Abstract
Following fracture reduction and initial reconstitution of spinal alignment, loss of correction over time is frequently observed after posterior instrumentation. The degree of stability to provide a favorable environment for protection of initial correction is not known. A total of 36 patients with thoracolumbar burst fractures were divided into three groups. Group 1 included 12 patients treated by two-levels fixation, group 2 included ten patients treated by four-levels fixation, and group 3 included 14 patients treated by four-levels plus offset-hook fixation. Preoperative, early postoperative, and 1-year follow-up lateral spinal radiographs were evaluated by measuring the local kyphosis angle (LKA), the percentage of anterior body-height compression (%ABC), and the sagittal index (SI). For protecting the initial correction of LKA, group 3 was superior to the other groups (P<0.05). For protecting the initial correction of %ABC, groups 2 and 3 were the same (P>0.05), and these two groups were superior to group 1 (P<0.05). For protecting the initial correction of SI, group 3 was superior to group 1 (P<0.05), and the other groups were the same (P>0.05). Group 1 had a significant failure rate compared to the other groups (P<0.05). Two-levels fixation was the least stable system, and four-levels fixation plus offset hook was the most stable.
Résumé
Après réduction des fractures et reconstruction initiale de l’alignement vertébral, une perte de correction est très souvent constatée avec les instrumentations postérieures. Le degré de stabilité nécessaire pour obtenir un environnement favorable et conserver la correction initiale n’est pas une donnée connue. Un total de 36 patients avec des fractures comminutives thoraco-lombaires a été divisé en trois groupes ; Le groupe 1 comprend 12 patients traités par fixation sur deux niveaux, le groupe 2 comprend 10 patients traités par fixation sur quatre niveaux et le groupe 3 comprend 14 patients traités par fixation sur quatre niveaux addition de crochets adjacents. Les radiographies pré-opératoires, post-opératoires précoces et après un an ont été évaluées en mesurant l’angle local de cyphose (Local Kyphosis Angle ou LAK), le pourcentage de hauteur antérieure du corps vertébral (% ABC) et l’indice sagittal (SI). Pour la conservation de la correction initiale du LAK, le Groupe 3 était supérieur (aux deux autres (P<0.05). Pour la conservation de la correction initiale du (% ABC), les groupes 2 et 3 étaient identiques (P>0.05) et ces deux groupes étaient quant à eux supérieurs au groupe 1 (P<0.05). Pour la conservation de l’indice sagittal (SI), le groupe 3 était supérieur au groupe 1 (P<0.05), et les autres groupes étaient identiques (P>0.05). Le groupe 1 avait un taux d’échecs supérieur aux autres groupes (P<.05). La fixation de deux niveaux était la moins fiable et la fixation sur quatre niveaux avec crochets additionnel était la lus fiable.
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Serin, E., Karakurt, L., Yilmaz, E. et al. Effects of two-levels, four-levels, and four-levels plus offset-hook posterior fixation techniques on protecting the surgical correction of unstable thoracolumbar vertebral fractures: a clinical study. Eur J Orthop Surg Traumatol 14, 1–6 (2004). https://doi.org/10.1007/s00590-003-0110-5
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DOI: https://doi.org/10.1007/s00590-003-0110-5