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Minimally invasive fixation techniques for thoracolumbar fractures: comparison between percutaneous pedicle screw with intermediate screw (PPSIS) and percutaneous pedicle screw with kyphoplasty (PPSK)

  • Gaetano CarusoEmail author
  • Enrica Lombardi
  • Mattia Andreotti
  • Vincenzo Lorusso
  • Alessandro Gildone
  • Sara Padovani
  • Leo Massari
Original Article • SPINE - MINIMAL SURGERY

Abstract

Purpose

To assess and compare the efficacy of two minimally invasive techniques (percutaneous pedicle screw with intermediate screw vs. percutaneous pedicle screw with kyphoplasty) for spinal fracture fixation by comparing the segmental kyphosis and vertebral kyphosis angles after trauma before surgery, after surgery, and at 4-month and 12-month follow-up.

Methods

Data from 49 patients without neurological deficit treated by either percutaneous pedicle screw with intermediate screw or percutaneous pedicle screw with kyphoplasty were retrospectively analysed. The segmental kyphosis and vertebral kyphosis angles over time were calculated and correlated with the type of procedure, AO classification, lumbar or thoracic site and the age and sex of the patients.

Results

After surgery, both techniques were found to be efficacious means of bringing about a significant correction of the segmental kyphosis angle (p = 0.002) and a just significant correction of the vertebral kyphosis angle (p = 0.06), although less effectively in thoracic fractures (p = 0.004). At follow-up, the vertebral kyphosis angle was stable in both groups, while there was a significant loss of segmental kyphosis angle stability in the percutaneous pedicle screw with kyphoplasty group at 1 year (p = 0.004); fractured thoracic vertebrae maintained a greater vertebral kyphosis angle (p = 0.06) and segmental kyphosis angle (p < 0.001), than the lumbar.

Conclusion

At 1 year after surgery, the use of intermediate screws in fractured vertebrae seemed to maintain a more efficacious correction with respect to kyphoplasty, although thoracic fracture sites appear to be associated with greater post-traumatic segmental kyphosis and lesser stability in the long term after both percutaneous surgical techniques.

Keywords

Thoracolumbar fractures Minimally invasive fixation Percutaneous screws Intermediate screw Kyphoplasty Vertebral kyphosis Segmental kyphosis 

