Short segment pedicle screw instrumentation with an index level screw and cantilevered hyperlordotic reduction in the treatment of type-A fractures of the thoracolumbar spine

Apr 3, 2014The bone & joint journal

Using short pedicle screw fixation with a middle-level screw and angled correction to treat type-A fractures in the middle-lower spine

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Abstract

39 patients with thoracolumbar fractures showed effective radiological outcomes after hyperlordotic short segment pedicle screw instrumentation with an intermediate screw.

Mean age of participants was 35.1 years, with follow-up averaging 22.9 months.
Patients had load-sharing classification scores of six or seven, with no significant differences in age or pre-operative measurements.
Pre-operative sagittal index improved from a mean of 19.6° to -1.8° post-operatively, with a final follow-up mean of 2.4°.
No revisions were necessary due to loss of correction or failure of instrumentation.
The treatment method is associated with excellent radiological results and a low failure rate, regardless of load-sharing classification.

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The purpose of this study was to evaluate and compare the effect of short segment pedicle screw instrumentation and an intermediate screw (SSPI+IS) on the radiological outcome of type A thoracolumbar fractures, as judged by the load-sharing classification, percentage canal area reduction and remodelling. We retrospectively evaluated 39 patients who had undergone hyperlordotic SSPI+IS for an AO-Magerl Type-A thoracolumbar fracture. Their mean age was 35.1 (16 to 60) and the mean follow-up was 22.9 months (12 to 36). There were 26 men and 13 women in the study group. In total, 18 patients had a load-sharing classification score of seven and 21 a score of six. All radiographs and CT scans were evaluated for sagittal index, anterior body height compression (%ABC), spinal canal area and encroachment. There were no significant differences between the low and high score groups with respect to age, duration of follow-up, pre-operative sagittal index or pre-operative anterior body height compression (p = 0.217, 0.104, 0.104, and 0.109 respectively). The mean pre-operative sagittal index was 19.6° (12° to 28°) which was corrected to -1.8° (-5° to 3°) post-operatively and 2.4° (0° to 8°) at final follow-up (p = 0.835 for sagittal deformity). No patient needed revision for loss of correction or failure of instrumentation. Hyperlordotic reduction and short segment pedicle screw instrumentation and an intermediate screw is a safe and effective method of treating burst fractures of the thoracolumbar spine. It gives excellent radiological results with a very low rate of failure regardless of whether the fractures have a high or low load-sharing classification score.

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Short segment pedicle screw instrumentation with an index level screw and cantilevered hyperlordotic reduction in the treatment of type-A fractures of the thoracolumbar spine

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