Treatment of thoracolumbar burst fractures: short-segment pedicle instrumentation versus kyphoplasty.

Feb 26, 2014Acta orthopaedica Belgica

Treating middle-back burst fractures: comparing short-segment spine screws and bone cement injection

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Abstract

Twenty-three patients underwent percutaneous kyphoplasty (PKP) and 25 patients received short-segment pedicle instrumentation (SSPI) for Type A3 amyelic thoracolumbar fractures.

Both PKP and SSPI showed effective and reliable outcomes for treating selected amyelic thoracolumbar fractures in the short term.
Blood loss, operation time, and bed-rest time were lower in the PKP group compared to the SSPI group.
Patients in the PKP group experienced faster improvement in Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores postoperatively.
No significant difference was found in final VAS and ODI scores between the two groups.
Significant improvements in vertebral body height and kyphotic angle were observed in both groups.
SSPI demonstrated a significant improvement in spinal canal compromise, while the PKP group did not show statistically significant changes.

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UNLABELLED: The management of amyelic thoracolumbar burst fractures remains controversial. In this study, we compared the clinical efficacy of percutaneous kyphoplasty (PKP) and short-segment pedicle instrumentation (SSPI). Twenty-three patients were treated with PKP, and 25 patients with SSPI. They all presented with Type A3 amyelic thoracolumbar fractures. Clinical outcomes were evaluated by a Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) preoperatively, postoperatively, and at two years follow-up. Radiographic data including the anterior and posterior vertebral body height, kyphotic angle, as well as spinal canal compromise was also evaluated. The patients in both groups were similar regarding age, bone mineral density (BMD), follow-up period, severity of the deformity and fracture. Blood loss, operation time, and bed-rest time were less in the PKP group. VAS, ODI score improved more rapidly after surgery in the PKP group. No significant difference was found in VAS and ODI scores between the two groups at final follow-up (p > 0.05). Meanwhile, the height of anterior vertebrae (Ha), the height of posterior vertebrae (Hp) and the kyphosis angle showed significant improvement in each group (p < 0.05). The postoperative improvement in spinal canal compromise was not statistically significant in the PKP group (p > 0.05); there was a significant improvement in the SSPI group (p < 0.05). Moreover, these postoperative radiographic assessments showed significant differences between the two groups regarding the improvement of canal compromise (p < 0.05). At final follow-up, remodeling of spinal canal compromise was detected in both groups.

CONCLUSION: Both PKP and SSPI appeared as effective and reliable operative techniques for selected amyelic thoracolumbar fractures in the short-term. PKP had a significantly smaller blood loss and shorter bed-rest time, but SSPI provided a better reduction. Long-time studies should be conducted to support these clinical outcomes.

Treatment of thoracolumbar burst fractures: short-segment pedicle instrumentation versus kyphoplasty.

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