[Treatment of thoracolumbar vertebral fractures with posterior short segmental pedicle screw fixation and pedicle screw at the fracture level].

May 22, 2010Zhongguo gu shang = China journal of orthopaedics and traumatology

Treating mid-back spine fractures using short screws placed behind the spine, including at the broken bone

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Abstract

Eighty-two patients with thoracolumbar fractures achieved bone fusion without significant loss of vertebral body height or implant failure over an average follow-up of 18.3 months.

All patients showed improvement in anterior body compression and Cobb angle after surgery, with statistically significant results (P < 0.05).
No significant loss in anterior body compression or Cobb angle was observed during the follow-up period (P > 0.05).
Caudal intervertebral disc height did not show significant improvement after surgery (P > 0.05).
Patients with incomplete neurological injuries demonstrated improvement of one to two grades in neurological function.

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OBJECTIVE: To explore the feasibility and clinical effects of posterior short segmental pedicle screw fixation adding pedicle screw at the fracture level in treatment of thoracolumbar vertebral fractures.

METHODS: From September 2005 to September 2007, 82 patients (male 50 and female 32, the age from 18 to 63 years, at mean age of 36 years,the courses of disease from 2 hours to 7 days with an average of 2 days) with thoracolumbar fractures were treated with posterior short segmental pedicle screw fixation adding pedicle screw at the fracture level. According to the AO classification, 25 patients were type A1 fracture, 48 were type A2 and 9 were type B2. According to the ASIA neurological function grading system, 9 patients were grade C, 17 were grade D and 56 were grade E. Reduction and posterolateral fusion were achieved through fixation of the fractured vertebra and the adjacent normal vertebrae with the transpedicle screw.

RESULTS: Eighty-two cases were followed up from 12 to 24 months (averaged 18.3 months). All cases achieved bone fusion, without significant lose of the vertebrae body height and implant failure. The anterior body compression and Cobb angle were significantly improved after surgery (P < 0.05). The anterior body compression and Cobb angle did not significantly lose compared with after-surgery ones (P > 0.05). The caudal intervertebral disc height (h/H) were not significantly improved after surgery (P > 0.05). Improvement of one to two grades of neurological function was observed in patients with incomplete neurological injuries.

CONCLUSION: Posterior short segmental pedicle screw fixation with pedicle screw at the fracture level is a safe and effective therapeutic option to treat thoracolumbar vertebral fractures, which can help to correct the kyphosis and maintain the reduction, and avoid the over-distraction of the contiguous discs.

[Treatment of thoracolumbar vertebral fractures with posterior short segmental pedicle screw fixation and pedicle screw at the fracture level].

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