Bulent Ozdemir1, Ayhan Kanat2, Cihangir Erturk1, Osman Ersagun Batcik1, Mehmet Sabri Balik3, Ugur Yazar4, Fatma Beyazal Celiker5, Yavuz Metin5, Mehmet Fatih Inecikli5, Ali Rıza Guvercin4. 1. Department of Neurosurgery, Medical Faculty, Recep Tayyip Erdogan University, Rize, Turkey. 2. Department of Neurosurgery, Medical Faculty, Recep Tayyip Erdogan University, Rize, Turkey. Electronic address: ayhankanat@yahoo.com. 3. Department of Orthopedic Surgery, Medical Faculty, Recep Tayyip Erdogan University, Rize, Turkey. 4. Department of Neurosurgery, Medical Faculty, Karadeniz Technical University, Trabzon, Turkey. 5. Department of Radiology, Medical Faculty, Recep Tayyip Erdogan University, Rize, Turkey.
Abstract
BACKGROUND: The treatment of unstable thoracolumbar fractures remains controversial. Long-segment pedicle screw constructs may be stiffer and impart greater forces on adjacent segments compared with short-segment constructs. Short-segment pedicle screw fixation alone may be associated with instrumentation failure. Reinforcement fractured vertebra by the placement of an additional 2 screws at fracture level may be useful in thoracolumbar fractures for restoration of anterior vertebral height. MATERIAL AND METHODS: We retrospectively analyzed 35 patients (21 males, 14 females) with unstable thoracolumbar fractures. The patients were divided into 2 groups. In group I, patients were operated with posterior approach via the use of pedicle screws fixed long (2 levels above and 1 or 2 levels below of the fractured vertebra). In group II patients, short-segment stabilization with additional screwing at fracture level was made. Immediate postoperative radiologic evaluations were done by measuring the correction and maintenance of kyphotic angle at the fracture level, Cobb angle, and height of fractured vertebra. RESULTS: Average local kyphosis angle, anterior kyphotic angle at the fracture level, and Cobb angle were not statistically significantly different in the postoperative period (P > 0.05); however, postoperative anterior height of fractured vertebra was statistically significantly different between the 2 groups (P < 0.05). CONCLUSIONS: We compared a standard long-segment construct with a short-segment construct using instrumentation of the fractured segment. Short-segment pedicle screw fixation with screwing of fractured vertebra in unstable thoracolumbar fracture levels is an effective method to restoring anterior vertebral height for the treatment of unstable thoracolumbar fractures. It also provides anterior column support.
BACKGROUND: The treatment of unstable thoracolumbar fractures remains controversial. Long-segment pedicle screw constructs may be stiffer and impart greater forces on adjacent segments compared with short-segment constructs. Short-segment pedicle screw fixation alone may be associated with instrumentation failure. Reinforcement fractured vertebra by the placement of an additional 2 screws at fracture level may be useful in thoracolumbar fractures for restoration of anterior vertebral height. MATERIAL AND METHODS: We retrospectively analyzed 35 patients (21 males, 14 females) with unstable thoracolumbar fractures. The patients were divided into 2 groups. In group I, patients were operated with posterior approach via the use of pedicle screws fixed long (2 levels above and 1 or 2 levels below of the fractured vertebra). In group II patients, short-segment stabilization with additional screwing at fracture level was made. Immediate postoperative radiologic evaluations were done by measuring the correction and maintenance of kyphotic angle at the fracture level, Cobb angle, and height of fractured vertebra. RESULTS: Average local kyphosis angle, anterior kyphotic angle at the fracture level, and Cobb angle were not statistically significantly different in the postoperative period (P > 0.05); however, postoperative anterior height of fractured vertebra was statistically significantly different between the 2 groups (P < 0.05). CONCLUSIONS: We compared a standard long-segment construct with a short-segment construct using instrumentation of the fractured segment. Short-segment pedicle screw fixation with screwing of fractured vertebra in unstable thoracolumbar fracture levels is an effective method to restoring anterior vertebral height for the treatment of unstable thoracolumbar fractures. It also provides anterior column support.
Authors: Hizir Kazdal; Ayhan Kanat; Osman Ersagun Batcik; Bulent Ozdemir; Senol Senturk; Murat Yildirim; Leyla Kazancioglu; Ahmet Sen; Sule Batcik; Mehmet Sabri Balik Journal: Asian Spine J Date: 2017-10-11