Temporary short-segment pedicle screw fixation for thoracolumbar burst fractures: comparative study with or without vertebroplasty

Apr 5, 2017The spine journal : official journal of the North American Spine Society

Short-term pedicle screw treatment for spine burst fractures compared with or without bone cement support

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Abstract

62 patients with thoracolumbar burst fractures experienced significant kyphotic deformity reduction after temporary short-segment fixation.

Improvement in neurologic function was noted in all patients with deficits, corresponding to at least one grade increase on the American Spinal Injury Association scale.
Fracture union was achieved in all cases following the surgical procedure.
Kyphotic deformity reduction was significant and maintained regardless of the use of vertebroplasty.
No patients required additional anterior reconstruction during the follow-up period.
Subsequent kyphotic changes were observed at the disc level after implant removal, occurring with or without vertebroplasty.

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BACKGROUND CONTEXT: Short-segment posterior spinal instrumentation for thoracolumbar burst fracture provides superior correction of kyphosis by an indirect reduction technique, but it has a high failure rate.

PURPOSE: The purpose of the study we report here was to compare outcomes for temporary short-segment pedicle screw fixation with vertebroplasty and for such fixation without vertebroplasty.

STUDY DESIGN: This is a prospective multicenter comparative study.

PATIENT SAMPLE: We studied 62 consecutive patients with thoracolumbar burst fracture who underwent short-segment posterior instrumentation using ligamentotaxis with Schanz screws with or without vertebroplasty.

OUTCOME MEASURES: Radiological parameters (Cobb angle on standing lateral radiographs) were used.

METHODS: Implants were removed approximately 1 year after surgery. Neurologic function, kyphotic deformity, canal compromise, and fracture severity were evaluated prospectively.

RESULTS: After surgery, all patients with neurologic deficit had improvement equivalent to at least one grade on the American Spinal Injury Association impairment scale and had fracture union. Kyphotic deformity was reduced significantly, and reduction of the vertebrae was maintained with and without vertebroplasty, regardless of load-sharing classification. Although no patient required additional anterior reconstruction, kyphotic change was observed at disc level mainly after implant removal with or without vertebroplasty.

CONCLUSIONS: Temporary short-segment fixation yielded satisfactory results in the reduction and maintenance of fractured vertebrae with or without vertebroplasty. Kyphosis recurrence may be inevitable because adjacent discs can be injured during the original trauma.

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Temporary short-segment pedicle screw fixation for thoracolumbar burst fractures: comparative study with or without vertebroplasty

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