Abstract
Purpose
Thoracolumbar burst fractures treated with short-segment posterior instrumentation without anterior column support is associated with a high incidence of implant failure and correction loss. This study was designed to evaluate the clinical and radiographic results following posterior short-segment instrumentation and limited segmental decompression supplemented with vertebroplasty with calcium sulphate and intermediate screws for patients with severe thoracolumbar burst fractures.
Methods
Twenty-eight patients with thoracolumbar burst fractures of LSC point 7 or more underwent this procedure. The average follow-up was 27.5 months. Demographic data, radiographic parameters, neurologic function, clinical outcomes and treatment-related complications were prospectively evaluated.
Results
Loss of vertebral body height and segmental kyphosis was 55.3 % and 20.2° before surgery, which significantly improved to 12.2 % and 5.4° at the final follow-up, respectively. Loss of kyphosis correction was 2.2°. The preoperative canal encroachment was 49 % that significantly improved to 8.8 %. The preoperative pain and function level showed a mean VAS score of 9.2 and ODI of 89.9 % that improved to 1.4 and 12.9 % at the final follow-up, respectively. No implant failure was observed in this series, and cement leakage occurred in two cases without clinical implications.
Conclusions
Excellent reduction and maintenance of thoracolumbar burst fractures can be achieved with short-segment pedicle instrumentation supplemented with anterior column reconstruction and intermediate screws. The resultant circumferential stabilization combined with a limited segmental decompression resulted in improved neurologic function and satisfactory clinical outcomes, with a low incidence of implant failure and progressive deformity.
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References
Alpantaki K, Bano A, Pasku D et al (2010) Thoracolumbar burst fractures: a systematic review of management. Orthopedics 33:422–429
Kallemeier PM, Beaubien BP, Buttermann GR et al (2008) In vitro analysis of anterior and posterior fixation in an experimental unstable burst fracture model. J Spinal Disord Tech 21:216–224
Kramer DL, Rodgers WB, Mansfield FL (1995) Transpedicular instrumentation and short-segment fusion of thoracolumbar fractures: a prospective study using a single instrumentation system. J Orthop Trauma 9:499–506
McCormack T, Karaikovic E, Gaines RW (1994) The load sharing classification of spine fractures. Spine 19:1741–1744 (Phila Pa 1976)
McLain RF, Burkus JK, Benson DR (2001) Segmental instrumentation for thoracic and thoracolumbar fractures: prospective analysis of construct survival and five-year follow-up. Spine J 1:310–323
Butt MF, Farooq M, Mir B et al (2007) Management of unstable thoracolumbar spinal injuries by posterior short segment spinal fixation. Int Orthop 31:259–264
Knop C, Fabian HF, Bastian L et al (2001) Late results of thoracolumbar fractures after posterior instrumentation and transpedicular bone grafting. Spine 26:88–99 (Phila Pa 1976)
Shen YX, Zhang P, Zhao JG et al (2011) Pedicle screw instrumentation plus augmentation vertebroplasty using calcium sulfate for thoracolumbar burst fractures without neurologic deficits. Orthop Surg 3:1–6
Liao JC, Fan KF, Keorochana G et al (2010) Transpedicular grafting after short-segment pedicle instrumentation for thoracolumbar burst fracture: calcium sulfate cement versus autogenous iliac bone graft. Spine 35:1482–1488 (Phila Pa 1976)
Rahamimov N, Mulla H, Shani A et al (2012) Percutaneous augmented instrumentation of unstable thoracolumbar burst fractures. Eur Spine J 21:850–854
He D, Wu L, Sheng X et al (2013) Internal fixation with percutaneous kyphoplasty compared with simple percutaneous kyphoplasty for thoracolumbar burst fractures in elderly patients: a prospective randomized controlled trial. Eur Spine J 22:2256–2263
Korovessis P, Repantis T, Petsinis G et al (2008) Direct reduction of thoracolumbar burst fractures by means of balloon kyphoplasty with calcium phosphate and stabilization with pedicle-screw instrumentation and fusion. Spine 33:E100–E108 (Phila Pa 1976)
Marco RA, Kushwaha VP (2009) Thoracolumbar burst fractures treated with posterior decompression and pedicle screw instrumentation supplemented with balloon-assisted vertebroplasty and calcium phosphate reconstruction. J Bone Joint Surg Am 91:20–28
Verlaan JJ, Dhert WJ, Verbout AJ et al (2005) Balloon vertebroplasty in combination with pedicle screw instrumentation: a novel technique to treat thoracic and lumbar burst fractures. Spine 30:E73–E79 (Phila Pa 1976)
Edwards CC, Levine AM (1986) Early rod-sleeve stabilization of the injured thoracic and lumbar spine. Orthop Clin North Am 17:121–145
Guven O, Kocaoglu B, Bezer M et al (2009) The use of screw at the fracture level in the treatment of thoracolumbar burst fractures. J Spinal Disord Tech 22:417–421
Turner TM, Urban RM, Gitelis S et al (2001) Radiographic and histologic assessment of calcium sulfate in experimental animal models and clinical use as a resorbable bone-graft substitute, a bone-graft expander, and a method for local antibiotic delivery. One institution’s experience. J Bone Joint Surg Am 83(A Suppl 2):8–18
Kelly CM, Wilkins RM (2004) Treatment of benign bone lesions with an injectable calcium sulfate-based bone graft substitute. Orthopedics 27(1 Suppl.):s131–s135
Marino RJ, Barros T, Biering-Sorensen F et al (2003) International standards for neurological classification of spinal cord injury. J Spinal Cord Med 26(Suppl 1):S50–S56
Aebi M, Thalgott JS, Webb JK (1998) AO ASIF principles in spine surgery. Springer, Berlin, pp 107–122
Keynan O, Fisher CG, Vaccaro A et al (2006) Radiographic measurement parameters in thoracolumbar fractures: a systematic review and consensus statement of the spine trauma study group. Spine 31:E156–E165 (Phila Pa 1976)
Walsh TL, Hanscom B, Lurie JD et al (2003) Is a condition-specific instrument for patients with low back pain/leg symptoms really necessary? The responsiveness of the Oswestry Disability Index, MODEMS, and the SF-36. Spine 28:607–615 (Phila Pa 1976)
Kaneda K, Taneichi H, Abumi K et al (1997) Anterior decompression and stabilization with the Kaneda device for thoracolumbar burst fractures associated with neurological deficits. J Bone Joint Surg Am 79:69–83
Yang H, Pan J, Sun Z et al (2012) Percutaneous augmented instrumentation of unstable thoracolumbar burst fractures: our experience in preventing cement leakage. Eur Spine J 21:1410–1412 (author reply 1413)
Ge CM, Wang YR, Jiang SD et al (2011) Thoracolumbar burst fractures with a neurological deficit treated with posterior decompression and interlaminar fusion. Eur Spine J 20:2195–2201
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This work was partly supported by grants from the National Natural Sciences Foundation of China (81102037).
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Chen, C., Lv, G., Xu, B. et al. Posterior short-segment instrumentation and limited segmental decompression supplemented with vertebroplasty with calcium sulphate and intermediate screws for thoracolumbar burst fractures. Eur Spine J 23, 1548–1557 (2014). https://doi.org/10.1007/s00586-014-3374-z
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DOI: https://doi.org/10.1007/s00586-014-3374-z