Hiroyuki Aono1, Keisuke Ishii2, Hidekazu Tobimatsu3, Yukitaka Nagamoto4, Shota Takenaka5, Masayuki Furuya4, Horii Chiaki6, Motoki Iwasaki7. 1. Department of Orthopedic Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka city, Osaka 540-0006, Japan. Electronic address: h-aono@umin.ac.jp. 2. Teikyo University Trauma Center, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8606, Japan. 3. Ikeda City Hospital, 3-1-18 Jonan, Ikeda city, Osaka 563-8510, Japan. 4. Department of Orthopedic Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka city, Osaka 540-0006, Japan. 5. Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita city, Osaka 565-0871, Japan. 6. Saitama Red Cross Hospital, 1-5 Shintoshin, Chuo-ku, Saitama city, Saitama 330-5883, Japan. 7. Osaka Rosai Hospital, 1179-3 Nagasonecho, Kita-ku, Sakai city, Osaka 591-8025, Japan.
Abstract
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.
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.
Authors: S V Likhachev; V B Arsenievich; V V Ostrovskiy; A E Shulga; A V Zaretskov; D V Ivanov; A V Dol; A M Donnik; V V Zaretskov Journal: Sovrem Tekhnologii Med Date: 2020-08-27