Risk factors of kyphosis recurrence after implant removal in thoracolumbar burst fractures following posterior short-segment fixation

Apr 27, 2016International orthopaedics

Factors linked to kyphosis returning after implant removal in middle back fractures treated with short back surgery

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Abstract

Cobb angle decreased from 23.7 to 3.0 after surgery, demonstrating significant correction.

Kyphosis recurrence may be influenced by age and pre-operative anterior vertebral height below 50%.
Surgery resulted in significant corrections of the Cobb angle, vertebral wedge angle, and anterior vertebral height.
Cobb angle, vertebral wedge angle, and anterior vertebral height were well maintained during follow-up, with only minor losses of correction.
Neurological function and pain levels improved significantly post-surgery without any deterioration observed.

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PURPOSE: Our aim was to evaluate the results of short-segment pedicle instrumentation with screw insertion in the fracture level and find factors predicting kyphosis recurrence in thoracolumbar burst fractures.

METHODS: We retrospectively analysed 122 patients with thoracolumbar burst fracture who were divided into two groups: kyphosis recurrence and no kyphosis recurrence. Pre-operative radiographic data comprising Cobb angle (CA), regional angle, anterior vertebra height (AVH), upper intervertebral angle, vertebral wedge angle (VWA), pre-anteroposterior A/P approach, superior endplate fracture, load-sharing classification (LSC) score and clinical data including age, visual analogue scale (VAS) score, thoracolumbar injury classification and severity score were compared between groups. T test, Pearson's chi-square and multivariate logistic regression were calculated for variables.

RESULTS: CA, VWA and AVH were significantly corrected after surgery. CA changed from 23.7 to 3.0 (p <0.001), VWA from 38.7 to 9.6 (p <0.001) and AVH from 48.8 % to 91.2 % (p <0.001). These parameters were well maintained during the follow-up period with a mild, tolerant loss of correction. Neurological function and pain were significantly improved without deterioration. Age, pre-A/P and pre-AVH < 50 % influenced kyphosis recurrence (p = 0.032, 0.026, 0.011, respectively).

CONCLUSIONS: Short-segment pedicle instrumentation including the fractured vertebra was effective in treating thoracolumbar burst fractures. The loss of correction at follow-up after implant removal was associated with age, A/P ratio and anterior vertebral height < 50 %.

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Risk factors of kyphosis recurrence after implant removal in thoracolumbar burst fractures following posterior short-segment fixation

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