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Thoracolumbar fracture dislocations treated by posterior reduction interbody fusion and segmental instrumentation

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Abstract

Background

Literature describing the application of modern segmental instrumentation to thoracic and lumbar fracture dislocation injuries is limited and the ideal surgical strategy for this severe trauma remains controversial. The purpose of this article was to investigate the feasibility and efficacy of single‑stage posterior reduction with segmental instrumentation and interbody fusion to treat this type of injury.

Materials and Methods

A retrospective review of 30 patients who had sustained fracture dislocation of the spine and underwent single stage posterior surgery between January 2007 and December 2011 was performed. All the patients underwent single stage posterior pedicle screw fixation, decompression and interbody fusion. Demographic data, medical records and radiographic images were reviewed thoroughly.

Results

Ten females and 20 males with a mean age of 39.5 years were included in this study. Based on the AO classification, 13 cases were Type B1, 4 cases were B2, 4 were C1, 6 were C2 and 3 cases were C3. The average time of the surgical procedure was 220 min and the average blood loss was 550 mL. All of the patients were followed up for at least 2 years, with an average of 38 months. The mean preoperative kyphosis was 14.4° and reduced to - 1.1° postoperatively. At the final followup, the mean kyphosis was 0.2°. The loss of correction was small (1.3°) with no significant difference compared to postoperative kyphotic angle (P = 0.069). Twenty seven patients (90%) achieved definitive bone fusion on X‑ray or computed tomography imaging within 1 year followup. The other three patients were suspected possible pseudarthrosis. They remained asymptomatic without hardware failure or local pain at the last followup.

Conclusion

Single stage posterior reduction using segmental pedicle screw instrumentation, combined with decompression and interbody fusion for the treatment of thoracic or lumbar fracture‑dislocations is a safe, less traumatic and reliable technique. This procedure can achieve effective reduction, sagittal angle correction and solid fusion.

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References

  1. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976) 1983;8:817–31.

    Article  CAS  Google Scholar 

  2. Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 1994;3:184–201.

    Article  CAS  Google Scholar 

  3. Gertzbein SD. Scoliosis Research Society. Multicenter spine fracture study. Spine (Phila Pa 1976) 1992;17:528–40.

    Article  CAS  Google Scholar 

  4. Liljenqvist U, Halm H, Castro WH, Mommsen U. Thoracic fracture-dislocations without spinal cord injury: A case report and literature review. Eur Spine J 1995;4:252–6.

    Article  CAS  Google Scholar 

  5. Sapkas GS, Papagelopoulos PJ, Papadakis SA, Themistocleous GS, Stathakopoulos DP, Efstathiou P, et al. Thoracic spinal injuries: Operative treatments and neurologic outcomes. Am J Orthop (Belle Mead NJ) 2003;32:85–8.

    Google Scholar 

  6. Carl AL, Tromanhauser SG, Roger DJ. Pedicle screw instrumentation for thoracolumbar burst fractures and fracture-dislocations. Spine (Phila Pa 1976) 1992;17:S317–24.

    Article  CAS  Google Scholar 

  7. Francaviglia N, Bragazzi R, Maiello M, Bernucci C. Surgical treatment of fractures of the thoracic and lumbar spine via the transpedicular route. Br J Neurosurg 1995;9:511–8.

    Article  CAS  Google Scholar 

  8. Stambough JL. Posterior instrumentation for thoracolumbar trauma. Clin Orthop Relat Res 1997;335:73–88.

    Article  Google Scholar 

  9. Sasso RC, Cotler HB. Posterior instrumentation and fusion for unstable fractures and fracture-dislocations of the thoracic and lumbar spine. A comparative study of three fixation devices in 70 patients. Spine (Phila Pa 1976) 1993;18:450–60.

    Article  CAS  Google Scholar 

  10. Yuan HA, Garfin SR, Dickman CA, Mardjetko SM. A Historical Cohort Study of Pedicle Screw Fixation in Thoracic, Lumbar, and Sacral Spinal Fusions. Spine (Phila Pa 1976) 1994;19:2279S–96.

    Article  CAS  Google Scholar 

  11. Moon MS, Choi WT, Moon YW, Kim YS, Moon JL. Stabilisation of fractured thoracic and lumbar spine with Cotrel-Dubousset instrument. J Orthop Surg (Hong Kong) 2003;11:59–66.

    Article  CAS  Google Scholar 

  12. McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine (Phila Pa 1976) 1994;19:1741–4.

    Article  CAS  Google Scholar 

  13. Oprel PP, Tuinebreijer WE, Patka P, den Hartog D. Combined anterior-posterior surgery versus posterior surgery for thoracolumbar burst fractures: A systematic review of the literature. Open Orthop J 2010;4:93–100.

