Intermediate Pedicular Screws at The Fracture Level For Thoracolumbar Burst Fractures
Keywords:
Fracture, spine, pedicular screw, intermediateAbstract
Surgical Treatment of thoracolumbar burst fracture with posterior short segment pedicle fixation could provide initial correction of kyphosis , but it has been associated with loss of reduction and instrument failure. This study evaluates the clinical relevance of short segment pedicle fixation with intermediate screws at fracture level. 21 patients were assessed in this retrospective study. All patients were followed for a minimum 36 months
(X= 38 ; SD 17 ). Preoperative mean Anterior vertebral height compression (AVHC) and local kyphosis angle
(KA) were 40 % ( SD 20 % )and 16° (SD 12°) ,respectively.
The mean correction of AVHC and kyphosis were 24% (SD 15% ) and 14° (SD 8° ) respectively. The mean loss of correction at the last follow up was
1.1 % (SD 3.2 % ), and 2.2° (SD 2.8°) for AVHC and KA, respectively. The loss of correction of kyphosis was significant (p< .001 ) ,whereas of AVCH was not significant (p = 0.135 ). Despite there was significant loss of the correction of local kyphosis, the final KA at the latest follow up compared with the preoperative value was still significantly improved (p< .001). There was no evidence of instrument failure or neurologic deterioration in this series.
It is concluded that short segment pedicle fixation with intermediate screw at fracture level provides a significant correction of local kyphosis, The initial correction was well maintained and there was no serious complication.
References
1997; 22:680 – 690.
2. Dick W, Kluger P, Magerl F. A new device for internal fixation of Thoracolumbar and lumbar spine fracture. The fixateur interne. Paraplegia 1985;
23:225 – 232.
3. Benson DR, Burkus JK, Montesano PX et al Unstable thoracolumbar and lumbar burst fracture treated with the AO fixateur interne J Spine Disord
1992; 5:335 – 43.
4. Mclain RF, Spaling E, Benson RD. Early failure of short segment pedicle Instrumentation for thoracolumbar burst fractures: A preliminary report. J Bone Joint Surg (Am) 1993; 18: 977 – 87.
5. Dick JC, Jone MP, Zdeblick TA et al A biomechanical comparison evaluating the use of intermediate screws and crosslinkage in Lumbar pedicle fixation J spinal Disord 1994; 7: 402 – 407.
6. Lynn G Mukherjee DP, Kruse RN et al Mechanical stability of thoracolumbar pedicle screw fixation. The effect of crosslinks Spine. 1997; 22: 1568 – 1572.
7. Dick JC, Zdeblick TA, Bartel BD et al. Mechanical evaluation of cross – link designs in rigid pedicle screw systems Spine. 1997; 22: 370 – 375.
8. Leduc s, Mac – Thiong JM, Maurais G, Jodoin A. Posterior pedicle screw fixation with supplemental laminar hook fixation for the treatment of thoracolumbar
burst fractures Can J Surg. 2008 ; 51: 35- 40.
9. de Peretti F, Hovorka I, Cambas PM, et al.Short device fixation and early mobilization for burst fracture of thoracolumbar junction Eur spine 1996;5: 112 – 120.
10. Acosta FLL, Aryan HE, Taylor WR ,Ames CP .Kyphoplasty– augmented short- segment pedicle screw fixation of traumatic lumbar burst fracture : initial clinical experience and literature review. Neurosurg Focus 2005; 8: 1- 6.
11. Korovessis P, Repantis T, Petsinis G, Direct reduction of thoracolumbar burst fracture by means of balloon Kyphoplasty with calcium phosphate and
stabilization with pedicle screw instrumentation and fusion Spine. 2008; 33:100 – 108.
12. KorovessisP,Hadjipavlou A, repantis T. Minimal invasive short posterior instrumentation plus balloon Kyphoplasty with calcium phosphate for burst and severe compression lumbar fractures spine 2008; 33: 658 – 667.
13. Oner FC, Verlaan JJ, Verbout AJ, DhertWJA. Cement Augmentation techniques in Traumatic thoracolumbar spine fracture. Spine 2006; 31: 89- 95.
14. Anekstien Y, Brosh T, Mirovsky Y .Intermediate screws in short segment pediclular fixation for thoracic and lumbar fractures. A biomechanical
study.J Spinal Disord Tech 2007: 20: 72 – 77.
15. Mahar A, Kim C Wedeneyer M, Mitsunaga L, Odell T, Johnson B, Garfin S. Short segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Spine 2007; 32: 1503 – 1507.
16. McAfee PC, Yuan HA, Fredrickson BE. The value of computed tomography in thoracolumbar fractures: An analysis of one hundred consecution cases and a new classification J Bone Joint Surg (Am) 1993; 65: 461.
17. Keynan O, Fisher C G, Vaccaro A, Fehling MG, Oner FC, Dietz J etal.Radiographic measurement parameters in thoracolumbar fractures: a systematic
review and consensus statement of the spine trauma study group. Spine 2006; 31: 156 – 165.
18. Alanay a, acaroglu E. Yazici M .Short segment pedicle instrumentation of thoracolumbar burst fractures .Does transpedicularintracorporeal grafting
prevent early failure .Spine 2001 ; 26:213 – 217.
19. Denis F. Spinal instability as defined by the threecolumn spine concept in acute spinal trauma. Clin. Orthop. 1984; 189:65-76.
20. Frankel HL, Hancock DO, Hyslop G, et al: The value of postural reduction in the initial management of closed injuries of the spine with paraplegia
and tetraplegia. Paraplegia 1969:7:179-92.
21. Acikbas SC, Arslan FY, Tuncer MR. The effect of transpedicular screw misplacement on late spinal instability ActaNeurochir (wien) 2003; 145: 949 –955.