Notes

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

References

  1. 1.
    Oner FC, Wood KB, Smith JS et al (2010) Therapeutic decision making in thoracolumbar spine trauma. Spine 35:S235–S244CrossRefPubMedGoogle Scholar
  2. 2.
    Scheer JK, Bakhsheshian J, Fakurnejad S et al (2015) Evidence-based medicine of traumatic thoracolumbar burst fractures: a systematic review of operative management across 20 years. Glob Spine J 5(1):73–82CrossRefGoogle Scholar
  3. 3.
    Bailey CS, Urquhart JC, Dvorak MF et al (2014) Orthosis versus no orthosis for the treatment of thoracolumbar burst fractures without neurologic injury: a multicenter prospective randomized equivalence trial. Spine 14(11):2557–2564CrossRefGoogle Scholar
  4. 4.
    Wood K, Buttermann G, Garvey R et al (2003) Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit: a prospective, randomized study. J Bone Joint Surg Am 85:773–781CrossRefPubMedGoogle Scholar
  5. 5.
    Sun XY, Zhang XN, Hai Y (2017) Percutaneous versus traditional and paraspinal posterior open approaches for treatment of thoracolumbar fractures without neurologic deficit: a meta-analysis. Eur Spine J 26(5):1418–1431CrossRefPubMedGoogle Scholar
  6. 6.
    Elsawaf AM (2016) 330 outcome of percutaneous versus open posterior spinal fixation in thoracolumbar fractures. Neurosurgery 63(Suppl 1):196CrossRefGoogle Scholar
  7. 7.
    Phan K, Rao PJ, Mobbs RJ (2015) Percutaneous versus open pedicle screw fixation for treatment of thoracolumbar fractures: Systematic review and meta-analysis of comparative studies. Clin Neurol Neurosurg 135:85–92CrossRefPubMedGoogle Scholar
  8. 8.
    Korovessis P, Repantis T 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 33:100–108CrossRefGoogle Scholar
  9. 9.
    Zairi F, Court C, Tropiano P, Charles YP, Tonetti J, Fuentes S, Litrico S, Deramond H, Beaurain J, Orcel P, Delecrin J, Aebi M, Assaker R (2012) Minimally invasive management of thoraco-lumbar fractures: combined percutaneous fixation and balloon kyphoplasty. Orthop Traumatol Surg Res 98:S105–S111CrossRefPubMedGoogle Scholar
  10. 10.
    Dick JC, Jones MP, Zdeblick TA, Kunz DN, Horton WC (1994) A biomechanical comparison evaluating the use of intermediate screws and cross-linkage in lumbar pedicle fixation. J Spinal Disord Tech 7(5):402–407Google Scholar
  11. 11.
    Mahar A, Kim C, Wedemeyer M, Mitsunaga L, Odell T, Johnson B (2007) Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Spine 32(14):1503–1507CrossRefPubMedGoogle Scholar
  12. 12.
    Dong SH, Tian JW, Wang L, Xia T, Zhao QH (2009) Application of posterior short-segment fixation combined with intermediate screws in fresh thoracolumbar compressed fracture: short-term outcomes in 27 cases. Zhonghua Yi Xue Za Zhi 89(11):740–743PubMedGoogle Scholar
  13. 13.
    Kepler CK, Vaccaro AR, Koerner JD, Dvorak MF, Kandziora F et al (2016) Reliability analysis of the AOSpine thoracolumbar spine injury classification system by a worldwide group of naïve spinal surgeons. Eur Spine J 25(4):1082–1086CrossRefPubMedGoogle Scholar
  14. 14.
    McAnany SJ, Overley SC, Kim JS, Baird EO et al (2016) Open versus minimally invasive fixation techniques for thoracolumbar trauma: a meta-analysis. Glob Spine J 6:186–194CrossRefGoogle Scholar
  15. 15.
    Kanna RM, Shetty AP, Rajasekaran S (2015) Posterior fixation including the fractured vertebra for severe unstable thoracolumbar fractures. Spine J 15(2):256–264CrossRefPubMedGoogle Scholar
  16. 16.
    Chen C, Lv G, Xu B, Zhang X, Ma X (2014) 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(7):1548–1557CrossRefPubMedGoogle Scholar
  17. 17.
    Formica M, Cavagnaro L, Basso M, Zanirato A, Felli L, Formica C, Di Martino A (2016) Which patients risk segmental kyphosis after short segment thoracolumbar fracture fixation with intermediate screws? Injury 47(Suppl 4):S29–S34CrossRefPubMedGoogle Scholar
  18. 18.
    Li C, Zhou Y, Wang H, Liu J, Xiang L (2014) Treatment of unstable thoracolumbar fractures through short segment pedicle screw fixation techniques using pedicle fixation at the level of the fracture: a finite element analysis. PLoS ONE 9(6):e99156CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Li K, Zhang W, Liu D, Xu H, Geng W, Luo D, Ma J (2016) Pedicle screw fixation combined with intermediate screw at the fracture level for treatment of thoracolumbar fractures: a meta-analysis. Medicine (Baltimore) 95(33):e4574CrossRefGoogle Scholar
  20. 20.
    Li K, Li Z, Ren X, Xu H, Zhang W, Luo D, Ma J (2016) Effect of the percutaneous pedicle screw fixation at the fractured vertebra on the treatment of thoracolumbar fractures. Int Orthop 40(6):1103–1110CrossRefPubMedGoogle Scholar
  21. 21.
    Guven O, Kocaoglu B, Bezer M, Aydin N, Nalbantoglu U (2009) The use of screw at the fracture level in the treatment of thoracolumbar burst fractures. J Spinal Disord Tech 22:417–421CrossRefPubMedGoogle Scholar
  22. 22.
    McCormack T, Karaikovic E, Gaines RW (1994) The load sharing classification of spine fractures. Spine 19:1741–1744CrossRefPubMedGoogle Scholar
  23. 23.
    Alpantaki K, Bano A, Pasku D, Mavrogenis AF, Papagelopoulos PJ, Sapkas GS, Korres DS, Katonis P (2010) Thoracolumbar burst fractures: a systematic review of management. Orthopedics 33(6):422–429CrossRefPubMedGoogle Scholar
  24. 24.
    Tezeren G, Kuru I (2005) Posterior fixation of thoracolumbar burst fracture: short-segment pedicle fixation versus long-segment instrumentation. J Spinal Disord Tech 18(6):485–488CrossRefPubMedGoogle Scholar
  25. 25.
    Wei FX, Liu SY, Liang CX, Li HM, Long HQ, Yu BS et al (2010) Transpedicular fixation in management of thoracolumbar burst fractures: mono-segmental fixation versus short-segment instrumentation. Spine 35(15):E714–E720CrossRefPubMedGoogle Scholar
  26. 26.
    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 9:499–506CrossRefPubMedGoogle Scholar
  27. 27.
    Scholl BM, Theiss SM, Kirkpatrick JS (2006) Short segment fixation of thoracolumbar burst fractures. Orthopedics 29(8):703–708PubMedGoogle Scholar
  28. 28.
    Knop C, Fabian HF, Bastian L, Blauth M (2001) Late results of thoracolumbar fractures after posterior instrumentation and transpedicular bone grafting. Spine 26:88–99CrossRefPubMedGoogle Scholar
  29. 29.
    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 91:20–28CrossRefPubMedGoogle Scholar
  30. 30.
    Oner FC, van der Rijt RR, Ramos LMP, Dhert WJA, Verbount AJ (1998) Changes in the disc space after fractures of the thoracolumbar spine. J Bone Joint Surg (Br) 80-B:833–839CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Biomedical and Specialty Surgical SciencesAzienda Ospedaliero-Universitaria di Ferrara – Arcispedale Sant’Anna, University of FerraraFerraraItaly
  2. 2.Orthopaedic and Traumatology DepartmentAzienda Ospedaliero-Universitaria di Ferrara – Arcispedale Sant’Anna, University of FerraraFerraraItaly

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