    Google Scholar 

  14. Machino M, Yukawa Y, Ito K, Nakashima H, Kato F. A new thoracic reconstruction technique “transforaminal thoracic interbody fusion”: A preliminary report of clinical outcomes. Spine (Phila Pa 1976) 2010;35:E1000–5.

    Article  Google Scholar 

  15. Lee CK, Vessa P, Lee JK. Chronic disabling low back pain syndrome caused by internal disc derangements. The results of disc excision and posterior lumbar interbody fusion. Spine (Phila Pa 1976) 1995;20:356–61.

    Article  CAS  Google Scholar 

  16. Wood KB, Li W, Lebl DS, Ploumis A. Management of thoracolumbar spine fractures. Spine J 2014;14:145–64.

    Article  Google Scholar 

  17. Alobaid A, Arlet V, Ouellet J, Reindl R. Surgical technique. Technical notes on reduction of thoracic spine fracture dislocation. Can J Surg 2006;49:131–4.

    PubMed  PubMed Central  Google Scholar 

  18. Aebi M, Mohler J, Zäch G, Morscher E. Analysis of 75 operated thoracolumbar fractures and fracture dislocations with and without neurological deficit. Arch Orthop Trauma Surg 1986;105:100–12.

    Article  CAS  Google Scholar 

  19. Moore TA, Steinmetz MP, Anderson PA. Novel reduction technique for thoracolumbar fracture-dislocations. J Neurosurg Spine 2011;15:675–7.

    Article  Google Scholar 

  20. Wang F, Zhu Y. Treatment of complete fracture-dislocation of thoracolumbar spine. J Spinal Disord Tech 2013;26:421–6.

    Article  Google Scholar 

  21. Razak M, Mahmud M, Mokhtar SA, Omar A. Thoracolumbar fracture–Dislocation results of surgical treatment. Med J Malaysia 2000;55 Suppl C: 14–7.

    PubMed  Google Scholar 

  22. Ebelke DK, Asher MA, Neff JR, Kraker DP. Survivorship analysis of VSP spine instrumentation in the treatment of thoracolumbar and lumbar burst fractures. Spine (Phila Pa 1976) 1991;16:S428–32.

    Article  CAS  Google Scholar 

  23. Machino M, Yukawa Y, Ito K, Nakashima H, Kato F. Posterior/anterior combined surgery for thoracolumbar burst fractures–Posterior instrumentation with pedicle screws and laminar hooks, anterior decompression and strut grafting. Spinal Cord 2011;49:573–9.

    Article  CAS  Google Scholar 

  24. Xia Q, Xu BS, Zhang JD, Miao J, Li JG, Zhang XL, et al. Simultaneous combined anterior and posterior surgery for severe thoracolumbar fracture dislocations. Orthop Surg 2009;1:28–33.

    Article  Google Scholar 

  25. Yu SW, Fang KF, Tseng IC, Chiu YL, Chen YJ, Chen WJ. Surgical outcomes of short-segment fixation for thoracolumbar fracture dislocation. Chang Gung Med J 2002;25:253–9.

    PubMed  Google Scholar 

  26. Yadla S, Lebude B, Tender GC, Sharan AD, Harrop JS, Hilibrand AS, et al. Traumatic spondyloptosis of the thoracolumbar spine. J Neurosurg Spine 2008;9:145–51.

    Article  Google Scholar 

  27. Machino M, Yukawa Y, Ito K, Nakashima H, Kanbara S, Morita D, et al. “Transforaminal thoracic interbody fusion” in the management of lower thoracic spine fracture dislocations: Technical note. J Spinal Disord Tsssech 2013;26:E209–14.

    Article  Google Scholar 

  28. Schmid R, Krappinger D, Seykora P, Blauth M, Kathrein A. PLIF in thoracolumbar trauma: Technique and radiological results. Eur Spine J 2010;19:1079–86.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Spine Surgery, The Second Xiangya Hospital, Changsha, Hunan, 410011, P. R. China

    Guang-Zhong Xiong

  2. Department of Spine Surgery, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan, 410011, P. R. China

    Xiao-Bin Wang, Ming Yang,  Jing Li, Chang Lu & Guo-Hua Lü

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  1. Xiao-Bin Wang
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  2. Ming Yang
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  3. Jing Li
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  4. Guang-Zhong Xiong
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  6. Guo-Hua Lü
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Correspondence to Jing Li.

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Wang, XB., Yang, M., Li, J. et al. Thoracolumbar fracture dislocations treated by posterior reduction interbody fusion and segmental instrumentation. IJOO 48, 568–573 (2014). https://doi.org/10.4103/0019-5413.144219

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  • DOI: https://doi.org/10.4103/0019-5413.144219

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