fixation without anterior column augmentation may not be adequate to withstand the repeated axial load.
METHODS
Fifteen patients were treated with two segment fixation alone(Group 1), seven with anterior interbody fusion(Group 2), another seven with disc space fusion(Group 3) and remaining six with longer construct involving two segments abode the fracture(Croup 4). Change of anterior body height, upper disc height, lower disc height, kyphotic angle, inter-screw angle and gross screw bend- ing were measured using post-operative and follow-up lateral radiographs.
RESULTS
Comparing the two groups(Croup 1 Ys. Group 2, 3, 4), the Group 1 showed definitely more loss of reduction than those groups which had anterior augmentation. But, loss of anterior body height was not significantly different. Comparing the four groups, loss at upper and lower disc height was significantly greater in the Group 1 than the Group 2. Change of kyphotic angle was significantly higher in the Group 1 than the Group 4 and change of inter-screw angle was also higher in the group 1 than every other group. Seyen patients in the Group 1 showed gross screw bending, but none in the Group 2, 3 and 4. All the seven patients with screw bending showed loss of inter-screw angle more than 5 .
CONCLUSIONS
These results mean that anterior column augmentation is necessary for the treatment of thoraco-lumbar burst fracture. All the three methods(Group 2,3,4) are effective to prevent excessive loss of correction and screw bending. The best method should be selected considering the characters of each fracture.

MeSH Terms

Body Height
Follow-Up Studies
Humans