Clin Orthop Surg.  2017 Dec;9(4):465-471. 10.4055/cios.2017.9.4.465.

The Relationship between Superior Disc-Endplate Complex Injury and Correction Loss in Young Adult Patients with Thoracolumbar Stable Burst Fracture

• Lee KY
• Kim MW
• Seok SY
• Kim DR
• Im CS

• KMID: 2412247
• DOI: http://doi.org/10.4055/cios.2017.9.4.465

Abstract

BACKGROUND
To determine the relationship between superior disc-endplate complex injury and correction loss after surgery in a group of young adult patients with a stable thoracolumbar burst fracture.
METHODS
The study group was comprised of young adult patients who had undergone short-segment posterior fixation and bone grafting under the diagnosis of a stable thoracolumbar burst fracture from March 2008 to February 2014. Follow-up was available for more than 1 year. Before surgery, magnetic resonance imaging was performed to determine injury to the anterior longitudinal ligament, posterior longitudinal ligament, and superior and inferior intervertebral discs and endplates. Correction loss was evaluated by the Cobb angle, intervertebral disc height, upper intervertebral disc angle, vertebral wedge angle, and vertebral body height.
RESULTS
No significant relation was noted between correction loss and an injury to the anterior longitudinal ligament, posterior longitudinal ligament, inferior intervertebral disc/endplate, and fracture site, whereas an injury to the superior endplate alone and superior disc-endplate complex showed a significant association. Specifically, a superior intervertebral disc-endplate complex injury showed statistically significant relation to postoperative changes in Cobb angle (p = 0.026) and vertebral wedge angle (p = 0.047).
CONCLUSIONS
A superior intervertebral disc-endplate complex injury may have an influence on the prognosis after short-segment fixation in young adult patients with a stable thoracolumbar burst fracture.

Keyword

Stable burst fracture; Short segment fusion; Correction loss

MeSH Terms

Adult
Bone Transplantation
Female
Fracture Fixation, Internal
Humans
Intervertebral Disc/diagnostic imaging/*injuries
Longitudinal Ligaments/diagnostic imaging/*injuries
Lumbar Vertebrae/diagnostic imaging/injuries
Magnetic Resonance Imaging
Male
Prognosis
Spinal Fractures/*diagnostic imaging/*surgery
Thoracic Vertebrae/diagnostic imaging/injuries
Vertebroplasty
Young Adult

Figure

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  Fig. 1 Radiological evaluation using plain lateral radiography. ①: Cobb angle, ②: intervertebral disc height, ③: upper intervertebral disc angle, ④: vertebral wedge angle, ⑤: anterior vertebral body height.

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  Fig. 2 Radiological evaluations using T2-weighted sagittal magnetic resonance imaging.

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  Fig. 3 (A–D) Magnetic resonance imaging (MRI) scans and X-rays showing correction loss in a patient with superior disc-endplate injury. The Cobb angle decreased (dotted lines) in the patient. (E–H) MRI scans and X-rays of a patient without correction loss. (A, E) Initial X-rays. (B, F) Initial T2 MRI scans. (C, G) Postoperative X-rays. (D, H) One-year follow-up X-rays.

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