[Short-segment posterior pedicle screw combined with vertebral arch bone grafting for thoracolumbar burst fractures].

Apr 1, 2015Zhongguo gu shang = China journal of orthopaedics and traumatology

Using short spinal screws with bone grafts to treat middle-back burst fractures

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Abstract

A total of 62 patients with thoracolumbar burst fractures were treated using a combined surgical approach.

The average age of patients was 38 years, with a range from 17 to 65 years.
Most fractures were classified as type A3.1 (34 cases), followed by type A3.3 (21 cases) and type A3.2 (7 cases).
At 6 months post-operation, 58 patients were graded as ASIA grade E, indicating complete neurological recovery.
Radiographic assessments showed significant improvements in Cobb angle, relative height of anterior vertebral body, and spinal canal encroachment rate at 3 days post-operation.
Results indicated good fracture union by the final follow-up, with no significant changes in measurements between 3 days post-operation and final follow-up.
One patient experienced an infection, which was successfully treated, and two patients reported mild back pain.

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OBJECTIVE: To analyze the clinical effects of short-segment posterior pedicle screw combined with transpedicle vertebral bone grafting in treating thoracolumbar burst fractures.

METHODS: From March 2008 to March 2013, 62 patients with thoracolumbar burst fractures were treated with short-segment posterior pedicle screw combined with transpedicle vertebral bone grafting. Including 40 males and 22 females, the age from 17 to 65 years old with an average of 38 years. According to AO classification, 34 cases were type A3.1, 7 cases were type A3.2 and 21 cases were type A3.3. Load-sharing scores were from 4 to 6 points with an average of 5.4 points. According to ASIA grade, 2 cases were grade C, 5 cases were grade D and 55 cases were grade E. Preoperative, postoperative at 3 d and final follow-up, the Cobb angle, the relative height of anterior vertebral body and the encroachment rate of spinal canal were measured by X-ray films and computed tomography (CT) scan, meanwhile, the information of bone healing and spinal nerves recovery were observed.

RESULTS: All patients were followed up from 11 to 14 months with an average of 12.2 months. The duration of removing internal fixation were from 9 to 13 months (averaged, 11.5 months). One suffered from infection and was cured by debridement. Two cases had mild pain of back. At 6 months after operation, according to ASIA grade to evaluate never function, 1 case was grade C, 3 cases were grade D and 58 cases were grade E. X-ray and CT showed the fractures obtained good union at final follow-up. The Cobb angle, the relative height of anterior vertebral body and the encroachment rate of spinal canal had obviously improved at 3 days after operation (P<0.05); but there was no significant differences between postoperative at 3 d and final follow-up (P>0.05).

CONCLUSION: Short-segment posterior pedicle screw combined with transpedicle vertebral bone grafting is an effective method to treat thoracolumbar burst fractures. It can reduce the loss of postoperative correction and prevent the internal fixation failure.

[Short-segment posterior pedicle screw combined with vertebral arch bone grafting for thoracolumbar burst fractures].

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